310552_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

F)
(Type of Visit: Q CColiance Inspection U Operation Review U Structure Evaluation p Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emeruency 0 Other 0 Denied Access lj
Date of Visit: („ J �3 // Arrival Time: 3 Departure Time: p County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:Z
Certification Number:
Longitude:
Region:
Design C►urrent
Swine C►apacity Pop.
W arf to Finish
Wet Poultry
[Layer
Non -La er
D , P,ault ,
Layers
Design
Capacity
Design
Ca aci
Current
Pop.
P,v
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
can to Feeder
5'0 r2 o
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
I Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the. State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
r
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rNo❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility Number: 31 - Date of Ins ection:6 1 Z Z
Waste CQUection & 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 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q-N�oY ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0-No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN D 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
[a ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
WNo❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
l rJ '�o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes❑
VNo 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 rNo
' [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: & - /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo NA ❑ NE
2�- Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No ❑ NA ❑ NE
❑
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NAB[] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ Q No 'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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
❑ Yes
❑ Yes
No
[] NA
❑ NE
No
❑ NA
❑ NE
[] No
❑ NA
❑ NE
Comments (refer to queshon #} 4 Eapla�n anyYES� a"nswerand/oTany addi63,toaal_recvmendations�oiany otlier;comments.
Use d"raw►ngs of facdityto lfe#ter explaun>stuattons;(use add�ironat;pages:astgecessary..).=
btA
ID,C4,-- ur(it,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
✓t
J14UJII
tvk 1" +n re je�C�.
k1JA
Phone: R t 0— 9
Date: L7- l7
21412015

im
Type of Visit: Q Co pliance inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Vc►lJprTi a p tom Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
C►urrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder r2ab
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder I)iy P�oultr.. Ga aci P,o ,
Farrow to Finish Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
l . 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 DW R)
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 DW R)
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 Z/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑Yes Zo
o ❑NA ❑NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continuer!

Facility Number: ^ - Date of Ins ection: a j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: T_A(="j (a1C�s
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � qt, IVI
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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 environment 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 �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CZ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes LZJ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Co
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L rN
❑ NA
❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 EjNo ❑ 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 QVc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: jDate of Inspection:
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No D NA ❑ NE
A 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: 77
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ej�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
[] Yes
Koo ❑ NA ❑ NE
�❑ NA ❑ NE
No/D NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paizes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6 0j F k. (, Phone: -I 10 116 ` 13
Date:
21412 k S

Type of Visit: (ZF Co liance Inspection U Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: © Countylllrnl) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
p ` LLIq-,,} --4 I 6& Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
I Dairy Calf
Wean to Feeder
I INon-Layer I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oult ,
Lavers
Design
Ca aci
C*urrent
P,o
Dry Cow
'
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1.' Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ o
❑ Yes
❑ Yes I yNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facility Number: Date of Inspection: 71-.A 3 1 1 LY
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes 2(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: LA HIV } LAbzay L L# 6rw
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q I
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 environmen 1 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 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
/
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes [,}�No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0/wo
❑ 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 [2/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes D No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [;k<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �lo
❑ 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.
eyes ❑ 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
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes rNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes !J No ❑ NA ❑ NE
35. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JdNo ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eNo ❑ 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 Io ❑ NA ❑ NE
❑ Yes [%] No ❑ NA ❑ NE
❑ Yes [21/No ❑ NA ❑ NE
❑ Yes , <O ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
['JNo ❑ NA ❑ NE
[�14o ❑ NA ❑ NE
�No ❑ NA ❑ NE
Comments (refer to question #): Explain any:YES answers and/or:any additional recommendations or any other comments.:
­
a" drawings of facility to bettee ezplain situations '{use additional pages as necessary).
MFC dao5 To oc- jia<e:;� 6FF "5T'� ?LAd 6K 4 UVcu
,� CAE G� 1► +� j I vA PPt.x CA rt d
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
V 6H � C �f`JL� Phonk o 11 b l
re: Date: 01
21412015

(Type of Visit: (2) Co�p1pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: J09&--W92 Wt �_ _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er I
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . $oul , Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
JLavers
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

>r acili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: N 1 LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lill S
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Cjje/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 D Yes YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement.,
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
dyes
D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ 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
�J/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t 20 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 " ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faci tity Number: - Date of —Inspection: 2,1�{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes to ❑ NA ❑ NE
❑ Yes Ng ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
[—]Yes No
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L'J no ❑ NA ❑ NE
❑NA ❑NE
o ❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/201

Type of Visit: 0 LR
ance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance V
Reason for Visit:tine 0Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r
Date of Visit: t Arrival Time: _ Departure Time: E= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:, _
r
Onsite Representative:
Certified Operator:
Title:
aN >trgAp-)_ Naukg Integrator:
Phone:
Certification Number: j9 "703
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poultry
[Layer
-Layer
Dr. P,oult .
Layers
Design
Capacity
Design
Ca aci
Current
Pop.
Current
Pao ,
Cattle
Da' Cow
Design C*urrent
Capacity Pop.
Da' Calf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes /No ❑ NA ❑ NE
[:]Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ o '❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate 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: LA {�OL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
WNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
No
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
&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
0No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Nu
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C N90
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesE?114o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ato
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eta ❑ 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 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
Facility Number: - Date of Ins ection:
44. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? El Yes❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes qo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes : ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes I No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
-]
Use drawines of facility to better exulain situations (use additional napes as necessarv).
fs), rAF6 HA-� 14j-&fq"zP 5-r�u" 'Do oo-t
f:T_&LD. Com-?:Txb�- -Fo Coj9�1a4J
Reviewer/Inspector Name:
r
Phone?
Reviewer/Inspector Signature:
Page 3 of 3
Date: h 1 L 5

Type of Visit: (YCo Iiance Inspection O Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: / 2 D ' County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: �G1!/j f't l�{_.(�i4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: r�
Certification Number: )Z 6FI
Longitude:
Design Current
Design
Current
Design Current
Swine CapacityPop.
Wet Poultry
Capacity
Pop.
Cattle C►apacity Pop.
Wean to Finish
ILayer
Non -La er
I
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,o_uit .
Ga aci.
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
Qther
,Turkey Poults
OtherI
Other
Discharges and Stream Impacts
L'Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes rNq�
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ❑NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes T❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: - Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � �d0� LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q Z./ s�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D 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 C 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 `fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 10 ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Y�Ze's
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2�`No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
—/
I X D
"'777"'""�
❑ 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 0Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C31<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: y/
r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is th : facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JyNo 0 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 E rNo ❑ NA ❑ NE
❑ Yes [2 o ❑ NA ❑ NE
❑ Yes NNo
❑ Yes �o
❑ Yes O No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer. to question �'. Ex _l,a,m an YE S answers and/or any;additional;recommendahons'or any:©tber= comments.
..-.
Use dra'wingsof facility to better, explain situations (use additional pages as necessary)
a7K C 'IV06 f? PIVOT 64-r E� �UnJ �Cufi r'a pllmf al/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t
Phone
Date: J
11412061

Type of Visit: U Co liance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L 1 Arrival Time: �/ �� Departure Time: Za County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: `:rrA)A f k41449 L4&
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design ourrr" Design Current
Swine Capacity P p. Wet Poultry Capacity Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
(7
Non -La er
Dai Calf
Feeder to Finish
Design Current
D , Pooult , Ca aci P,o ,
Layers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
TU1 Aey s
urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes g �/No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IfaciTy Number: - Date of Inspection: 7 j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes
a. If yes, is waste level into the structural freeboard? [] Yes
Structure 1 Structure 2 Structure 3
Identifier: CA6,6A11 LkTcWJ 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (0 0
to ❑ NA
❑No DNA
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
❑ Yes rNo ❑ NA
❑ Yes CNo ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeptaI threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Na ❑ 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
dwo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
a<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Q'Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
B N
❑ 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
EKo
❑ 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
�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
To
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

FaciliDate of Inspection: —]
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Elxo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes �io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EfNo
❑ 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
❑Wo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�;�o❑
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or:any.other comments
Use drawings of facility to better explain situations (use additional pages as nece"ssary). «,-u
(�) S�vEriqt $ S MS 3�a�. %I�SE. CA rJ
rJvT l3 E 'y�tP�9 6�t1, P-D D KESS 5_L7VAT,rd-,1 t-1,-LW�a L�
A 0 D ACr"ti o &tz S j', C-A N aJ a-t-
F6 n_— Pt1,n.-, eVJG- vt.J T_Z L_ AeM6JC n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6 + 3
Date:
V4/2011

-Division of Water Quality a
FaMity •Numbir' SL OmDmsion of Soil and Water Conservarion r „
fi.
Q Other °Agency
Type of Visit �Co%pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ©O Departure Time: County: DLPi,YN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o= 4=di Longitude: = o= 6 0 u
Design "Current, Qes�giu Carrent
~'Swine Capacity :Population Wet P©ultry ,CapacityPopulafio
❑ Wean to Finish ❑ Layer
Wean to Feeder Non -Layer
cr ❑ Feeder to Finish
❑ Farrow to Wean
v ❑ Farrow to Feeder
ElFarrow to Finish
El Layers
❑ Gilts
❑ Non -Layers
"° ❑ Boars
` ❑ Pullets
.w ❑Turke s
Othefk = m ❑ Turkey Poults
❑ Other
❑ Other
P k
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?
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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
❑N El NA
❑NE
❑Yes
ElYes
N El NA
9No
El NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Date of Inspection
facility Number:
3�
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: /AGoseJ I Z C-AG-,vU3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes Z 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 ONo []NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P<90 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
b"'No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jVNo ❑ NA
❑ NE
Comments (k6fer to question #) Explain'any YES answers and/or any recommendations or gny other eomments "�.
N�
=Use 6twings of facility to better explain situations: (use additional pages as necessary);
.
Ak
Reviewer/Inspector Namef,]p/;;.Y Phone:
���
Reviewer/Inspector Signature: Date: (�
Page 2 of 3 1 12128104 Continued

t" •Facility Number: - Date of Inspection Z
Required Records & Documents
19. Did the facility fail to have 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 E]Xo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �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 ONo. ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 <No❑
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNoo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[J 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
oeo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately �
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 0 No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application) ��
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes JZo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 6f Arrival Time: 1 Lord Departure Time: County: DOfLdAW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
OnsiteRepresentative: Jf�1�11� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c= d Longitude: = 0 0 i
�C-urrenln
Wet Poultry Capacity
Population C*attle Capacity Populafion
❑ Wean to Finish
❑ Layer I
I
❑ Daia Cow
21 Wean to Feeder
D
SZ-0
❑ Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Da Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Cow
❑ Boars
Other
Number of Structures:
Turke Poultser Other
F
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[INA
❑ NE
❑ Yes
❑rNo
El Yes
�
ElNA
[:3NE
❑ Yes CJ No ❑ NA ❑ NE
12128104 Continued

Facility Number:.3l� Z Date of Inspection I 1g/d7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L-A
r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 54o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNVNo
[:3 NA ❑ NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? ❑ Yes MNo ❑ NA ❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo
I(o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?Q Yes
lLl No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rJ No
❑ NA
❑ NE
�
$Comments (refer.,tb;quest nn #) Eicplain£any YE5�answers and/or any;recommendatdons�or any,.other comments.
Use�drawtngs of facility to better explain situations {use addihotial;pages� as necessanZ
ry)
i
Reviewer/Inspector Name A Ahk(h, Phone 6 3
Reviewer/Inspector Signature: Date: o
rage a of 3 11A/ZoiUlf %.ururnuea

'Facility Number: t Date of Inspection
Ikeauired Records & Documents �..�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes VNo
El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -EfNo ❑ 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?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
Q NII*'O
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 94
❑ NA ❑ NE
❑ Yes
[ '<o
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
fj'No
❑ NA
❑ NE
❑ Yes
eo
❑ NA
❑ NE
❑ Yes
ElNA
❑ NE
ElYes
rNo
❑ NA
❑ NE
12128104

Type of Visit 6 Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Le2j 1
ice 1 d U Arrival Time: Departure Time: County: V Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = S = Longitude: = ° = 1
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle C*apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
I-10 Other
Dry Poultry
❑ La ers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0
0NNo ❑ NA ❑ NE
❑ Yes :No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

ltacility Number: 3 j —
Date of Inspection T�
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
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA4226.) 1 4 L_ L4 GvW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (1 a S G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environm ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI 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
El Yes
�,/
[ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes(2/No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If ycs, check the appropriate box below.
❑ Yes
Ll No ❑ 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)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� N
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
V
❑ NA
El NE
16.
17.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Does the facility lack adequate acreage for land application? El Yes
VNp
❑ NA
❑ NE
,� ❑ NA [I NE
18. Is there a lack of properly operating waste application equipment? El Yes LI'N""o ❑ NA ❑ NE
Reviewer/Inspector Name hS i Phone: 9'lQ
Reviewer/Inspector Signature: Date: a Y
Page 2 of 3 12128104 Continued

s
Facility Number: Date of Inspection 7 Ifa b
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
LI No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ yes
2 No
❑ NA
❑ NE
the appropirate box. ❑ WLp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspectionss El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
zo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�❑,/No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U<(O ❑ 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?
El Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
125INNv ❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C No ❑ NA
❑ NE
Additional, Comiinents.aiid/or Drawings
Page 3 of 3 12128104

I
Facility Number ) SSA
U Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Co iance 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: 1G D Arrival Time: Departure Time: County: baq� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ��1 Title: Phone No:
Onsite Representative: C1-JA1 /Yr - '��
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
f f} ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Puults
❑ 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?
Longitude: =o=' =«
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stacker
❑
Beef Feeder
❑
Beef Brood Cowl
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
❑ Yes No ❑ NA ❑ NE
❑ Yes W ❑ NA ❑ NE
❑ Yes VNo. ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection IG
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure
• 3 Structure 4
Identifier: t A (,,,oA1 (4"jA1 Z 4X6,y6N .7
Spillway?:
Designed Freeboard (in): 2`7 Z7 l i,
Observed Freeboard (in): T y k �L
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes n No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Q No ❑ NA ❑ NE
❑ Yes B"No Cl NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes Ekf o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 940 ❑ 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 Q/0 ' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LT"No ❑ NA ❑ NE
maintenance/improvement? 11, Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes D Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.ZNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Iq,) 4EFb tort' of /.lEuv_f)GoC 4 TEF-rAXT 541m 9W
Je u4 &»J ( 4 L IlAs
2.-7 0 Rt-habvzp
L
er/inspector Name cJ c%,l Qq OWL— L, Phone: 10 7 -73tf
er/Inspector Signature: Date:
12/2VI)d enutinued

t
Facility Number: 3 j —S 'Z Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ER-fes ❑ No ❑ 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 appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0'1 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I( No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
El NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2 o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CfNo ❑ 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
N ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

SS 2
Type of Visit �Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason far Visit V Routine ()Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 1 0 $ Arrival Time: dls Departure Time: j r l d County: CIOLS t•! Region:
Farm Name: _ ,1 or+n N Rtjz . W A=FME'—O Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6ew41t' CbJ_ _- y
Certified Operator: DENPaSt�_QQ
Back-up Operator: ltU-SA fNtATC cz
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = g = « Longitude: = ° = 6 = [{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
t 17 i) ❑Non -La et
I
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
ElTurkeys
ElTurke Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field [I Other
a. Was the conveyance man-made?
Design Current . I
Cattle Capacity Population
❑ DairyCow
El Dairy Calf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
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?
A
❑ Yes [ /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZINO ❑ NA ❑ NE
❑ Yes iJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — 57- Date of Inspection J�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
16No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA&aoiy f A( -,vat.) 7—
Spillway?:
Designed Freeboard (in): `q let
Observed Freeboard (in): ^ 141 S'Z-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
enviro ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo ❑ 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
El Yes
21 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C W A DJ
13. Soil type(s) RA A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
`7J IJAgr, SaF•.ft�C. vJO(L' 0on1(` ot,1 C-"5=fltiI SP&rs ens
RA10 G AJGC_ A7rFAll..rn
�t� � wi.TH acOM�s
ig.7 Nc� Co[ �o PEan�
❑ Yes
[!I No ❑ NA
�/No ❑ NA
[2 No ❑ NA
Fo
El NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/inspector Name I �- Phone: 510 3 q an . Za 3
Reviewer/Inspector Signature: Date: l tD�
12128104 Continued

) Facility Number: `�� — sS Date of Inspection
Reguired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[�] Yes
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
7No
❑ NA
❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
,.�/
L/ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
9 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[Yes
❑ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
dA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
14A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E 1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Z NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d�
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
7 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
cn<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
['No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
,�,ll
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'f No
❑ NA
❑ NE
Additional Coinmenfs and/or Drawings:
12128104

r
Facility Number 3 Date of Visit: Time:
Not Operational 0 Below Threshold
M Permitted MCertiifieejd [3 Conditionally Certifed 0 Registered Date Last Operated or Abo a Thresbold:
Farm Name: '/ d 0 it �i +*ten^' County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: �/ Title: l Phone No:
Onsite Representative: ✓_ 1,� L i h �i2z `�, Integrator: ✓ t
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 6 0" Longitude ' 01
Swine
El Wean to Feeder
Des g .Current:111
Ca acih P,o ulation
%/
Design Current Design Current
Ploultry . Ca achy P,o ulation Cattle Ca aeity P,o ulation
❑ La er ❑Dai
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Non -Layer ❑Non-Dai
❑ Other
e. Otal Design Capacity
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ ❑ S Lagoon Area ra Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management S 'stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f 2 3
Freeboard (inches): z 7 z ��
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

ti r.
Facility Number: 31 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
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv 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 ❑ HydrauIic Overload ❑ Yes ❑ No
12. Crop type edrA /G✓%�1 ✓
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 ElNo
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? (iel irrigation, freeboard, waste analysis & soiI 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 ReviewerAnspector fail to discuss reviewiinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
E3 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit-
Coniments;(refer to`gn 4oie`�e `Eitplam ads YES�ans viers' ud! x say rectamaie�itaErons or s v.oth r comme�s. �. _�< `; ='•�' �'
lise drawrngs of fac�ty to better ezph3tn sttttahons;{nse addigonal..pages as necessary) .
rx -- - �, ��,,� ,� �, -w� ,�., --y- - ❑Field Copv ❑Final tes Noa,
.:+.: ..,..+-„-,-4-:,..:a,�„." :-n-„su.--,®� _�.�'�s.-=rsa"§P'�m:'.��.a..�r �.�.s�"'a...�...^aE.�r!.sr"s_'�am.e:'"�sw'.w..err.—+�-s«r..—�.--r•�.+r�w.�---- ,�r'3�i
�us o Y d 41L i t rt Gl� -f� f� or-.- m will call *,r-, wlow i �-
i
Reviewer/Inspector Name ; LL
Reviewer/Inspector Signature: Date: 0 u
05103101 Continued

Facility Number. 31 — 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
❑ 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
05103101

Tom Whitfield N and T farm
Subject: Tom Whitfield N and T farm
Date: Fri, 23 Jan 2004 07:28:31 -0800 (PST)
From: Geno Kennedy <agrimentservices @yahoo. com>
To: Gale Stenburg <[e-mail]>
Gale, Tom cleaned up the shingles in the ditch. He wanted me to notify you of this_ Have a nice
weekend.
With Kind Regards,
Ronnie "Geno" Kennedy Jr.
President of Operations
Agriment Services, Inc.
PO Box 1096 Beulaville, NC 28518
Office [phone] Fax [phone] Mobile [phone]
www.agrimentser-vices.com
Do you Yahoo!?
Yahoo! SiteBuilder - Free web site building tool. Try it!
i of 1 1/23/2004 11:46 AM

<Swinefl
nlali0n
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Type of Visit JD Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit (&Routine 0 Complaint O Follow up 0 Emergency Notification Q Other ❑ Denied Access
F 10 Facility Number 31 Z Date of Visit: Time: %Z%
Not Operational 0 Below Threshold
® Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Gi
Farm Name: OOCounty: , A, 04`�l —�
Owner Name:' �,1�?r��vL/l Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: 4�2$Q prlrl eal S/
Certified Operator:
Location of Farm:
Title:
Phone No:
l
Integrator: tl� ^YD II _ -
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' �J u Longitude ' 4
Design "Current �Deslgh ' -.:Current. :Design
Poultry -Capacity ";Popnla#ean ;Cattle Capadif
11LJ Non -Laver
❑ Other
Current
,
[Milation '
r i M
M1
x h x`•-'NUmbE! ufL�goons a.' Subsurface Drains Preset[t Lagoon Area Spray Field Area
HoldtngTonds I S ;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? (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 ollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
identifier: r< 7
Freeboard (inches): 17i 3 2 1__�5
❑ Yes UffNo
❑ Yes Z[No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X[No
❑ Yes PINo
❑ Yes ]ZNo
Structure 6
0510310.1 Continued

Facility Number- 3( — Date of Inspection / i3
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 over application? ❑ Excessive Ponding ❑l PANI ❑ Hydraulic Overload
12. Crop type Z P- . / A. -','A Ae,- / / /D �/�PQ ,
❑ Yes
allo
❑ Yes
C,No
❑ Yes.
X No
❑ Yes
K,No
❑ Yes
rl No
❑ Yes
%No
❑ Yes
P.No
13.
7
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
_
❑ Yes
[51No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
10 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
JV No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Re wired Records & Documents
17,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
JR 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
IRNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
10 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
JONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)ZNo
No violations ordeficiencies were noted during this visit. You will receive no further correspondence about this visit.
Nillazam
uils�c=pep
Immism ❑ Field Copy
lop
❑ Final Notes
IVO-le. /Dp W/'dpt.5
cre ea in4V 744
40-A AId9. "e-
.��/JIllsr�j
Amok %f's �Jd -/-o
^(At sure -740-1r i'S
ho '-&A R7
P ? I,,, S #6
Reviewer/Inspector Name�"'_
" '�• rN ''� . `
"` v
Reviewer/Inspector Signature:
Date:
O5103101 Continued

Facilit}� Number: 3 f
Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
O5103101
❑ Yes g] No
❑ Yes ®.No
❑ Yes FANo
❑ Yes M No
❑ Yes RNo
❑ Yes No
❑ Yes No

�N..
Type of VIsh P(Gompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit -0 Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of VisitTime:
Q Not Operational Q Below Threshold
Permitted U Certified0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ...... [.FC............. &
��^..'.r!!-'�.............•............ County:......�4-11-.-' .. .............................. �......... .....
OwnerName: ................................................... ........................................................................ Phone No:....................................................................................:.
FacilityContact : .......................... ....... ..............I .... I ............... .......... Title:..................................................... Phone No:
MailingAddress: ............................................................................................... ............................................................................................................ ......_...__..........
Onsite Representative: ... �...`� ............................................ Integrator:................._
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude �• �' �"
Design Current Designi: Current Design Correa! =
5wtne
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
r
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .....................we-'3........................................
Freeboard (inches):
5/00
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes &No
❑ Yes DTNo
❑ Yes &No
Structure 6
Continued on buck

flFacffio 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 gNo
(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 *E1 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? OYes ❑ No
Waste AP12lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes �fNo
11. Is there evidence of over /application? ❑l 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 ZNo
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
WNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
N(Yes
(ie/ WUP, checklists, design, maps, etc.)
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
O Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
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
N'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
)J` No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
tdNo
0' * •yiolA6fis:or &f de'nd*e -wire . toted ii4rritig tb s v'sjt! • Y;oo wid - iye o fui-tit�r'
.. i�arrespondence about this visit. • '
Comme(refer to quest<an) Ecplain any nts YES answers aad/ar any recommmen oilier contmeaia.
,a
Use`dra of [aicili to`better explain`sYtuatmns. use;addet,onal' es asp; u gty
... ., - - - Pam. necessary)
A.
C)(
pU ��--�•� Gs � 2�c�. � �� ����w-•v�sz.L-d t'�' �•t�2►—s2�2
Reviewer/Inspector Name
Reviewer/inspector Signature: Dater g/{gyp

Faci ty Number: '3k Date of .Inspection Q 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes )9�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 KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �rNo
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 eNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes "0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JK(No
Additional omments an or swings:
a
�[,,t�. e t,�c�5' �y t,�►=c ep -\,,, '7-,�r-t. .
p
,a V4e
5100

• e
E3Division of Soil aif& er Conservation -Operation Review
Division of Soil and; Water Conservation' ,Compliance In_.spectron r� x
ion .of Water Quality Compliance Inspection
Other Agency Apei ahoin"Review_; -a�'s -
N
I(I
Routine Q Complaint Q Follow-up of DW inspection Q Follow -tip of DSWC review 0 Other
Facility Number JrSr Date of Inspection S/7 OD
Time of Inspection : 30 124 hr. (hh:mm)
Permitted Pk Certified [3 Conditionally Certified 0 Registered 10 Not Operational Date Last Operated: ...........................
Farm Name: ........
........ ✓....................... .................................... County: --....-.P.40i.. ........................,,
Owner Name:......��? .. P. r............................. Phone No:................... ..
......................................... ......................
Facility Contact: �d ........f/v �TZ. CO'� j . Phone No: ......................................... ....... ................��.. ......-..................Title• .........� ..............-................ ..........
Mailing Address: ...............
....
....
.......................
Onsite Representative:.....0-2 . ..........................3P......... ... .............................. Integratnr:..............id.�%.�.-�............................................
Certified Operator: ............................................................................ Operator Certification Number:
Location of Farm:
-
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- IV
Latitude Longitude • �° �«
Number of Lagoons 10 Subsurface Drains Present ❑Lagoon Area
-'Holding Ponds / Solid Traps 10 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? (If yes, notify DWQ)
Spray Field Area
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Mnodyl-I 114oaplY 3
Freeboard (inches): ......3ate ............................................................. ................. ......
Co .
5. Are there any imiCdithreats t the integrity of any of the structures observed? (ie/ trees, severe erosion,
. seepage, etc.)
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
-NA-
El Yes ❑ No
❑ Yes EgNo
Cl Yes VNo
❑ Yes [;9 No
Structure 6
❑ Yes Wo
Continued on back
3/23199

Fkwcility Number: 3 ( —53,;L- I Date of Inspection
5. Are therea y immediate threats to the integrity of any of the structures observed? (iel 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? y
(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 pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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'? ❑ Ponding ❑ Nitrogen
12. Crop type.................................................................._...._
( M ..........................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
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? (icl 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 certified operator in responsible 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'?
1Vo.violations:or. deficiencies .were noted during this: visit:: You varill.retceive no further. : ' ::
corr&b6ndence: about: this visit.::::::: ::: :.:.:.:.:.:.:.:.:.:.. ..:...:...:. • : • : • ; • : • : .
❑ Yes D(,No
❑ Yes &No
❑ Yes KNo
❑ Yes KNo
❑ Yes ANo
❑ Yes Z No
❑ Yes QNo
❑ Yes No
❑ Yes No
❑ Yes J�No
❑ Yes Callo
❑ Yes KNo
❑ Yes K No
❑ Yes ONo
❑ Yes ZLNo
❑ Yes RNo
❑ Yes RNo
❑ Yes b.No
❑ Yes ONo
Comments (refer to question #):' Explain any YES answers and/or any'recommendati6M ofrany otlietr eomments -,, .:
Use drawings'(if facilityAo better -explain situations. (use additional pages as necessary) , - r
12) C t�L uH,.�j e-f5 .l�L v� }v. '1n) N.. so.� a.rs ►,o i l� -�61aw - _.
cuc"M.�.l„r-
Reviewer/Inspector Name , !/• C7r
Reviewer/Inspector
f Date: 1116/99

Facility Number: — Date of Inspection-}
Odor Issue.. 4
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes CNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes C(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 fi�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 JNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes _$(No
Additional.Comments andor_ ravings:_ :• r. r ; _ _s,..s., ry . , �,
i

Water Quality Active Lagoon Ranking
Draft
Central Office Criteria
1. Was facility constructed before 1993 NRCS Standards or there is no verification of standard?
2. Plant Available Nitrogen (PAN) Deficit < 500 n.per dear or F 1, F3 or F4 Wettable Acre Determina ion
Flags
Fl Lack of Acreage resulted in over application in last two years
F3 Obvious field limitations ditches_ buffers irregular shape
F4 Application acreage in excess of 75% of total acreage
3. Lagoon Capacity greater than 1,000,000 cubic feet
4. Was there a discharge from waste system in last five years? NO
Central Office Criteria available after new verified GIS data is gathered from field GPS Units
i. Distance from Lagoon to Water of the State (WOS) > 300'?
5. Is lagoon in 100 year flood plain? / V 0
Field Inspector Criteria
7. Modify Question 94 from current inspection, add choice box: Is high freeboard due to storm water or
management? 011-16
8. Modify- Question 4 5 from current inspection form (take immediate out) and define in form instructions:
Current question_ Are there immediate threats to the integrity of any of the structures observed? (trees,
erosion) / ' d
9. Add question on effective embankment Height > 10' �v
2/3100

'ytv J
i
Groundwater Rating
The following questions will be incorporated into the current inspection form or answered at the
central office.
Rating Questions for Groundwater
YE
N
UNKNOW
S
O
N
1
Has the lagoon/sprayfield been in use for 5 years or more?
2
Is there a water supply well within 250' of the potential
pollution source (lagoon or sprayfield) with no intervening
groundwater discharge?
3
Is the predominant soil drainage classification well drained
to excessively drained?
4
Are rock outcrops present?
5
Are either of the following true?
• The lagoon was constructed befoie 1993 MRCS**
standards
• There is no -verification of adherence to the 1993
NRCS standards
6
Have groundwater standards been exceeded at this site
based on existing monitoring records?
7
Was groundwater encountered during construction of any
lagoon?
Depth to Groundwater (feet below land surface)
+
*Generally unknown, but if this data is available is should be recorded.
"Natural Resources Conservation Service
Responses to the questions will be entered into a computerized version of the scoring table on the
following page to determ-1ne the rating
W- ads{
I
0

Sri Devision of Soil and Water Conservation.= Opeiation liev�ew
Division of Soil and Water Conservation -Compliance Inspection
_ ..
1`Division of Water Quality - Compliance `Inspection _
0 Other Agency - Operation Review z
110 Routine Q Complaint Q Follow -tip of DWQ inspection Q Follow-up of DSWC review O Other
FFacility Number Date of Inspection
rime of Inspection t(: fS 24 hr. (hh:mm)
© Permitted ® Certified ❑ Conditionally Certified © Registered E3 Not Operational Date Last Operated:
Farm Name: .......... �{......�frrttx,. .l�`�" ...N. ........................................... County: ...... D10A ........................................... .......................
Owner Nanre:........................ ltr�+......-...1 ......... s.................................. Phony \u: - L .....................
Facility Contact: • ' Title: Phone No:...........:.......................................
MailingAddress: ...........Q..G................................................................................... .Y..tfrt�,....it.•L...N...................................$7.z.,.......
Onsite Representative . C-��y�,. a,�A . ri Integrator:
� Yt'1�, ,,,,,,,,,,,,,,,
....... ,�..r f ........ 4.............. r, fly.............................................
Certified Operator: ................................................ .. .................................. .......................... Operator Certification Number:..........................................
Location of Farm:
dia.... ..4.......0. (1.. L.,..%...tM;. 5.......c,2S�.......Q.........1??...r.............................. h................................ ...
............................................... ........................................................................... ................................ .............. .......................................................................
Latitude Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
99 Wean to Feeder 104 110 ❑ Layer 10 Dairy
❑ Feeder to Finish 10 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity 710
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ElLagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. II'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freeboard (inches):
Structure I Structure 2
!ck 7 3
..r.................................3.Z..............
Structure 3 Structure 4 Structure 5
❑ Yes a) No
❑ Yes No
❑ Yes No
❑ Yes V No
❑ Yes No
❑ Yes No
❑ Yes V No
Structure 6
1/6/99 Continued on back

Facility Number: S- — �7s_ Date of Irrspection
S. 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 Q 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? OYes ❑ 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 top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [5� No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes 0 No
12. Crop type ............... ......:
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes FO No
14.
Does the facility lack wettable acreage for land application? (footprint)
Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
(P No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
R No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?'
❑ Yes
[3 No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
00 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same Agency?
❑ Yes
P No
0 NO. violations -or. defiiciericles .were noted. during *this -visit.. You will.rec' ive na fiurihe,
• • ;
. ecjrrrzsb6fidehee: abotit: this visit.: ; ; ; ::: ; : ; ::: ; ; ; ; ::: ; ; ; ; ; :: ; :: ;
Comnients (refer to question #): -Explain any YES answers and/or any recommendations:6r any other; comments., 7
Usedrawirigs of facility to better explain=situations. (use additional pages as necessary}:
e
v
a , w Yi � 4i 5oi c J reMe A,
�. ErostQs� r,�y- s or atil�c+r. �`Y.�, w�(1 a`�t. MSS la�or. S�ou�} its Q
ue�trc_ O.tr[�-5. 3y,ptJiQ1 � � C�C55[cl W'`ri- {o� So i � ew-� itaFP�[-�t�C�� �ty�` b+lrvorl� tt� o.i 1
i4.�cer �o.a�oars d c1 S �1cui� �� rtn� ate See dt�. �rastor. 6rOL�'z to�>`ec� �e 6ei"e
�a Oar` MF� d ULTrZ Shav� 1a� Siab►�ittc�. Vrit��+r � r,. N��2. cC t�;11� fu g sip A
Wpt[dt'1GY ,Ot�
''nix n��- �� en�� tcfc� �r r,xi5l�.-A,
J 1
DeSuo*-�-nUv�-
Reviewer/Inspector Name r.
Reviewer/Inspector Signature: Date: �`�� 11/6/99

r.._ _.
Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality'
fi
,
Routine 0 Com laint 0 Follow-up of DW ins ection 0 Follow-uE of DSWC review 0 Other
Date of Inspections
Facility Number [ Time of Inspection �24 hr. (hh:mm)
• ©Registered bl Certified D Applied for Permit © Permitted 113Not Operational Date Last Operated :..................
Farm Name: ! ".T N.11[5 County: ..... 1�:.......................................... .......................
Owner Dame:....... T4.x-... f ........4�s.�............... W� � 1IJ �!
�t- N �.................................................... Phone No:.....�.1�....sfa.�:..!��!�Z-.......................................
FacilityContact: 1 Q.r." ....... on"E -A. .............. Title:................................................................ Phone No:...................................................
MailingAddress:...... ...12...4 ........................................................................... .. .�!h.leill��..W..V.....---.....-----......I...................... 5-.......
Onsite Representative:...... Win A............ Q .. son ..................... Integrator: ....... L. carx.d.cs ........................................................
Certified Operator;
Location of Farm:
Operator Certification Number ;........................
�....�?. f ....l.SI.. l:.3..... niG.S.....t � .....sa.:.....S13..1.t;W.................................. ..... .... ..... ....... .. f..................................................... i
............................................. ............... ................ .............................. .. ........ ........ .............
T
Latitude Longitude �• �' r��"
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes ® No
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 ,aUmin?
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?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [�g No
❑ Yes M No
❑ Yes CP No
❑ Yes(] No
❑ Yes [g] No
❑ Yes M No
[T Yes ❑ No
❑ Yes No
❑ Yes No
Continued on hack

E
Facility Dumber: 31
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
0 No
Structures (Lagoons,Iioldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
09 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure fi
Identi Fier: 14 Z� 3
Freeboard(ft):........7.'�r.......................�:.`..............................................---.......................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
CO No
11. Is erosion, or any other threats to the integrity. of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
00 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..........L rt•............W ................ 1t. t-.................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
09 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement? ❑ Yes (j No
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (@ No
22. Does record keeping need improvement? (KP Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fait to have a copy of the Animal Waste Management Plan readily available? ❑ Yes [�No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes Ud No
0 No.violations or deftciencies.were-noted during this visit. - .You.will receive no ftirther
correspondence about this: visit:- : � : : � ' • � � . - � . - ; � � � � � � . • �. ; - . � � _ � � - � � � . � . . • - .
Carn.ments�(refer:ti► question #): •�Explatti any. YE5 answers and/nr any r�coinmenitations or any other cq�tnenis�
Use draw><ngs of;facdtty to better explaui`„situations (use aAdIW6nal pages . necessan) k
(O,d orcat o- k4
12_ I k(( f...h
nru.r J:Yi ca�(ts O f (��ror s 1#L, "64'0 1 'p C
YhG,I( on' M O C P- o S jo ve��.t� do.\.
z. I.w�je� +liSer K.JM6A- on
7/25/97
-
.r
k
Reviewer/Inspector Name p t� µ
Reviewer/Inspector Signature:__ n, Date:

� '� � ❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
Routine 0 Con laint 0 Follow-u2 of DIVO inspection 0 Follow-up of DSWC review 0 Other
Date of inspect ion 1
Facility Number 55
Time of inspection � 24 hr. (hh:mm)
Registered 0 Certified [3 Applied for Permit 13 Permitted 13 Not Operational I Date Last Operated:
FarmName: ...... ygoq ....... F&.eft'�!i�.....4..--1.....................f--................................ ............... County:........NVIM....... .............................. .......................
Owner Name:........TDr1nl ...`t.. AJ......!�11�1.��4C11�.. Phone No:..�" yj)—.5zT:n..to.3.�z- ..
..................................................................................
Facility Contact:...... W ► -11A...... ►o SC1za...................... Title:.......... k...'1Vi! e ............ Phone No:. 016.... ........
MailingAddress: ........Cb....... ... 3.-A.......................................................................... C:%1�_...�:.�.�.t.kG....................................... MA:2 ........
Onsite Representative: ........... !!u.ind(II........... Integrator: ........ canzfl.k.........................................................
Certified Operato..................................................... ............................................................. Operator Certification Number-,
Location of Farm:
`1 �..:....N. .... .... �,...... ti.l ......! t�Y�..... e......aa-,...4�.... SR ...l .L.,..-. r�................. >e... Qrx......i �...... ......
1<Sri ....mod...... -fie.. ...a.......�0.:... S.K...: .1.... &cr.v... i s........f.r.%.' l�........ a..%......... . L[.Q:........................................
Latitude Longitude•
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
. Design Current
Poultry Capacity Population Cattle
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 ❑ Non -Dail
❑ Other
Total Design Capacity
Total SSLW
------------
lesign. Current
opacity Population
Number of Lagoons / Holding Ponds 0 ❑ Subsurface Drains PresentJ10 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
10 No
2. Is any discharge observed from any part of the operation?
❑ Yes
Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
UNo
b. If discharge is observed, did it reach Surface Water" (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in ,al/ nin?
d. Does discharge bypassa. lagoon system? (Ili yes, notify DWQ}
❑Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
1P Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
allo
7/25/97
Continued on back

i Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 03 No
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0'
Identifier: .........1.!."t................ ...........tr......... .....................
Freeboard (ft): ..........'�............... Z
10. Is seepage observed from any of the structures? ❑ Yes B No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes jd No
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)
15. Crap type C4rin.......................WLA.--................ �PG ....---.....--.-... ........ ....................................................
..........
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?
c
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities ()nly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Cr
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?
®- No.violations or. deficiencies. were noted during this:visit.- .You;will receive no further . -
coenspondence about this: visit... ' : .
® Yes ❑ No
❑ Yes ® No
❑ Yes tO No
...............................
❑ Yes allo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
C} Yes ® No
X) Yes ❑ No
❑ Yes 03 No
❑ Yes No
❑ Yes No
Cott ents (refer :to question #) Explain any YES answers and/or;any recommendations or any other eonuttents: �i
Use drawings of racihty to'b tter explain situations {use additional pagges as necessary} s, ,yam
I z- &, rc S c tar. i 0.. ccr. 14 � hog d �� r1es eedfJ - Erm, an ty, 5 rth iuers y jt,�t Al
ZZ• 5 e [aro S)XOUI be (l t i 6riser numv er arJ �,e j rtm�ber a�0�ia odr.
�� W 4Mm � � aS � iA� uth • �� art T�IOi1 5 C[t �iG aTiOYIS L10 e 1 n Man.
p s old i a
S . �c.ms sl�ovjrj � i7�1i �' ar�nY'�3 �8ca�-+eci in{.ar r,�lcr rJa,�S,
1 7/25/97 [,1
Reviewer/Inspector Name _ F
Reviewer/Inspector Signature:_ Date:

�� •- .., .. _ � .._ � � .. ,+.:x`%ti�f9.i?�i+r- _ rr.RdxS;�'~�+rz;zf3:ti,�'��2•� n�ti.�=
DSWC Animal Feedlot Operation Review REC
DWQ Animal Feedlot Operation Site Inspection
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other_
Date of Inspection l / 7
Facility Number -' 1 55?
Time of Inspection �24 hr. (hh:mm)
0 Registered 6 Certified ©Applied for Permit [3Permitted . 0 Not O peratimial Date Last Operated:
FarmName: ...... Mxf,�........ County:....................................................................
Owner lame:.........t.1Rx�:�....`F..Na.........��..................................... Phase No:.....�.! � ? .'..�a.3.` z.. ....... o `l ��. f.....:{..:7 ..... }-- ..........................
FacilityContact......(......1...................... Title: ............ Phone No: 401 �G.:..G�uz
1
Mailing Address :........ }.G........ ikx....�.. ....... ........... .............I............... �_..i
Onsite Representative............ v}.i.! .lid ........ ....................................... Integrator:........ G..Cic f. S.......................................................
Certified Operator; ................................. ......... ......... .... ................. ............ ............... ............. Operator Certification Number ..........................................
Location of Farm:
Latitude Longitude �• �° ��
trrent - Desiga Current Destgn� Cur rent
ulation. .4Pouitrv. Capacity>P6vulatron Cattle Capactty Population`
Wean to Feeder
`t1
❑ Feeder to Finish
❑ Farrow to Wean
`. ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Subsurface Drains Present U Lagoon Area Ip Spray Field Area �..
No Liquid Waste ManagementSystem x
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
©No. = "
2. Is any discharge observed from any part of the operation?
❑ Yes
Q No
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
❑ Yes
($-No
b. If discharge is observed, did it reach Surface Water? (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 systetn? (if yes, notify DWQ)
❑ Yes
] No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
fA No
5. Does any part of the waste management system (other than lagoonstholding ponds) require
9) Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E(No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes,
fgNo
7/25/97

W.,
j
a'
ere o6onsorr storage ponds on site which need.tobeproperly;closed?,'�
lag
e
0 Y s
No,
�_
res La 1-1-Iddin Po' Pits Letc. l.
L oohs kjo
storage111 apa* �,jtus'�torrn storage less than ad6quate c' :cityffre�eboarc storage)
•El Ye's ®No
S Structure 51 Structure 6
Structure L tructure Structure 3- Structure 4 St
Identifier: :.i ... ........ .
--
.-2
reebmd ......... ...
. . .... ...
-
.... ....
............................... ..
A
.
10Isseepage observed from any of the structures?
.,T.
0 Yes
IS No
,
I I., Is erosion; or, any other threats,to the integrity of any of the structures obkrved?
C1 Yes
©No.
12-- Do any of the structures need maintenancelimprovement?
El Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation POWs
-;'.,_an i.nunediate public health or environmental threat, notify-WYQ)
13. ,Do,any of the structures lack adequate minimum or maximum liquid level markers?,.
❑ Yes
91 No-
Ap,plication
14!1stl; g'phy:sical evidence of over application?
❑ ;nk
12 No
(If in'excess of WMEP or runoff entering waters of the State, notify DW
A
15 660 i* UJ .... ............
. .............. . . ............................................................................... ..........................................................
A 6.'- Do'the receiving clops differ with those desighat6d in the An'imaiWaste Management Plan (AWMP)?
Yes
(NNo
17. boes the facility have. a lack of adequate acreage. for land application?'
Ej Yes.:
®No' 0
18-' Does'thi rcceiv'tng:cr-op� need irpr'overnent?
❑ Yes
1,;0 k
F,
_1: 19., Isllhire.a lack of a v7aila'ble waste application -equipment!
s
NO
20.-� Dees'. facility require.a.follow-up visit by same agency?
Yes
91 No
2 '-�DURF�j6�verfin�kZt& fail to dis6u'is revi' -site re L ewfinspection with.on presentative?
Yes
[D No
t.0
22.-::;D(>es record kee eed Ve ment?...�,
ping-n Impro
(0
0
0 1'�
.
For
Certified or Permitted Facilities Only :"
•23iDoes, the facility,failAq, havea copy fthe' i W Management
M A Plan readily available? Ah mal aste ana
"Yes
No
24' Were aay'.iiidifi6nal problems noted which cause noneoffi6lianc6'of the ,certified'AWM P?...
❑ Yes
No
I -A
1'4;25�-,Vere any. additional, problems noted which cause noncompliance of the Permit?
0 Yes
0 No
z
N'O.Vii)la'tioiLsOr',deiriciencies.'were,n6ted"d6ii6g this'vis"it."-Not! rkei've` fi6ftirtheir'
-correspondence ahouf -this. Visit.,.
.................
Gamnne�ts (refer Eo questro #� �Explatn any�YES='answers and/or auyrecQminendatrons or any other comments, r'`
-
. , w .� Xf- V " 0 A
J#v 0c,"1; JJt A IN
A'S
Y\ Ovr\��V_ a r, fi� YN 'm 6 er ckA 06A
V
Was-
luf).s 51wdd-_ 1ian.
Reviewei/Inspector Name
Reviewer/Inspector Signature: -
-E.
­7-77
71
r
-E, 206aev&, ME . .......
:7/25/97
Date: . q

BIG GUN@ PERFORMANCE TABLE U.S. UNITS
100 SERIES BIG GUNS - 240 TRAJECTORY -
inn T TGPFR Rr1RF N171771 FC
PS.I.
50
Noz 119
'S'
GPM 01A.
NOZZ1e
GPM DtA.
k0tz16
GPM DIA.
Nozzle
I GPM.65' DIA.
Nozzle
GPM.T DIA.
Nozzle
GPM DIA,
Nozzle
GPM OW
Nozzle
DIA.
I Nozzle
9"
GPM DIA
'. o:
j G PM
<
DiA
100 245'
1$5 256'
130 265'
150 273'
165 280- 204
300'
50 205'
64 215,
74 225'
87 235'
1 70
60
225'
75 238'
88
250'
103
263,
120
275'
136
263,
155
295'
177
302'
197
310'
243
338'
50
68
2A5'
83 2-W
too
270'
117
283'
135
295'
1 355
306'
175
3t5r
201
326,
223
33S'
1 274
362'
j�110
76
265'
92 278'
1 111
290-
129
303,
150
3i5'
1 171
324'
1 195
335'
222
344•
2A7
355'
304
38C-
'a,allaDle only -in FtOQ S SR100-
100 R RING NOZZLES
100 DN DIFFUSER NOZZLES
PSI
71 RING
.77 RING
61 RING
.88 RING
89 RING
I
93 RING
96 RING
0.6 DN
0.6 DN
3 7 DN 3 d D�• _�
GPM DIA
GPM DIA
GPM DIA
GPM DIA
GPM DIA
GPM DIA
GPM DIA
GPM DIA
-GPM DFA
GPM DIA GOM -;
)9 212
Er.1I
91 162 lie
e0
66 208
91 215
103 224
its 235
134 236
152 242
45 154
fib 168
60
6l 235
96 240
110 245
125 260
141 270
164 275
183 280
110 2DO sea 2'-
60
94 255
its 265
127 275
145 265
163 300
189 305
211 315
t `
272 325
236 335
r
-
y,t
-
.r w•� �..cc..vpI���
- - - -
1p0I
lo5 770
124 280
142 295
lfi2 305
182 320
h110
µ'i
-' na oiamsleI of inrow 4 a0D10><lmaMIy 3% Ie55 $Of the 21' tf&jeclOry a-gla, 6% less Ior 1V
150 SERIES BIG GUNS - 24" TRAJECTORY"
150 T TAPER BORE NOZZLES
1`lOzz19
NO2Zle
Nozzle
Npzile
Npiite
Nozzle
Noe Zle
.9"
1.0'
1.1'
1.2'
1 J"
PSI
GPM
DIA.
GPM
DIA.
GPM
DIA,
GPM
DIA.
GPM
01A.
GPM
DIA.
GPM DIA
60
1to
265'
143
285'
182
305,
225
325'
275
aw
345'
330
365'
385 38C
3o 1
126
290'
165
310'
21D
335'
260
355'
375
375'
380
395'
445 41_
—`
ZS4251QQ
355
400'
425
a20'
143310'
t655
355'
290 3T5'
S00 a=:.330'
�350ie:
465
440'
20e6
375'
320 395'
385 420'
545 46C
_ A
150 R RING NOZZLES 7a Sr /TTL
uH
�Ainq
R.np
Ring
�1�g
"- ainc
Ring
Ring
�ng
P51
36"
G?IA 07A.
.97"
I GPM DIA.
108,
Gi'lf DL;
i62 300'
1.18'
GPM
225
DIA.
3t5'
1.26'
GPM DIA,
1 3A-
GPM
OIA
a r
I GPM DIA
275 335'
330 150'
385 �365r,
60
I 110 260'
143 280'
I
1i8f7
5
j 6J
12f 280'
165 300'
210 320'
260
340'
315 360'
380
380,
4=5 -39:
1'xcfA
100
1c3 300'
t85 320'
235 340'
290
360'
355 380'
425
400'
S100 415
Y
170
t57 3:5'
204 335'
256 360,
j
320
38
1 385 400'
465
420'
S45 +3c.
"7,e a,ame•%er of mro� -s aDoroaimaiely 3% lass 10, Ina 214
lra,c!c1y angle. _
----
200 SERIES BIG GUNS - 27° TRAJECTORY"
­200 T TAPER 80RE NOZZLES
NOZ;le
Nozzle
Nozzle
Nozze
Nozzle
Nozzle
Nozzle
Nozzle
t nozzle
105'
•- t_r
t,2'
1.3'
1.4'
t 5'
1 6'
L75'
29
P51
GPM 01A.
GPM
DIA.
GPM
355
DIA.
395'
GPM OW
1, rl ;r
415 410,
GPM
DIA,
GPM
DIA.
GPM
DFA.
M GP
DIA.
GPM Dix
480 430'
555 450'
,
70 I 270 360'
310 380'
630 465'
755 495'
1 890 Sit
nr
..
-
'13Efh`?iSQ�hit3s,"- I
90
310 390'
350
410,
405
425't
475 445'
545
465'
625
485,
715
505'
655
$35'
1005 5s5
zi5 1
110 {
340 410'
390
430'
445
450,
1 525 470'
605
495'
1 695
515
790
535
1 9+5
565'
1113 -
iSY20
r.
'.j .::1 i60.•:'D 60d:tJ
425
445'
485
465'
365 85'
655
Sty'
755
540'
860
$60
IX ! 370 425'
1025
590,
1210 ?2:
200 R RING NOZZLES
IJ' Ring,
•.�` itin,,}
i �i" Rinq
114° Ring
1 'h' Rinq 2- ^.n;
II,29" aCluill
(1,a6" ocluiI
l' ,B' �dualJ
(1.66" 3"..,1
(1 74" aClval)
(183" acltNll '1 93- acl:.a4
PSI I GPMS DIA.
GPM DIA.
G,' A GIA_
GPM DIA.
GPM DIA.
GPM DIA GPM DIA
60 2SO 340'
33D 370'
3135 390'
445 410'
515 425'
$85 440' 1 555 C55
Z= MIMS=
MNffiZw=1
7.55::tY-,_AZ5!4'
675 470' I 305 49C
6D I 290 370'
180 400'
4•1 420'
515 440'
590 less'
F'3r90 s
tl -
00 1 325 390
425 425'
SW 445'
575 465'
660 480•
7tt SOD' 300 `2:
w Qi OC7 L1C2.'=
Mmuft='"•}#��..
4'KEry
::Y'r3.5AJa r•
120 1 355 410.
465 445'
S=n 4W
630 465'
725 500'
825 520'
385 545
t
1025eiS i-55QC;
"Tna da:neier or :n,c- Is a7Dro=Mlalely 2% less 10r Inv 24' IrajeCl;:y angle. 5% less for the 21" ❑ajeCtory angle.
ins 6rG GL'r:s 7erormance Cara nas been oDtameo Vnoel ,pual lasl coT:,:ilions antl may be ao"rsely alfecle0 oy wino, Poor hygrau6C enhance conf7n1on5 or olner la C:o15
Nelson lrrlgaaOn COrjloraf cn '::a:.ae no rehraenlaiion rjgarilinq oroplel Condition, vrlilDfmily, or aDDICanon rate,

NORTH CAROLINA
Department of Environmental Qual
0)

Type of Visit: CJJCo ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 2 I ► Arrival Time: ; a 9 Departure Time: (j Q O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
a
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 2 0 2 ;' j--
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
feeder to Finish 2/j
Farrow to Wean
Farrow to Feeder
Farrow to Finish
42
Design Current
Dr,. P,oultr Ca aci P,o
Layers
Non -Layers
Dairy Heifer
I
Dry Cow
Non -Dairy
Beef Stocker
JBeef Feeder
Gilts
Boars
Pullets
I jBeef
Brood Cow
Other
Other I
Turkeys
Turkey Poults
10ther
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
0-No
❑ NA
❑ NE
❑ Yes
E] dN6
[DNA
❑ NE
Page I of 3 21412015 Continued

Facili Number: -31 Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
�f
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ N ❑ 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 environment 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 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 ffNo [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E rNo❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
jNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesNo
❑ 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 ❑
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [:]No [3NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 6-Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield Lff 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: z ?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate boxes) 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?
0 Yes
D<o ❑ N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Zj No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
COD
❑ NA
�No
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
0 NE
Comments (refer to question ft 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).
C-a V -;D0 z I Ix e__Ctf 11�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
c? (127 f & 73 °y
Date: 3 f 2 t t 7
2/4/20I5

rype of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L jPj7,!jrG Arrival Time:1 k 0Qp 4 - Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: N—A 4 f '(% Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design C►urrent Design Current
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
I INon-Layer I Dairy Calf
W to Feeder
Feeder to Finish
Farrow to Wean
j 2-
DairyHeifer
Design Current D Cow
Dr, ,oult ., C_a aci, P,o . Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Other
Turke s
ke Poults
EOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No
❑NA ❑NE
0 Yes ❑ No DNA ❑ NE
❑ Yes ❑ No D NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
i
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ff No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ff No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑eNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
[%'No
❑ NA
❑ NE
❑ Yes
P Xb
[] NA
❑ NE
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
ErVes
❑ No
❑ NA
❑ NE
the appropriates
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E31No
❑ 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
[%7,
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[] NE
Page 2 of 3 21412015 Continued

Faeifi Number: '3 - f Date of Inspection: O %ls
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ oo ❑ 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:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [;] ❑ NA ❑ NE
❑ Yes [2HNo ❑ NA ❑ NE
❑ Yes ZINO ❑ NA ❑ NE
❑ Yes PIKo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ "" ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑1No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Date: I ZY 1 r.
Page 3 of 3 21412014

r
(Type of Visit: QWpliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: URoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: ® County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: j p r V'{ irJ Integrator:
Certified Operator: Certification Number: 2Z
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Finish
rFeeder
Design Current
Capacity Pop.
FEELa
Design Current 11111111
Wet Poultry Capacity Pop..
er
Design
Cattle Capacity
DairyCow
Current
P,op.
Wean Feeder
Non-Layer
DairyCalf
o Finish
2-0 29
Design Current
D P■ouItr. Ca aci P,o ,
Dairy Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 E2rNo ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N []NA ❑NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes u No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - IDate of Inspection: -Z
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): 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 LJ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E 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 E]rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes Ed No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErN;o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes FKN ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [] Yes Ko ❑ 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 Eryes ❑ No ❑ NA ❑ NE
the appropriate b
WUP ❑Checklists ❑Design aps ❑Lease Agreements ❑Other
21. Does record keeping need improvement? If yes, check a appropriate box below. Yes ❑ No ❑ N ❑ NE
❑ Waste Application ❑ Weekly Freebj��
Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 "o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [TKo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

e
i
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 MNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No El"NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes D-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 ff No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes [: No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ]Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes NrNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.:oY'any other.comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
-ZC7
II �' 5 1a ,� < �► LM Z P cam. �
Forl�T 1
� it c"4-1o n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7(? C 7 3Q<[
Date:
21412014

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7 Arrival Time: s ' Departure Time: County: Region:Q
Farm Name: Maw Owner Email:
Owner Name: Phone:
Mailing Address: 7 c-r�/�Z �� Z{
Physical Address:
Facility Contact:
Onsite Representative:
• Certified Operator:
Back-up Operator: .
Location of Farm:
Title:
Latitude:
Phone:
Integrator: /' LIS
Certification Number: 21--)Z Z
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design C*urrent
C-opacity Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Daja Calf
Feeder to Finish
Dairy
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,oulh,
Ca aci P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �'No ❑ NA ❑ NE
❑ Yes -'[j No
❑ Yes E2'No
[—]Yes [�TNo
[:]Yes d'No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: �
Waste Collection & Treatment
4. �s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑'NTo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ; --
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ,EfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ,P!fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes eNo
❑ 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 12-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Ef No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,fn-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E�rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes ;]-No
❑ NA
❑ NE
aired Records & Documents
19 Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [:]No
❑ NA
❑ NE
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [7rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes O'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: % /
24.,Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes _'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F1 No
Other Issues
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes El 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 La'No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ,❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes 2rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes _L2'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes F-4'NTo
❑ NA ❑ NE
Comments (refer to question ft 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).
(W-/ 6 i/1--N
I.n C lace AJ{
r', LAB �i �7&f S 6 A
>ffu,r tec6,
' r r y a
d'r
Iles/ r-eC Graf.
lveeol a- raIY
cc,44 /
C' ck1�J�s
L� Corr G� f�,JL-•
a C 'r11h1Cu11 eye—,
b>Ocl�n / /
can
0 fa14, -use
Reviewer/Inspector Name: % �ef„j t c, Phone: Y1,71176,
Reviewer/Inspector Signature: �L Date: 7 1,
, Page 3 of 3 214 011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: gRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 6 1o,r��
j4Le6,,Ylfli✓lr Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification N tuber:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.JEEEaycr
Wean to Finish
Design Current
et Poultry Capacity Pop.
Design Current
Cattle Capacity Pop,
Da' Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Design Current
D . P,oul. C•_a aci_ P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turke Pouits
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 'F,�] No ❑ NA ❑ NE
❑ Yes W_fNo
❑ Yes ;2*190
❑ Yes �o
❑ Yes ETN
❑ Yes o
❑NA ❑NE
C] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

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

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pen/it? ❑ Yes No ❑ NA ❑ NE
25-Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA FINE
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
WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[Ao
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[—]Yes
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�?No
❑ NA
❑ NE
Comments (refer to question ft 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).
Oka C,
r.'a
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: " K7
Date:
1214111

.Facility Nu4ji er
3
I
(>-Division of. Water Quality
O Division of Soil'and Water..Conservation
0. Other,
Type of Visit P tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (>Woutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1411., 1 Arrival Time: d Departure Time: EzEwkounty: / Region: 4t1f ►
Farm Name: 2 0 H7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator
� v
Operator Certification Number: e?d2 .•.L
Back-up Certification Number:
Latitude: ❑ o = , ❑ " Longitude: ❑ ° ❑ ' ❑
z Design 'Current Design Current : Design -Current
. .. ' .. WeY Poultry " Ca ace Po " Mahon Cattle a ace Po ulaho' n1
Swine 4 �_ gym,
Capacity Eopulahon p ty p "" "� `""" C p typ z
El to Finish ❑ Layer El Cow
❑Wean to Feeder ❑ Non -Layer ❑ DairyCalf
Feeder to Finish
] Farrow to Wean
_Dry Poultry
] Farrow to Feeder
] Farrow to Finish
El Layers
J Boars
ether
] Other
❑ Non -La ers
❑ 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?
J Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
}
;NumbeK , UE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
A. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,LJ 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
P'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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
[�f 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 or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2fNo ❑ 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
01 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
&No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Of No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P(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
VNo
❑ 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 P� 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[FacilityNumber: - Date of inspection: G/
24: Di(I the facility fail to calibrate waste application equipment as required by the permit ❑ Yes No
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 12`No ❑ NA ❑ NE
[:]Yes C;�No ❑ NA ❑ NE
Dyes .PNo
❑ Yes No
❑ Yes No
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ WE
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).
(cr
`O-a,& 300c).
Reviewer/Inspector Name: Phone:
l - 7� 7
Reviewer/Inspector Signature: ' Date:
Page 3 of 3 4 ll

Type of Visit s,Pf, Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: . f Q Arrival Time: C �% Departure Time: I� County: Regio>W�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 44/ Z�4 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = ° = 6
4-Swine
:.- ❑ Wean to Finish'
�" I ElFl Wean to FPerfiPr
z.
n Cur'rent
ity Population e . W.ei7Poultry
,z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
V
❑ Farrow to Finish
El Gilts
Boars
Non Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Current n g
w°Eopulation':'- .Cattle .
�❑ Dairy Cow
, ❑ Dairy Calf
❑ Daia Heifer
❑Dry Cow
LJ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
Numlaerdfl;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �INo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
<o
❑ Yes
JZ'No
❑ NA
❑ NE
❑ Yes
)No
❑ NA
❑ NE
12128104 Continued
r-,

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E!CNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[:1 Yes E] No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
i
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes JZ'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 _ZjNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes W(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
❑ NA ❑ NE
maintenance/improvement?
.16No
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes FerNo
[]NA ❑ NE
❑ Excessive Pending ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �TT10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
kRo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1:1' No
/
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of operating waste equipment?
❑ Yes
❑ Yes
]�T
❑ NA
❑
❑ NE
❑ NE
properly application
5�""o
NA
mComments (refer to question #}�Eaplain any YES;answe�s andlorgany�recammendat�ons„�„or�any other comments: ,�; '� � .
Use_drawings' of facility to better explain sttuattons (use,addittonal pages�as"necessary) " ` ,:,.
Reviewer/Inspector Name ,. ;, r'� ri«�`, Phone: t/CA`
Reviewer/Inspector Signature: Date: i' 2
12129104 Continued
o- - r

Facility -Number- — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L2 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �allo ❑ 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 j No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes „ allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ,D'No
❑ NA
❑ NE
Q6.Pid 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 Jallo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes RNo
❑ 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 ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes )allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
F1 Ye., I1 No , n NA
F1 NF
Additional Comments and/or Drawings:
A � %� DI d x 6T` see CUG e r C er f/-xl�r cP
oX
�/o t �6 _ 7.9-15-
---d-G - 3S/0
C7 d 1Ge
Cc�f
Page 3of3
12128104

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit'01ioutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time:
re Time: County: % Region:
Facility Contact: Title:
al ��
Onsite Representative: ,
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: I--] c Longitude: [� o [� 4
Design C■urrent
Design Current
M
Design
Current
Swine Capacity Population
—
CUPCapacity Population
CattleffC agmelt
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I
I
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Pullets Non-ts ers
❑
El Beef Feeder
El Beef Brood Cowl
El Boars
❑ Turkeys
Other
❑ Turkey Puuets
❑ Other I i
Number of Structures:
❑ Other
Dischary—es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the -conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ; No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
PTNo
❑ Yes
rvo
❑ NA
❑ NE
❑ Yes
Eli<o
❑ NA
❑ NE
12128104 Continued

acility Number: — Date of Inspection D"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes �rxo
❑ NA ❑ NE
Struc ure 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?
❑ YesNo
P
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes KNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
OdNo
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes Jam-'
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
1 t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes Or'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Qo�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &No
❑ NA
❑ NE
Coinments (refer to quesh6n #) Explam any YES'ansRers and/or any recom ndah�ons or any otheIrI 2'rife'nisiX=
Use drawings of facility to,16etter explain situations; (use addrttonaI page's as necessary).;
c
ail +!'4w.��` -!f _ .iXi"ftr
C/♦
`
7
Reviewer/Inspector Name z Phone: S+
Reviewer/inspector Signature: Date: C
I2/28/04 Continued

Facility Number: Date of Inspection
Required Records & Docume is
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YezdNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -,bNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative imrnediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes JnNo
❑ Yes �No
❑ Yes 1
❑ Yes P?�o
❑ Yes <o
❑ Yes [ 40
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ONo
❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
❑ Yes .� o
❑ NA ❑ NE
❑ Yes ❑<o
(
[INA ❑ NE
❑ Yes +10
❑ NA ❑ NE
❑ Yes _Q o
❑ NA ❑ NE
12128104

Facility Number ZDZZ21
,X"ivision of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit C>- ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J01houtine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: rj Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 'title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to,Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' 0 Longitude: = 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I I ❑ Non -La er
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
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 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: 3' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ❑ NA ❑ NE
Struc re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immedi a threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
XNo
ElNA
[INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes VI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, in, etc.)
❑ PAN [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA-
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(((( No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 00 No
❑ NA
❑ NE
-1-45'e ,r4,/­'�
• Ae1,'ew25A5--
/If
Reviewer/inspector Name ! ,-e Z Phone: -- (� 7�—
Reviewer/Inspector Signature: Date: y{�"
Page 2 of 3 121281041 Continued

• Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes :dNo ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
( No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWIv1P?
❑ Yes'
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ 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
PNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
6No
❑ 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
j3No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings-.," . a
.13 r -
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ! U P Departure Time: County: Lr, Region:/� [)
Farm Name: ///C / Gi!
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
f
Onsite Representative: 0
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Owner Email:
Phone:
Phone
No:
Integrator: /
Operator Certification Nu ber:
Back-up Certification Number:
Latitude: = e = i Longitude: = n = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
s 11 ❑ Non -La er
Dry Poultry
Pullets
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
ElDry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
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 ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
;YNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — s",� Date of Inspection
Waste Oollection & Treatment
4''Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes]
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes]
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�o []NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(,2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No ❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
.f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
,ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
j2vo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
El"No
❑ NA
❑ NE
isjt . ef6f to quesh6n #) En
r.
any YES,ai
Reviewer/Inspector Name F Pwez Phone:
Reviewer/Inspector Signature: Date: ! F D
12128104 Continued

Facility Number: Date of Inspection L�
Requiiat Records & Documents
Ig. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Nes ❑ No [I NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking � Crop Yield ❑ 120 Minute Inspections El Monthly and V Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
ZI NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
,E] NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
Rj NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes /❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 1] No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �?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 [7No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes Z No
❑ NA
❑ NE
Additional Comments and/or Drawings:
.�, l �I�a'IC �'c'L c�/z� GJl�•�r G�` G� r Gr� / I�IG�_S
lam' i- q 51 Y_. 611r eerie c,A_ 16)r a 00-5"[_
T UTG,rr'c,/
12128104

Facility Number l SH Date of visit: /a j s e Tune: 16 b
Q Not O erational O Below Threshold
El"Permitted Cer 'hied ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: M A-70 (L- gM E PA a k^ _ County:
Owner Name: _ ._ .----- -.. . Phone No: c11'9 (o S 57(a 9 — 6 S . _. jL�
Muling Address:
Facility Contact: Title: __- Phone No.
Onsite Representative: M oR �E j Integrator: M IWA V
Cerdfied Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 A& Longitude •
u
C t
Destgn ye
Cnn�ent
3 �,
" Cnrreat
Desagn
Swore Po tion F tr3' `._ . P6
Cattle =Po aan
Wean to Feeder ❑ Layer
airy
Feeder to Finish I ❑ Non -Layer
= Non -Dairy
Farrow to Wean
Farrow to Feeder~
- F K
Farrow to Finish /�--{,�j {■�—'¢� `/r�{�,�1,
'',�
IS
Boars
Total SSL�V
t� 15
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: --_! _. .... —_ .
Freeboard (inches):
12112103
❑ Yes M/Mo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M o
❑ Yes
❑ Yes No
Structure 6
Continued

Facility Number: $ — 5 Date of Inspections o
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ 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 ❑ Yes E No1
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
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;/0-
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type , ` E ft.W+t1 lq L W S & 6
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?
I6. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
o_Src O&W foa_. 5 Pz_�rN r'1CL.j PErLr�rrr,
❑ Yes
❑ Yes to,�No
❑ Yes
El Yes
Yes ❑ N
❑ Yes No
❑ Yes L7 No
❑ Yes ��o
❑ Yes 640
❑ Yes B tv o
Feld CoDv LCl Final Notes
Reviewer/Inspector Name d 14 PMkA
Reviewer/Inspector Signature: Date:
12f]2/U3 Continued

Facility Number: _ Date of Inspection I W i2 tP /dy I
Required 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?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes L No
❑ Yes [ No
❑ Yes W
❑ Yes � lvo
❑ Yes id�vo
❑ Yes
❑ Yes No
❑ Yes <No
❑ Yes �No
❑ Yes O No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation ,c
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification jU Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O erational 0 Below Threshold
Permitted U Certified D Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: County:
County:
Owner Name: �/ I%>'�S� �P -� Phone No:
Mailing Address:
Facility Contact: Title:
OnsiteRepresentative: _2✓"
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 1 " Longitude ' 4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
10 Wean to Feeder 1 10 Layer I ❑ Dai
FFeeder to Finish / ❑ Non -La er r Non-Dai
E3 Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Msigri Capacity
❑ Gilts
❑ Boars Total SSLW
i
umber�of Lagoons ❑ Subsurface Drains PresentJJEI Lagoon Area ❑ Spray Field Area
Holding�Pond's I SOhd "Traps ❑ No Liquid Waste Management System t w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A 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? zrYes ❑ 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 stone storage) less than adequate? ❑ Spillway ❑ Yes RjNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): 2 $
05103101 Continued

fi�. _. _
Facility Number: —S Date of Inspection /� O
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
El 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
Required Records & Documents
IT 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? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21 _ Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
[--]No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ctifnmets {refer to queshin #) Eapla,n anv"YES answers and/or any recommendations'.or�any-other;comments,
tUse<drawrngs of facility to better egplaiii situations.(nse;addihonal pages -as necessary): - a
❑ Field Copy ❑ Final Notes _
t _
�T�S: .�nISPEc�4dn1 CD�I.O�lCYF_p �C'i�c�Sf' QG c.Ii✓�J�`' � ROsY1
��s�,� AP®��e�� za.� ��d pes,��e✓F� �r�rl. ,/J� �F -yav�e
l
Reviewer/Inspector Name s%
Reviewer/Inspector Signature: Date:
O5103101 Continued

A— ""
Facility Number: 57 --W Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fait to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan btade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings: a
/ e A el 1'64IV// 4PPZ- 5CA47,z221L.1 �r�, 14A!!�9 e
O5103101

Date of Visit: '�-= V /[�� Time: 02
Facility Number 1 T
�/ 10 Not O era 'onal Below Threshold
�1 Permitted 0(certifed 0 Conditionally Certified ❑ iZegistered Date Last Operated or Above Threshold:
y� �
Farm Name: _ //!� t/ .�✓r •/li/hl County: t*'+
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: e2Q 6P­—
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: x/�/�'�� rl
Operator Certification Number:
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0" Longitude 0' 0
ischarges & Stream Impacts
1. Is any discharge observed from any pats of the operation?
❑ Yes [9-Mo
Discharge originated at: ❑ Lagoon ❑ Sorav 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 E}'Ko-
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0-w
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [g-Ntf
Structure I Structure Z Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d
Freeboard (inches):
r��
05103101 Continued

F
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?
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 Annlication
❑ Yes M-Mb
❑ Yes 0-N6-
❑ Yes 0-ND
❑ Yes U'NO
❑ Yes ®'No
10. Are there any buffers that need maintenance/improvement? ❑ Yes M-Ko
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload II ❑ Yes 05q6
12. Crop type , jL44 k Cl>S CG he
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? ❑ Yes Oho
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
[;R�
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑-Nb
RkSuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ERNu-
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
[3No
19.
Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
R;-tdo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
99-No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
BNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
S-No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
cEhq-0
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ lq
No violations or deficiencies were'noted during this visit. You will receive no further correspondence about this visit.
Gu€i%iseit� (ireferstb ques#i©ii #) Ex}tlaia ai►y YES abi*ersxand/or any recommenda oas or aov other atimcnents..
Lse drawings of facility to better explain sitimttons: (ase addttioum pages as necesssrvj 4
- LL❑ Field Cony ❑Final Notes
l�0s �� keh Set 5 kmO �e u 7� ��s efi
Y�Gp Ul'l e- Y-t;u�-
yet
F4/*L zoo,�s
�{ D
Reviewer/Inspector Name
k
Reviewer/Inspector Signature:
Date: )% C 072-
05103101 !/ U
Continued

Facility Number: 31 — Date of inspcetion 1 ZG
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [a.'16
28. Is there any evidence of wind drift during land application? (i.e. residue on'neighboring vegetation, asphalt, ❑ Yes
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 L-14G
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 22-1?6
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes
Addit":ohal Comments acid/or;Drawingsi:.:.
05103101

Drv�ston of Water Quahty
f
_ 'T
0. !vision of Soil and Water Ctiasei=vation
-
r
r
Type of Visit ,Otompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit eRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
,I II'I.I.I'I I Date of Visit: Di Time: !rJ/ d Printed on: 7/21/2000 Facility Number � j
3 �,..,. A Not O erational 0 Below Threshold
0 Permitted ❑ Certified ❑ Conditionally Certified t] Registered Date Last Operated or JAbove Threshold : ....................
► r �ji
Farm Name Y. .................._............-..................................... ......................4% 'o r...�V ��......... �.....M....................................... Count U 'n
�a r
OwnerName ........ L........................................................... Phone No................................................._......................................
FacilityContact: ..... ..................... Title:................................................................ Phone No:...................................................
Mailing Address: ............................ ......
Onsite Representative:..-.' '!�i J Ve.t ]........................ Integrator:..:,.,.! u �..
tT. . f......................................................
Certified Operator:........ ................................ ................... Operator Certification Number:................. .
Location of Farm:
,01b rt►lne ❑ Poultry ❑ Cattle ❑ Horse Latitude ram' ' " Longitude 0 4 44
Design Current
Design Current Design Current
Sti ne Ca Po riatio
Poultry
Catte Ca - . Po ulatidni
c
Wean to Feeder
❑ Layer
❑ Dairy
-- r to Finish r ]
❑ Non -Layer
❑Non -Dairy
w: Farrow to Wean
Farrow to Feeder
❑ Other
'r Farrow to Finish
Total Design Capacity.
Gilts
Boars
Total SSLW
,.
< ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes �0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes,,ffNo
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 gallrnin`? yi
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes JuNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes '0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'Ej No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 21No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .................... ........... ..... ... ................................ ............ ............... ......... .................................... ....................................
Freeboard (inches):
5100 Continued on back

Facility dumber_ _? j -5 j (fate of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1p!rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes _9T No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type seem..✓ d. oq Ha v W l n �ee Ayr ► v q )
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?
(iel 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/lnspector 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?
0: ib ati fis br• del�ciencies mere noted• during this:visit; Yoi� will i-eeeiye Rio further : :
correspondence: ahatit this visit :::::..: ::::::::..:.:::: :
Itty tt%�lbetter ezpla�n szntaat
❑ Yes No
❑ Yes ❑1q0
❑ Yes'WNo
❑ Yes-ONo
❑ Yes )2�`No
❑ Yes -No
❑ Yes ONo
❑ Yes"'KNo
❑ Yes ,ffNo
❑ Yes XNo
❑ Yes j3'No
❑ Yes ❑'No
❑ Yes 'gNo
❑ Yes ONo
❑ Yes_.,ONo
❑ Yes ONo
❑ Yes z No
❑ Yes ff No
❑ Yes jEfNo
❑ Yes jd No
-7—t,2 Fc�c��,"c� pecoords are A;Lzo wel)kefl. spfa+• y f;dd ;.F
Wei)
AL
Reviewer/Inspector Name �>/ )... F
a �, r
Reviewer/Inspector Signature: - -
Date:
5100

Facility Number: —�j Date of luspection 5 d Printed on: 7/21/2000
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ayes ❑ 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__,E]'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _Q-N'o
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes _,Z'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes-,EfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )D*No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes—Jallo
AdditionW Comments:and/or D
rawtngs:_ -
i
J
5100

ivision of Water
Quality
- . Q Division of Soil and: Water Conservation W.
Q Other Agency -
"
Type of Visit 9��o pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit flRouline O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: ime: Printed on: 7/21 /2000
Facility Number "L
79LL:Operational O Below Threshold
❑ Permitted Certified Conditionally Certified ❑Registered Date Last Operate Above Threshold: --•----••••
r w
Farm Name: 11 ✓ �. K�1....................... County �1...-
....... ......17V. �� ......
OwnerName:... ............. ...................................................................................................... Phone No:.......................................................................................
5 �
Facility Contact: .....ti/. Title:...... f/ y�................................... ... Phone No:...................................................
MailingAddress: ........................................................
...................... ................................... .................. ................................................................... ..........
Onsite Representative:.. ..........:................. ........-..................-...... Integrator: ........
i Operator: Operator Certification Number: Cert fied Op ................................................... .
Location of Farm: =
COWlne ❑ Poultry ❑ Cattle ❑ Morse Latitude • 4 « Longitude • ��69
Saiwlfae urrent Dsi CurrentaClio
(inPoultry Cattle
PoC
orietniotnCr Po eatiCaciPo ulation C rFarrow
Feeder ❑ Layer F[3 Dairy Finish ffo O ❑ Non -Layer Nan -Dairy
o Wean
_ =
o Feeder ❑ Other
o Finish
Total Design Capacity:'
Gilts
Boars Total SSLw
Number N Lagoon . 10 Subsurface Drains Present ❑ L -Pn Area 10 Spray Field Area
Hold><ag Ponds I Solid Turps ❑ 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'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: .......30 ...t.f..................................................................................................................
Freeboard (inches):
S/00
Structure 5
❑ Yes )dNo
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
ONO
❑ Yes
&CNo
❑ Yes 9No
Structure 6
Continued on back

po
Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse ed? 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
O(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11. Is there evidence of over ap hcation? ❑ Excessive Ponding PAN ❑ Hydraulic Overload
❑ Yes
0(,No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Ej�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
4No
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
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
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
,Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑1Yes
Rio
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
&�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes [To
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P�No
24. Does facility require a follow-up visit by same agency? ❑ Yes U41No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes L'�(No
Rio viola>�io ....... n... mere . btet�• during �. s.visit; You wiil receive iio lfutth&
coi resporideicce: abauti this visit:. ' '
Comments (re#er io, queition #} -' Explain any: YES answers and/or any. i ec©emendations Qr any other comments': = w
Use of facility to'betterexplain situations {use additeonal pages as sec
rY)
Alse?l
ReviewerfInspector Name / Q
_,.
ReviewerlInspector Signature !Y1/J� ,t _ Date:

Facility umber: 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 J« "' ❑ 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 Abw
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes 19"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
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 Xxo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNO
3/23/99

Facility Number 3 j $s Date of Inspection 9
Time of Inspection 24 hr. (hh:mm)
© Permitted ® Certified 0 Conditionally Certified 13 Registered 10 Not Operational I Date Last Operated:
1
Farm Name: 1 / Ve- filp
rvt
........ ......�^.�. .r.--... ---V4.... ....J` �� r.Yl -• ...................................County: ... .... U ... l ri Jew
Owner Name:........-�%„j.-..... Phone No :................ k3
................................................................................. ot .................. ...
Facility Contact: ......... ............. .......... I ........................ .................... Title: Phone No:
Mailing Address:
Onsite Representative...... ot.. � Y U Integrator:.....
. ........................G........................................ U'��
Certified Operator . Operator Certification Num er:
Location of Farm:
y
....................................................................................................................................................................
Latitude 0 6 i Longitude • ' 44
.~ Number, of Lagoons Subsurface Drains Present 110 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?
h. 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)
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? []Yes JK No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? . ❑ Yes I? No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $j No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
!/
Freeboard (inches):
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes 19 No
seepage, etc.)
3123/99 Continued on back

Facility Number: 3J hate of Inspection 28
>r
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ;9 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? X Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 13 No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes El No
11. Is there evidence of over application? []Excessive Ponding JgPAN 19Yes ❑ No
12. Crop type 1 S�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R 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
19No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EffNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
8 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
E9 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
21 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
vWafi6hs ;oi - clef ciehdiEi s •mere noted• dinning :his:visit; • Yoit :W ill -receive do: further : :
. • . • �corres• 6MeRce: about: this visit.:::::::::::::: :::::::::::::::::.:: :
Comnmb_ & (refer to question #):-Explain auyYES answefs and/or any_recommendations or_any_`other comments: -
Use drawings of facility.to.better explain situations (use.addititinal pages as necessary) _
- _ -_
(. %�o[,� �algOOh t.Jgi� t� e1G i a ftIL'O
m''irfeY' Wa�l� 7'O� DG4;de �oo� GmeQd �Qd�
/I. P'Gf/rvierjJ ` o r'1 f Ae h� A, B �ieh 4Yl Lt%heAf bit4 n
g4►11 eev%4< 5dlb. Dver�q lied "1Z lbs.Q1n.4, Z gcr'c �IJ �a
� r7 lbs. or1 4.1-5ae re- v - full
rr+%L.,4A -4,e� ld .t2r� , t m�✓'C�i 'q8 and ,S bi') well ��
Aeed s weed Motv"j ,, rvt_e;7• �J
19. (,'�rr'enf Soil Scr�,�aJG ,s needed in'Ves. _
Reviewer/Inspector Name _ "` _ -= ' �
u ,
Reviewer/Inspector Signature. Okwwf_O a_1z1 Date: 7 20 `7q
3/23/99

Facility Number:3 f - 5 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 Ig 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 19 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ]A 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 j 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
itiona . omments an or_ rawin
f
3/23199

Division of Soil and Water Conservation ❑ Other Agency
M Division of Water Quality
Routine O-Com taint O Follow-u g of DW ins eetion O Fotlow-u of DSWC review O Other
Date of Inspection U_ Lion
Facility Number 3 5 Time of Inspection o: 24 hr. (hh:mm)
Registered Certified © Applied for Permit ❑ Permitted [3 not Operational Date Last Operated:
FarmName: .......... ...... ..--1 U.P9................................................................ Constty:.... i t�i..............................................................
OwnerName:.. .............................. 1QV.... ....... ....................................................... Phone No:....�`i.1.`1.�.�c�� c �. Sr i#...........................................
FacilityContact:...................................:...................................I...... Title :................................................................ Phone No: ...................................................
MailingAddress: ........... i.M....... 6xi....:................... 1......................... I...................... .....l�L" :... .��Y .t.. r...................................... .. ......
Onsite Representative:.......... A,\.Il !r....................I {. ........ Integrator:........ or ........................................................
J
Certified Operator,........................................................................ Operator Certification Number ..........................................
Location of Farm:
..........!�....4........Si..Q..:.rs........5 ...�%..t.:�a..M'..}....�f ........................�.�?C1.
...... ........ ............................... ........... ................................................... .... .. .
Latitude •,' °� Longitude
Des.
tgn Cur"rent Wr `Design Current Destgn hCurrent
Capacity Population ' -Poultry � Capacity Population Cattle _ Capacety; ;Population
❑ Wean to Feeder
Feeder to Finish
Za
❑ Farrow. to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
. Number of I:aaoans`/ Holding Ponds g p
:� _ ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
5 " ❑ No Liquid Waste Management System
General
L 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 ;al/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?'
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes [P No
❑ Yes No
❑ Yes No
❑ Yes [� No
❑ Yes '� No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: 31 -
�: -
8. Are there lagoons or storage ponds on site which need to be properly closed? El Yes Y,No
Structures (La.00ns,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes (\°o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ........... Z:............... .............................. I..... ........
........................... .................................... .................................... ........ I...........................
10. Is seepage observed from any of the structures? ❑ Yes ONO
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement? V Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
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 .................!?w.......... Y!'� �..FA.................0 CN h.... W ...... SA/.._................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW;MP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0, No.violations or deficiencies. werenote'd-during this. visit. Youmill receive no ftirther
_�:�cvrrespondenrea>ioutthis:visit:•"�.: :.:•�-.•:�� : ,;:."�_•"•.-��:�:: :•_••:•� :�. ,•�- -
❑ Yes � No
❑ Yes 0 No
WlYes ❑ No
❑ Yes [VNo
Yes [] No
❑ Yes KNo
[A'Yes ❑ No
❑ Yes No
,Yes ❑ No
Cl Yes No
❑ Yes No
❑ Yes KNo
Usedrawttsgs of facthty to' be#ter explain situations (use additional pages as;necessarv)
...a..W
14. G1tA3 Sha�l�r� C `tOlity. �Ytner �i�Lrl W0.�� 5�neuU Qklr(' ;
IG . �..� 1v� �'-(t�� 3 , GJU C0. ��5 YUr a�rr�'�,�c.`/-soy �j v� �•. - / �a f7r� r� c"`,
I Car'b-aue e. f f�jr i6 i L(oVt L { y (
Z2_, C�vtt� {toy1 � ra-- st �4d laL [ W` V'ecca-JS . sr+�..�f taln z)�
w,Vjk,� sG,�c} v� wv0 fit- R�
� � �y f � 1-h
� 7 oA►r1,( 6r. C-Y&
i 6 an5m1 L 2_ q DS 7125197
Reviewer/Inspector Name(1 v�
Reviewer/Inspector Signature. / ��, Date:

Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Date of Inspection
E:
Facility Number
Time of Inspection - p 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
❑ Certified ❑ Permitted Ior Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .. ------
Farm Name:.._ .� _'r .^ ti v. .!r ....._._.... _....__......_....... County:_ .x.t i.i .._.!_ ....._._.... 11�t i..
Land Owner Name: 4 .........La.91 .._ Phone Na: �9 �.... _.�� .... y +
Facility Contact:Title: Phone No:
MailingAddress: _ .. _ ..%.�...----1.4- ---- --- ----- _.... .... ..._ _........�'�: Q..� �r �„ � �. �.r .. _ .......:. �.�.� �..
Onsite Representative: a. .j-4.. Integrator: ,k
Certified Operator:...._. ......... ,� :........ .... Operator Certification Nu er:
Location of Farm: t
PIK. K.1 3.1?J6....__s!fYJPl4rlet_..a. .....i. rs . rS.li:.s... �.ys.....,a►�.i.._ _..} _0. 0.... ,�.... _ .... . 4
Latitude•©` ®K Loncitude �• �4 64
a
Type of Operation and Design Capacity
u�DestgnGWrredtDestgn� ;G�rrent Destg Cu rent
Swine A "
..:.Ca aej sPv ulatiion .. P°u�tryPa"alat�on, i :Cattle .,'' Ca ace Porila#ton
Wean to Feeder I❑ Layer ❑ Da'
® Feeder to Finish tit ❑Non -Layer 10 Nan -Da
Farrow to Wean a�
X. 171 Farrow to Feeder Total Design Capacity 20 q Y
Farrow to Finish
" r
❑ other �`TolaISSLW� si 20
. !P
..:
`Numb' r of L�o n 1 Holdin Pond ❑La o` __ _
�. '- ,�
ag g urface Drains Present
,,, g on Area ❑Spray Field Area � �;
General
1. Are there any buffers that need maintenance/improvement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 8 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ YesNo
c. If discharge is observed, what is the estimated flow in gal/min? ,,))A -
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
4/30/97 Continued an back

Facility Number:........ —.5.5
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
$9 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (j,aeoo,ns and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) Iess than adequate?
❑ Yes
® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.... 24...z5L . ....... _.....__ .� ......_. _ ......._.....�_.-.......- ...._W....
_......_.�..._.....
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
.99 No
Waste ADDlication
14.
Is there physical evidence of over application?
❑ Yes
14No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type t.I a -� -- $ t -- ..... -_.... .....J , .- .... _ .... — .-
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
19 No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JgNo
For
Certifiedlacilities On1X
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®,No
24.
Does record keeping need improvement?
19 Yes
❑ No
Comments„{refer to question #) Ezplam any YES,inswers andlor any,re commendattons`or any other continents
�.,.
Use drawings of facilrty to Better expiain situations. (use additional pages as necessary) , ;}�
a t L w a o a A.-3 a, -`�.,I ; W.-V V w►_
IB ,, R_ tY f 5 O' [_ p o �'�► rV — C� v. �, j OL ,Qn�� G P'�yr`' 1 �l Witt[
6c L v i 't� 5`^t tLtt_2 .) V /
� lb�
17. 0tr�- oh deq�fa���f -CAS,.- .a" woJ !i. C0 C� S{-a.✓►n
Q ,r k-o e_ a t a d n tv p v-e-, t^A.
y (r rat s fs d-4,r.a . KAa X-e 5 v i­e t q V1,V
0, aL 0 „1 1r CA e, wt.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 1
cc: Division of Water Quality, Water Quality Section. Facilitv Assessment nit 4/30/97

•
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 , 1995
Time:
Farm Name/Owner: _ _f, 0'-t����
Mailing Address:
County: " --
Integrator: L4 gjLq Phone: Z�e g I I el
On Site Representative: Phone:
Physical Address/Location: _1 f , SK !PAJM�� ! w►; [ t c~ir2vy►� tidy
Type of Operation: Swine Poultry Cattle
Design Capacity: _go 0 - -P1RP: 5 Number of Animals on Site: 1 C o o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:. off' o'er" Longitude: -7 -7_° S1, ' �` Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have i
ecient freeboard of 1 Foot t 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) r No Actual Freeboard: a Ft. C� Inches
Was any seepage observed from the lagoons)?. Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yr No 'Is the cover crop adequate? Yes or No
Crop(s) being utilized: �, 0
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? 41A or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi0o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: --_ j� e ,— _ jLWt,11- %,z0-c n-✓f p�Cra`� �t �.`P -
AV
G
Tiov, C64�1pz_�
Inspector Name Signt re
cc: Facility Assessment Unit
Use Attachments if Needed.

E
•
Site Requires Immediate Attention:
Facility No. 3/-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2� ^ '! _, 1995
Time:
Farm Name/Owner: or _7✓
Mailing Address
County: _ IJupl r/J
Integrator. z IV U Sign Phone:
On Site Representative: _ IUv oar e on Sr i2 Phone:
Physical Address/Location: q'03 From �A'fle, IeRon
75UYnm2.4'_f« X -rn 5. rt'Gh-F 9j J M; '-_0
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity:
Number of Animals on Site:
left. t07 ?'Y-ked)
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: " ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Deor No Actual Freeboard. 2 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Z
Crop(s) being utilized: 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Liner Yes oZ
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No 2
Additional Comments: _ _kY) 'onQ on ­,Ae .
L o_w 5
. Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

.OPERATIONS BRANCH - WQ Fax:[phone] Aug 1 '95 9:59 P.16/17
Site Requires,Irnmediate Amefttion
Facility Number:
�. SI'I"E visrT'Anw RECORD
�y ... " DATE: L
. , 1995
Owner, r ' s. Farm Name:
Cottrlty: i ► �+
Ageat Y"zsiting Site: Phone:
Operator. Phone:
On Site Representative: Phone:
Physieal Address: b L d ~z' t I D �' �,e- I tvy[`a �c�"t
r
Mailing Address:
Type of Operation: Swine Poultry ;^ Cattle
Design Capacity: Number of Ardm4s on Site:
Latitude: Longitude:
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot +25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes Cam.:.% Actual Freeboard: Feet Inches
For facilities with more than Qua lagoon, please address the other Iagoons' freeboard under the
comments section,
Was any seepage observed from the lagoon(s)? Yes or 1OWas there erosion of the dare?: Yes or No
Is adequate land available for land application? Yes or No Is the cove; crop adegua.te? Yes or No
Additional Comments: _ _ H Uf � ma _ S'J
Fax to [phone] Signature of A eat