310560_INSPECTIONS_20171231

Z Vn
NUH I H UAHULINA
Department of Environmental Qual

Reason for Visit: is Routine
Date of Visit: (� l
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Operation Review p Structure Evaluation Q Technical Assistance
O Follow-up O Referral O Emergency O Other O Denied Access
Arrival Time: O Departure Time: a>7 County: Region:
Facility Contact: Title:
�d,rl�`
Onsite Representative: y c 90 el
Certified Operator:
Owner Email:
Phone:
Back-up Operator:
i
Location of Farm:
Latitude:
Phone:
Integrator: r /l
Certification Number: f -7/ a 6
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current Design Current
Pap. Wet Poultry Capacity Pop.
Layer
I iNon-Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Dairy Calf
Dairy Heifer
Fee r to Finish
rrow to Wean
Farrow to Feeder
Farrow to Finish
19po
Design Current
lti, C•_a aci P.o .
Lavers
PrNon-Layers
Dry Cow
Non -Da'
Beef Stocker
Gilts
eder
Boars
"IBteef
ood Cow
Other
Other
Turkeys
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
FN
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: - G jDate of Inspection: 2
WasLi Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
315&
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D NA ❑ NE
7. Do any of the structures need maintenance or improvement?
❑Yes
No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
]�N'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
�o
❑ NA
❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑PAN > 10% or LO lbs. ❑Total Phosphorus ❑Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Approved Area
12. Crop Type(s):
13. Soil Types):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[] No
❑ NA
❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
[�io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
hlo
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑Yes
ETNo
❑ NA
[] NE
Re uired Records &Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
[�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
�o
❑ NA
❑ NE
the appropriate box.
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: 2
24. DJd the facility fail to calibrate waste application equipment as required by the permit,
❑ Yes
En No ❑ NA
❑ NE
'�r25. 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 provide documentation of an actively certified operator in charge?
❑ Yes
0 No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No a'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
El'go -
❑ NA
❑ NE
[]Yes
No
❑ NA
❑ NE
❑ Yes
Ld l o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes [3No , ❑ NA ❑ NE
❑ Yes Zo❑ NA ❑ NE
Comments (refer:to question #): Explain any YES answers and/or any additional recommendations or ait other comments .:
Use:drawings of facility 0,better explain sifuattons (use`additional pages as.necessary) . - �r
µ
Reviewer/Inspector Name: c-, Phone: Q Q 7
Reviewer/Inspector Signature: ���1 / Date: Z r�
Page 3 of 3 21412015

6._n
Type of Visit: C�'Co ance Inspection O Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 3 f Arrival Time: Departure Time: County: i �` Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: oa'�i`
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: j 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design
C+apacity
Current
Pop.
Wet Poultry
La er
I
Design
Capacity
Current
Pop.
Design Current
C►attle Capacity Pop.
Dairy Cow
Dairy Calf
WpAh to Feeder
I INon-Layer
eder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Znn
tl--5'L
Dtt P,oultr,
Design
Ca acit
Current
P■o ,
Dry Cow
Non -Dairy
Farrow to Finish I
I Layers
Beef Stocker
Gifts
I
INon-Layers
Beef Feeder
Boars
I
IPullets.
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
kN
❑ NA
❑NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facili Number: - �.%� Date of Ins ectton: 3 4
11341
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): 3 3 -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
l�o
❑ 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
th at, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
YKo'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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
PTI10
❑ 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
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
FTo
❑ NA
❑ NE
Required Records & Documents
T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CO ❑ NA ❑ NE
the appropriate box. iiii
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 10 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faiiii Number: 377 jDate of inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes VJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E]INA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA i�E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (`�rN
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes � rNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes,:� ❑ NA ❑ NE
Reviewer/Inspector Signature:��--�T' Date: 3 ~? / r 6
Page 3 of 3 2/4M 5

r
(Type of Visit: &Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: v Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: [1043—D-1 Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0.1 q n j cc, Q pe r' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop. Wet Poultry
I ILayer
Design Current
Capacity Pop. Cattle
Dairy Cow
F:-]
Design Current
Capacity Pop.
Wean to Feeder
I lNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1100 ! Z ! D P,oul
Layers
Design Current
C•_a_ aci_ P.o
D Cow
Non-Dair
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
::A
Discharnes 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 EJ/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No [:],TA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

F.
Faciliq Number: 51 - 5r..J Date of Inspection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L 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
[frNo
❑ 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
[y 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
[+ErNo
❑ 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
2No
❑ NA
❑ NE
maintenance or Improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes 2No ❑ 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 j o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eq No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [fNo ❑ 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?
Reauired Records & Documents
❑ Yes dNo ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes E-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3"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 LJZo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes l �d ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili 'lumber: -5 X57 jDate of Inspection: 7
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 Z[:] 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 [TNo D NA rNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No NA
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?
Reviewer/Inspector Signature:
Yes [�(No
Yes dNo
Yes No
Yes M/No
Yes
Yes N'
Yes LJ No
NA ❑ NE
NA NE
[—]NA [:]NE
DNA DNE
NA D NE
DNA NE
F-1NA NE
Date: 'J /
21412014
Page 3 of 3

Type of Visit: j2rCompliance 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: � Arrival Timer Departure Time: 11= County: Region:
Farm Name: c)x,l rsyyh Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: � Integrator: FAIL
y
Certified Operator:jrCertification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges
Design
Swine Capacity
Finish
Current
Pop.
Design C•.urrent
Wet Poultry Capacity Pop.
er
Design Current
Cattle Capacity Pop.
DairyCaw
Feeder
n-Laer
DairyCalf
o Finish
DairyHeifer
o Weanreo Feeder o Finish
U
Laers
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
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?
D Cow
Non -Dairy
Beef Stocker
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
[:]No
❑ Yes JfjNo
❑ Yes RfNo
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/201I Continued
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
[:]No
❑ Yes JfjNo
❑ Yes RfNo
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/201I Continued

Facili Number: - Date of Ins ection: 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
O'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
�XNo
❑ 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? to
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 EI-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9T No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Pa`No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 7r
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 ,E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [;jrNo [] NA ❑ NE
acres determination? jam'
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
VfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VrNo
❑ 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.
77��
❑WUP ❑Checklists ❑Desigri [:]Maps ❑Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
;no
❑ NA ❑ NE
❑ Waste Application _ ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
71 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

acili'lumber: - Date of Inspection: ..
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
91 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
ZrVo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
7TNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZrNo
❑ 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
&o
❑ 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
FfNo
❑ 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
Vj 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
Vf No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/Inspector Name: — ly�_N.0 , _ _ Phone: q5�-3j/•��
� a,. `
Reviewer/Inspector Signature:9'iDate:
E
Page 3 of 3 2/4/20II

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 County: Q I
Farm Name: _ �rj 1 j Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: �ii�a� . CisO
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: W
Integrator: 2�)
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle C*apacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dr, P,oult ,
Design
Ca aci_
C*urrent
P,o ,
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Ppullets
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Wither
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 2] No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes L�:FNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes F;�'&o ❑ NA ❑ NE
of the State other than from a discharge? TT
Page I of 3 21412011 Continued

a
Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WfNo
❑ 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: S�
Spillway?:
cc
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZrNo
❑ 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
ONo
❑ 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
2fNo
❑ 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
PMo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
iffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
eNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;�JNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VTNo ❑ 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?
Reauired Records & Documents
❑ Yes XNo ❑ NA ❑ NE
❑ Yes PTNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
WNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J2►No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
4 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
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
. ` No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: t' j - _ (Date of Inspection: n p/ m
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 60 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes XNo ❑ 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 ;jNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 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 VrNo ❑ NA ❑ NE
❑ Yes Vj No ❑ NA ❑ NE
❑ Yes. A No ❑ NA ❑ NE
❑ Yes 1K No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
Z No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Vr No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
R1 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 panes as necessary).
Reviewer/Inspector Name: V7O;Rs
Reviewer/Inspector Signature:
Page 3 of 3
Phone:"�jj�+'a
Date:
21412011

, (Division of Wat°" r Quality
Facility Number ©- ® OO Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J7 Arrival Time: Departure Time:rCounty: Region:
Farm Name: D] l (_ C�AGt- rn S 11 G. Owner Email:
(0 SE — lip Lw
Owner Name: �a 1 L �} =w S �>Il Phone: - a'a a - S 1 C
Mailing Address: I L4 0 `7 Sc tMmezu w S 6b3$5-axAvS V-4 ft?QLJ'V it C�_1oEA/C CM(oS
Physical Address:
Facility Contact:
Title:
Onsite Representative: �l�N � Cc<3 c-=�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
j %_+1 0
Swine
ean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry C►apacity Pop.
La er
Design Current
C►attle Capacit-VIEP.
airy Cow
ean to Feeder
Non -La er
airy Calf
to Finish
Dai Heifer
!Feeder
rrow to Wean
rrow to Feeder
rrow to Finish
QO
Design Current
D , Ploult , C•a aciP,o ,
La ers
D Cow
Non -Dairy
Beef Stocker
lts
Non -La ers
Beef Feeder
ars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
her
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 ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes tNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fgcili Number: - (¢� Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 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: SOS
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes VkNo
❑NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 O'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?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Q \ �` O
13. Soil Type(s): AA 10. �101 C,UF
14. Do the receiving crops differTrom those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes lkNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes tNo ❑ NA ❑ NE
❑ Yes t
o
❑ Yeso
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
QWUP ❑Checklists 0Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes)0 No ❑ NA ❑ NE
Q Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
[-1 Rainfall ❑ Stocking ❑/op Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

F%tili mber: - &C� Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ 'Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes tNo
❑ Yes �NO
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
Mom
❑ NA ❑ NE
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA NE
❑ NA ❑ NE
❑ 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).
C o u C3 h-7) I cam! C)l
ally
Q
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: q JO�'7&-_3 > 9 4
Date:17/19
2/4/ 011

Dtvtsion of Water Quality. �A - �'
Fac�l�ty Number 7D 1 �(AlJ Q Other ng f:Sy�l and Water Conservation m .
Divisi ,
.m .0
W
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit KRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /1 �-Arrival Time: ys Departure Time: County: 1 N Region:
Farm Name: �AJ ti �S . IAC Owner Email:
Owner Name: A, �I(_ �0Ar S SIC- Phone: qFi-(os$-�ooto w
, �
Mailing Address: "7 _ �t.�nllylE�Cr�YS (fics—sgo yC_
Physical Address:
Facility Contact: Title:
Onsite Representative: T
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current°
Swine CapaeFty Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Boars
ier
Other �-
1LJ Non -
Phone No:
Integrator:
Operator C, ratification Number:
Back-up Certification Number:
Latitude: = c= d 0 Longitude: = o= g
Design Current
apac, Poputation—
gar-�' .:n-s •q'..
❑ La ers
ElNon-Layers
El Pullets
❑ Turkeys
El Turkey Pouets
El Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
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 �o ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes '%LNo
❑ NA
❑ NE
El Yes t
[]NA
[3 NE
Page I of 3 12128104 Continued

l
Facinty Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rkNo [I NA El NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: +! AQO0,-,1
Spillway?:
Designed Freeboard (in): .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �l No El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.) {
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No [3 NA El 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste. Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes *,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) P
13. Soil type(s) HLA {Z Lk t l l CC G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes K] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer :to question #): Explain any YES answer and/or any.recom endations or any other comments
Use ,drawin s of facility, to better explain situations (useadditional pages as necessary):.,
,
g h' p g
Reviewer/Inspector Name y}NOA C A IN r-�- S Phone: (o - ]d-*
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104

f
Facility Number: — (a(j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. Q WUP ❑ Checklists
0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Yaste Transfers ❑ Ar/ual Certification
0 Rainfall ❑ Stocking ❑ Yop Yield 0 120 Minute Inspections ❑ Monthly and 1" 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 immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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
14 No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
) No
❑ NA
❑ NE
❑ Yes
❑ No
Pf.Z!A
❑ NE
❑ Yes I
❑ Yes No
❑ Yes 14'No
❑ Yes�INO
El Yes k,
❑ Yes $].Dlo
❑ NA ❑ NE
El NA ❑NE
El NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Additional Comments and/or Drawings: -
CALI gV-A71cW SO E_ 9C) 1 a2.
Ro WtNT �� Q
Page 3 of 3 12/28104

Division of Water Quality
Lail><ty Number 3 J WS (oQ 0'; nDrvis�ou of Soil and Water Gonservahon '>�
:Other Agency�
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: U %✓ Region:
Farm Name: D A I �A2 m 5 1 N e- Owner Email:
r I (w1
Owner Name: 919-(osS-IooLo
Cc-') 4t9 --99- -5a$1
Mailing Address:
lLISLI So_ArnmC-2trlN s C(ZG21sGroA0Z)s ii_'d ww",► o �Nc. CQE365
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 'AJYN' CoaD fZ
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
96 /Q
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o F--T ❑ Longitude: = o = ' 0
'.'Design -,Current=
Swine Capacity Population Vet Poultry `I
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
000
&I
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
„Other .
❑ Other
.ILJ Non -Layer I
_ .: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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood t
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: �j� —s� Date of Inspection IQ O
Waste Collection & Treatment
,�,�(
is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ' JfNo
El✓
❑ NA NE
El
a. If yes, is waste level into the structural freeboard?
[IYes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L r'64N _
Spillway?:
Designed Freeboard (in): P • 5
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 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
ElNA ElNE
(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
0
ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes Azo
❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El 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) S
13. Soil type(s) f —j l't.T ay1 U
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 o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes:No ❑ NA ❑ NE
Comments (refer'to question #):-Explain�any YES�'answers and/or anyrecominendaYins or any other eomments _
Use drawings of facility to better explain situations._ {use additional pages as.necessai-y.
Reviewer/Inspector Name A ()A tl}jXE 5::.:.; Phone:121
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 31 -- 5-&0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
]
the appropriate box. A
[WUP � Checklists [] Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ V/ ste Transfers ❑ . Inual Certification
0 Rainfall El Stocking ElVrop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections ,/❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t,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
VNA
❑ 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
4No
❑ 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
VNo
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
II
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
\
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Addrtional Comments sud/or�Drawings
II,,11
/yao/cf,
T
12128104

Division of Water Quality
Facility Number 131 mm '5(o 0 Division of Soil and Water Conservation
-- - - 0 Other Agency
Type of Visit C6Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit SvRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Qq Arrival Time: �} Departure Time: � County: � Region:
Farm Name: � A1,�, '1+-RRMS_ N C _ Owner Email:
Owner Name: 'b A 1 [_ i A (�.m J / S %V Phone:
Mailing Address: 14 9Y SUM mG WN C9,C33 ado'. S 0 ,1-1 r O' uue- 14 A/C 10k36 5
Physical Address:
Facility Contact: Zs is Title:
Onsite Representative: !V 2
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: = ° = 1
Design Current
Design C+urrent
urrentSwine
mmw@
Capacity Population
Wet PoultrypaciyPopuaon
Cattleulation
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
ZI Farrow to Wean
I aq(30
Dry Poultry
❑ Dry Cow
ElNon-Dai
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
❑ Non-ts ers
❑ Beef Feeder
PBoars
Pullets
El Turkeys
El Brood Co
Other
El Turkey Poults
El Other
Number of Structures:
L10ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts -to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
To
❑ NA
❑ NE
❑ Yes
'5No
❑ NA
❑ NE
Page I of 3 12128104 Continued

/Facility Number: 3 — s(aQ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
t,No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LaawN
Spillway?:
Designed Freeboard (in): •
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
7No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �4 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) SG Z F CLOA- C 4��
13.
Soil type(s) V I LA_fZ__
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
XNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
O ( C- ' U 0l G#AritD S N07- ou r' - Cr1---, 91 M-S
Qj tr Ar_rUC-
Reviewer/Inspector Name IIRFiItj� L . 6 — —� Phone: Cf/Q9(p 3oZ
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

acility-Number: ' —,:760 Date of Inspection �d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. Q WUP 0 Checklists El Design 0 Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ yaste Transfers ❑/iinual Certification
0 Rainfall ❑ Stocking ❑ ¢rop Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainhreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ 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 CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)'
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'E�No
❑ NA
❑ NE
Additional, Comments. andlor Drawings:.
m
�t
Page 3 of 3 12128104

F
—Q Division of Water Quality
acility Number `�j S %c, Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ($ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: I N-k(?0^1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ILA A6MA Cock Q- tli E A H Coo? E Q Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 00 0' =" Longitude: =° [--]' ="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean 1.200 JX:35
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
1 ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current.
Capacity Population:-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ 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?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E4 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

Facility Number: '3 —S(pQ
Date of Inspection 0
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C,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: L-AQOOAt
Spillway?:
Designed Freeboard (in): 1 9•
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
D�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
[KNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Eallo ❑ 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes n No ❑ NA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ( 'No El NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El 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
El 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
P9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2� No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
P 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):
AL
Reviewer/Inspector Name Ammofq C ALH� p QXEL Phone:
Reviewer/Inspector Signature: 141 , Date: b�
12128104 Continued

Facility Number: 1 —mid Date of Inspection 3
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 (Z-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 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 .4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
g] 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
[:1 No
E] NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CZVo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P9,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0-No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit JZ Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Z O Arrival Time: � Departure Time: ��County:
Farm Name: ��� ` �2M S L.✓r' Owner Email:
Owner Name: 4:s4v .. _ _K�ap." Phone:
Mailing Address:
Physical Address:
Facility Contact:
� /1
Onsite Representative: ./gin .✓./ �z 619PE/1
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Region:
Phone No:
Integrator:.L��.e -;:rl _
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = Longitude: 0 ° 0 6 =
SA
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
I I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I I
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish 1
Farrow to Wean O Dry Poultry
❑ Dry Cow
El Farrow to Feeder
El Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts El Non-Laers
❑Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Pouets
❑ Other ❑Other
Number of Structures:
Discharges & 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)?
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 VNo ❑ NA ❑ NE
❑ Yes [--]No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes X No
❑ NA
❑ NE
❑ Yes VNo
❑ NA
❑ NE
12128LI04 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: J
Spillway?: NO
Designed Freeboard (in):
Observed Freeboard (in): Jrd
Structure 4
❑ Yes No
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Rf 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 XNo ❑ 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 P�No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /VNo El NA El NE
El Excessive Ponding El Hydraulic Overload [I Frozen Ground [I 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) 6 4f^626--7"I'd �, �, �+/ � 4
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/0
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
'�oNo
�`No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any'recommendations or -any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
�� Pz.✓cc
Reviewer/InspectorName r Phone: f(i 2327-
Reviewer/Inspector Signature: Date: ,317
Page 2 of 3 IJ128164 Continued

Facility Number: 3z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10No
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X,No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
[DNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NoXNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
11"No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 6�0
Division of Water Quality
0 Division of Soil and Water Conservation.
0 Other Agency
Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other
❑ Denied Access
Date of Visit: (+J Arrival Time: Departure Time: County: "AIn Region:W"4—
Farm Name: G Owner Email:
Owner Name: 0,099Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 S 0 Longitude: = ° = ,
Design Current: Design Current Design "Currents
Swine .:: Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 120O
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
i
.Other
❑ Other
i
❑ La er
❑ Non -Layer
Dry Poultry .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
Number of Structures `- F/ T af�
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
No
A
❑NA
El NE
❑ Yes
No
❑ NA
❑ NE
11/28104
Continued

Facility Number: — Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes YINo ❑ 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?: P
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 yJ No
❑ NA ❑ NE
through a waste management or closure plan?
/
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes � No
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El / No
El ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes [ INo
❑ NA ❑ NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes VNo
ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy 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 D ' ❑ Application Outside of Area
12. Crop type(s) 6©(l
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /No
ElNA ❑ 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 VNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations.or.any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I i Phone: %d —
Reviewer/Inspector Signature: Date: 2 2 b
Page 2 of 3 12128104 Continued

t.
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes F(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? El Yes ❑ No VNA ❑ NE
Other Issues rr
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 9f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q' Departure Time: County:
Farm Name: _{� _. Owner Email:
Owner Name: �11/g2r�-Q,M S _ _ Phone:
Mailing Address:
Physical Address:
d
Facility Contact: Title: Phone No:
�1 f
Onsite Representative: !_/�n��_ IntegratorLGS
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Sack -up Certification Number:
Region:
0
Latitude: = c = ` = Longitude: = o = S Q
dg
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
I JEI Non -La et I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
UDry Cow
[I Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a]
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes 0,No
❑ NA
❑ NE
❑ Yes No
El NA
El NE
12128104
Continued

'CY .Iil
Facility Number: Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )21No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: e
Spillway?: 114
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
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 )XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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 ❑ Evidepce of Wind Drifl Q 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 CINo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer toquestiont#) Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facini to better explain situations. {use additional pages as necessary):
P2P
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No
El NA El NE
the appropirate box. ElWUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No
❑ NA ❑ NE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil 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 VrNo
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 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
21 NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 10 No
❑ NA ❑ NE
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [] Yes No
ElNA ❑ 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 VrNo
❑ 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) '0
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No
❑ NA ❑ NE
Additional Comments and/or Drawings:
/ _ / —
4/)47
6110P1.0 �F csJ
41AQk�,
lw'.5
IV,4
OTE
Ale
12128104

W
Type of Visit ;Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit OdRoutine O Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number mate of Visit: 3 Time: O Ef D
Not O erational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .... ..........
FarmName: ...... ...... .......... ..... .......................................... -....................... ........................... County: ...... PO4.4r.10...... ....................... ..................
Owner Name: ».».»._.»........»».».»....... »....
?Mailing Address:
PhoneNo: .....»».»... »...... — --�._........ ......».....».
Facility Contact: ........... ..................... ».... .... ...... ......... »» ....._. Title:.. ................» ...»...............» ... Phone No:
Onsite Representative:.......... » . »._ .W .. Integrator..... CA9AUL4-'
Certified Operator: ..».... »............. »............. ............ .._..»..._....... ».... ......... ..................... _... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 14 Longitude • �� �66
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5'
Identifier: ... ...... ---•------- — - - ».».....»..--- -- - _.. »....» »._.... ».»._ ».
Freeboard (inches): r' 1
❑ Yes ❑ No
❑ Yes
El Yes
❑ Yes
No
❑ Yes
�No
Structure 6
12112103 Continued

Facility Number: , 1 —Zo Date of Inspection $
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[7,.,�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[�INo
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 mainteriancelimprovement?
❑ Yes
7NV
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below.
El Yes
Zo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 3E2"vDA CG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
U1 640
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&;��
b) Does the facility need a wettable acre determination?
❑ Yes
7
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
To
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 7No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes;Nlo
Air Quality representative immediately.
Yv. ,,`yll �S r�'"°""'�
( q plain y ers sitd/or anyrvrecommendattoas orany other commeats.
S �" -
moo!
tU drawin l'aci}iu to better sitnghons. {use addthoaal pages as necessary}I ❑ Field Copy ❑Final Notes
:
ri
IZ.EP,oa,D S A PD t 1070 ic— G�aaD.
'7
Reviewer/Inspector Name �= (`/ �
..� , . _ _ 1
Reviewer/Inspector Signature: Date: S 3 0
12112103 Continued

Facility Number: 3 _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes VNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes N
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) El Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes7NV
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35) ❑ Yes INO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDI:S required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

J
Type of Visit 9rCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 8 Time:
FFacility Number
Not O erational 0 Below Threshold
[Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated r/A�bove Threshold-.
/Farm Name: qOA7L S .1 i� �� _ County:
FOwner Name: _ � -z % Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: T r� Integrator: .rAew'w_L 5
Certified Operator:
Location of Farm:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 u Longitude ` ° Du
Feeder to Finish I I'�'LU Non -Layer I I 1 U Non -
Farrow to Wean
Farrow to Feeder i7 ❑ Other
Farrow to Finish Tintal llpcian ranari
Boars
Subsurface Drains Present
No Liouid Waste Manauen
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
y Field _Mi
❑ Yes /No
[IYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes �O No
❑ Yes ?4NO
Structure 6
Continued

Facility Number: -- (p 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.)
G. 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
❑ Yes
�No
immediate public healtb or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VfNo
11. is there evidence of over applicatiotr ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
6 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9rNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
0 No
b) Does the facility need a wettable acre determination?
❑ Yes
r [N0
c) This facility is pended for a wettable acre determination?
El Yes
01.No
l5. Does the receiving crop need improvement?
El Yes
No
16. Is there a lack of adequate waste application equipment?
El Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (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
'ro
;dNo
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
O'No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
rCommeu` s`(refer to questroo Ei lain anv"YES answerkaad/beany recom endation Ie4'a y° tier conirttents '
U'se deawings of`facilityto better,explam srtuattons (use additional pages'as necessary). Field Copy ❑ Final Notes
.. , .:i
R Fo o R o 5 o D, R.
Reviewer/Inspector Name �^
Reviewer/Inspector Signature: z% Date: 3 Z
05103101 Continued

`Facility Number- 3 — �/� 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 m No
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 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 4NO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
J.
IA
t
t
3/?3/99
J

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ( Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: G ( Time:3 d
Q Not O erational Q Below Threshold
Permitted © Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: ..�\...c�1�!........................................................................................ County: ...�k.................................... ......................
OwnerName:........................................................................................................................... Phone No:
FacilityContact:..............................................•--............................. Title:................................................................ Phone No:
MailingAddress:..................................................................................................................... ...............
11
Onsite Representative: ,,,.,,, ._.-h.................$ Integrator:
C �\
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Locationof Farm:
qr
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• �� �
Swine
Design Current
Capacity. Pouulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
QUQ
❑ Farrow to Finish
_= ❑ Gilts
❑ soars
Design. Current- Design _ Cui
Poultry Ca aci Po ulation: Cattle Ca cii ...Po" i
❑ Layer L[2 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other I-
T061:0PSIgIt Capacity
TOW SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Ares ❑Spray Field Area
Holding:Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................................... ........................................................................................................................................
Freeboard (inches):
5100
❑ Yes )�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes K No
❑ Yes X(No
❑ Yes ;(No
Structure 6
Continued on back

1
A
1F'acility Number-S kQ Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes K 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
D(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
XYes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
)ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
b(No
�V-V
12. Crop type ' ctV �1 Qve 'i - - ---
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
J�rNo
b) Does the facility need a wettable acre determination?
❑ Yes
K No
c) This facility is pended for a wettable acre determination?
❑ Yes
1j No
15. Does the receiving crop need improvement?
❑ Yes
{(No
16. Is there a lack of adequate waste application equipment`?
❑ Yes
P�No
Reuuired 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?
Yes
(iel WUP, checklists, design, maps, etc.)
❑
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VRrNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
4 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
jXNo
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
ONO
' o yiolati0fis oi- d0flcientk� •mere noted diWing this;visit: - Y:ou wifi-reeeive fia i' rther; ; ;
correspondence. about this .visit.
Comments"(refer to question #): Explain any YES answers and/or any recommendations or, any other comments ' - -
Use _drawings of facility to better explainsituation5:"(use additional pages as necessary)
wr
Reviewer/Inspector Name
Reviewer/Inspector Signature: C Date: ! —3-�� (� 5/00

t
t ,
Facility Number: `3 (J Date of Inspection d Printed on: 10/26/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below []Yes kNO
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
0 No
28.
Is there any evidence of wind drift during Iand 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
_�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
Q�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
(b No
Additional Comments and/orDrawings: .
Vvk
VP� — A-r 41"\ 1 r
4-y5
oe- " ! . , V �\ 96r3s U 4e_r
5100

Facility Number Date of inspection (r Z> >
Time of Inspection 24 hr. (hh:mm)
13 Permitted © C ified ❑ Conditionally Certified 13 Registered 10 Not O erational nz.
ed:Farm Name : ................1..-!.•.............•''tti.........'.••!r.-Ll................. County:.....................l.................
Owner Name: ......... .................................... .. Phone No:.................
Facility Contact: ..1 .. 'l . ... Title:........... /!...... ....................... Phone No:.................... ............. ......
....................................
MailingAddress: ................. ... ........... .................................... ..........................
OnsiteRepresentative:....... ......... . . . ............................................................ Integrator:............ ......................... .....................................
Certified Operator:............................................................. .. Operator Certification Number:..................
Location of Farm:
Latitude 0` Longitude
Design Current ".." . :-. Design Current .. Design Current
Swine Ca Capacity Po ula6oit Poultry' ;Ca ac'
ty city Po dilation Cattle ,: Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑NEEIon-Dairy
❑ Farrow to Wean _ _
arrow to Feeder DpU ❑ Other -
❑ Farrow to Finish Total Design-Capadfy
❑ . _
.... Cilts,
❑Boars - -Total SSL-W
rt Number-nf Lagoons - ❑ Subsurface Drains Present ❑Lagoon Area 10Spray Feld Area
�Y
Iioldtng:Potids / Solid Traps - ❑ No Liquid Waste Management System _
Discharges &.Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [ &o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was die conveyance man-made'? ❑ Yes 1'Q� l-
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 6NO
c. if discharge is observed, what is the estimated flow in gal/min? 4*
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ET -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 15-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Er No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............. ..............................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0No
seepage, etc.)
3/23/99 Continued on back

Facility Number: �� - �� Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(I€ 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 maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A22lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
PER
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19.. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
....yiolaiigris:or• dfficiencies were noted• d(Wing #his:visit; • :Y:oWWitl-teeeiye rid further
corresporicience about. this :visit...... :::::::: ...
❑ Yes [�[No
❑ Yes �ANo
❑ Yes ANo
❑ Yes KNo
❑ Yes XNo
❑ Yes KNo
❑ Yes KNo
❑ Yes 9 No
❑ Yes V<No
❑ Yes CjfNo
❑ Yes XNo
❑ Yes 14 No
❑ Yes 1560
❑ Yes t<No
❑ Yes XNo
❑ Yes kNa
❑ Yes VNo
❑ Yes RNo
❑ Yes �No
❑ Yes A No
Comments_(irefer.fo question #) Explain any YES answers and/or any recommendations:or-any other comments _
Use drawtngs of facility ti =better.;explaiii situations {use additional pages as necessary)
w_
' C'�oao� rg,l-� �. // y lam►-. �pru.� �'�,... �,-,z,t l�,s
re Z
0102��1�1✓S CC�4'�' D-� cr1G{p� �tz.�c �u.l�L �ti,� i
c!o
sus � 7 7 �- ��� � �� ��r—
!�c✓t� �r-`1 Sim Q{`�.r� . �1��vCVUY c�.,ic..�a t„a�r�
S d` Z l�' 2 ct.rc s bw W a s 5 ZS ac ,rams o. _ 1 �..i , # q .
El
JW_
Reviewer/Inspector Name
A-c �h-svi�I ✓
Reviewer/Inspector Signatures
Date:
3/23/99

Facility Number: — Date of Inspection
Odol issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
j No
liquid level of lagoon or storage pond with no agitation?
t 1
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
C(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
LNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Q'No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
A No
_-Additional- Comments an or rawmgs
-
AL
A �v �
ZV3
N
M
I
C�
�/ 3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
�O a�nnRoutine O Complaint O Follow-up of DWQ inspection O Follow-up_of DSWC review � Other
. -
Facility Number
Date of Inspection f i
� � �
Time of Inspection 0 24 hr. (hh:mm)
© Registered Certified E3 Applied for Permit Permitted 10 Not Operational I Date Last Operated: .............
Fartii Name: ............. a.........�'� I!j+, ,.... �.if�C,r.................. County:.....................................................................................
Owner Name: ........ . .......... x1........ 4An'4r..................................................... Phone No.
FacilityContact ........ Title: ........................................................ I ....... Phone No: ...................................................
MailingAddress: ....................... .............................................................................................. ............................ ........................................................ ..........................
Onsite Representative:....... . &tI. .........R0'r_ k....................................................... Integrator:......................................................................................
Certified Operator:............................................................................. .... Operator Certification Number:.................
Location of Farm:
76.Afft......do,......h,��.......5:.4......1! ........ 1. 1 �.t...a :.Z....rr�`1� �......Q.........9 as?................................................................. A�
............................................ ....... ........................................ .. ... ...................................... T
Latitude 0 6 46 Longitude 0• ' "
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
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?
7125/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No

f/ S
`Fac�Iity Number: 3 �—
`�irn�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,tiolding Ponds lush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure f Structure 2 Structure 3
Identifier:
Freeboard (ft):
10. is seepage observed from any of the structures?
❑ Yes ❑ No
❑ Yes ❑ No
Structure 4 Structure 5 - Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste A tplicatioR
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
15. Crop type.....................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
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 PIan 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?
[� No:violatioin,or deficiencies.were"n'oted-during this -.Visit'.. Y064ill recei�e`no-further•:
. eorrespbbdent o about this.visit ,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
b Gbs�Yvc� rSo;k aPQ�ica�ioy. -'Prn-. Vn6 aJa0a5 254' Ree Sur. 15 „QUO tic 56?foed
5�or� a woo&.� �revr� �+,{ �1 No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: I�7� _Z1 l } _ Date: q / 11

❑ Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
10 Routine 0 Complaint , 0 Follow-u -of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number)
Time of Inspection • _OCi '24 hr. (hh:mm)
Registered Wertified E3 Applied for Permit 10 Permitted 113 Not O erational Date Last Operated:
Farm Name:...........Ds..,.,.... R tCl !.5... 6.................. County: ...... bs_, i............................................
OwnerName:...... ........................... Phone No:...°�.lf��.�. Q215 ... ..............................................................................
Facility Contact:....... r} .:........: ........................ Title:.....................:. ....-----.---
Phone No:.�.°i��,.�a .'iaD.� .........
Mailing Address: ..... 1 :..... [iu. iJ.............................. .. . Ak.....................
Onsite Representative: .... 14AYI .:....A.....:..L]t ........4-& .. Integrator: .........Crl �19.1l $.....................................................
Certified Operator:.-Y.a=l'YI-...... .-.....ct.:...................................... Operator Certification Number....j..�...........................
......
Location of Farm:
+`...x�Qa......... l.:....:......S.R....15.t1..1.:.Q: -S.. �.l�s....�� 1"......... ....1....................................................................................................
............................................ ... ......... ........ ... ---- ...... .................... ..... ......
Latitude ®•.�� ©" Longitude ©•'
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow, to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Neimber of Dons 1 Holdtn Ponds j ❑ Subsurface Drains Present ❑ Lagoen Area ©Spray Field Area
' ❑ No Liquid Waste Management System
..�,N
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
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 ;al/min?
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
j 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
iP No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[� No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

t
L
Facility Numher: 3i
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard (ft): ......... Z ;G
10. Is seepage observed from any of the structures?
❑ Yes g No
❑ Yes ® No
Structure 4 Structure 5 Structure 6
11. is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes R9 No
❑ Yes 0 No
12. Do any of the structures need maintenance/improvement? ❑ Yes N 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 EA No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ;3 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop hype...........i✓'(.!4..............................ral!u�`.-..P:tYt..-..............-.-........................................ _.-.-.....-.-.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No,.
18.
Does the receiving crop need improvement?
❑ Yes
CO No
19.
Is there a lack of available waste application equipment?
❑ Yes
19 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?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
E� Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
(R Yes
❑ No
0 No.violations or deficiencies. were`note'd-during this.visit. You.will receive no further
correspbndenee ahout this:visit:.:
Cbmments`.(refer to question,#).. Explain any ITS answers andlor'any recommendations ar any`other ciimmenls
lose drawings of facility to better explain situations. (use additional pages as_ necessarv).
}
t� �t:5� ilti�OrnnpiM �katlttl bZ rv,
'4�%u - Mt-ayr 61ra,4�C[ ion Of AJV-Q p,- , ar, r j e _ <
7/25/97
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: ae-Date:

� a'M&=11: ,Z.A G s
❑ Division of Soil and Water Conservation n Other Agency
"Division of Water Quality,4
y, f
QRoutine O Conanlaint O F4)llow-uo of DWO insn(_Ttian O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered W ertified J31pplied for Permit © Permitted JE3 Not O erational Date Last Operated
Farm Name:... ?.dl.�. ............ "+^ 5.....Iv......................... County:... sa.�.��.r....................q.............. .L. .
Owner Name: V. ,..l.. ......'�s>w.�r.xn.S, . �v� L.............................................I........ Phone No: _(..gi1.)....� 9..........).z �.s....................
Facility Contact: .. �„4ra s .. ..,.�2d ,n o ee,t'fitle• Phone No: �„9 �. S Q
(-Qal --
l.g...�......$...
Mailhi Address: g ......................
P�.� �..��.� �.�.s........�..�..:..................t�l�.' p..1�. �-�.t.....1,�...5,..l ...............
Onsite Representative:_-C4..,rar. ..G mot.: Integrator:.... Sri?..U.1...............................L................
Certified Operator:......VG'iYl � ........... Q� l%................... .... .............. Operator Certification Number. ... i 71 &f.7
Location of Farah.
.�r.:i....'^:Q.��Sh....S3.�1.4.,......A ..... p.�i.«:�7s,.l.�nr.-n....Ll.....�......�^^.a.1�..�......5.�.,5_t....A.......t..rk.........................
.............................................. ............................................................................ I ......... 11.1 .... I ...... PV
Latitude EKD•®' '.r--"" Longitude ©• EG/11
VE11
a Destgu �Cu rent Design Current Design` Current
�Capar�ty
k
5vvmg., E Population Paultry CapacttyFPopuiahvn Cattle„ CapacityPoptilatxoa
~
❑ Wean to Feeder z ❑ Layer ❑ Dairy
❑Feeder to Finish ❑Non -Layer ❑Non Dairy
❑ Farrow to Wean � . x h.} .:. m ¢ A M, 0 c
Farrow to Feeder ' Y ❑ Other;
❑ Farrow to Finish, oo a
Total Des]<gn Capacity
❑ Gilts s�
To SL
❑Boars, dd
E _mot ha.. ZZ
�.
Number of Lagoons ! xolding Ponds
❑ Subsurface Drains Present
❑ Lagoon Area
10 Spray Field Area
..... . ... .... . .. .... ......
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ® Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes E[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 galimin?
A. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes No
I 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 9[No
5. Does any part of the waste management system (other than lagoons/holding ponds) require XYes ❑ No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 19 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes CA No
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
B No
Structures (Lagoons,11olding Ponds Flush fits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
�&No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Freeboard(ft).......................................................................................................................................................................................................................
10, Is seepage observed from any of the structures?
❑ Yes
H No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
ER 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
9No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type1t... d y.9 Uh..................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r
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?
®; No'vio'latioiL •-6i deftcieizt:ies.were-noted-duririg this:visit: You�,AtiU recei�e,ito•ftirtherI
O&OSp)tideOn about this:visit:.: • :. ; .:. ; • :.: • :.:.: .
❑ Yes 53 No
,.Yes ❑ No
❑ Yes IR No
❑ Yes C9 No
❑ Yes M No
❑ Yes 9No
❑ Yes P3 No
❑ Yes Ed No
❑ Yes ifNo
is " a et i v �-r tV- - vJc c d s h t t �`el l a. r► e 1 t tk^'L H-I't 3
�-J'�`fa o, rep '.^ i t- I: 6 o v c a_ Ef-.e_
y. lz.a.�e-,w a b a { fie.-4-v t-�3 0-...� � o � � o-a a o 4,.. • - � a S S e�+�r-mod.�a�.-....X .
as- <t r v-L"t"
7125/97
Reviewer/Inspector Name
r.
Reviewer/Inspector Signature: p �„r -47- . , Date:

•
0
•
-t- - -
r
Site Requires Immediate Attention: P 1 C)
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
DATE. _ / �,y:, 1995
Time: i r
.— o a b
L
19C3-1V'\.. % C O CT]e_AI_ (--+d-)
Mailing Address: too `'eco, -2-► A . 6,r�3 L a 5? U
County-,
Integrator. - CcA�a f isPhone: 19 Ca Ste` `3 LF��
On Site Representative: Phone: — Ioo4 F=-i
Physical Address/Location: S.(t- )
S 1.1,y.,n.cn f _ hs �cg Op--
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: S-00 J Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW ..
Latitude: _° 3 ' `i. + Longitude: :14 ° S -0 ' 73. S`4 Elevation: Feet'
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ce) or No Actual Freeboard:1 `f* Ft. Inches
Was any seepage observed from the laQoon(s)? Yes or N Was any erosion observed? Yes or
Is adequate land available for spray? e or No Is the cover crop adequate? Gor No
Crop(s) being utilized: e,may-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinas? laor No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 'o
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 or 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:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.