310574_INSPECTIONS_20171231

NOHTH CAHULINA
Department of Environmental Quai

Type of Visit: WCompliance Inspection V Operation Review (,,,) Structure Evaluation V Technical Assistance
Reason for Visit: atoutine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: ( Arrival Time: Departure Time: County: i-t---t'-
Farm Name: ^ Owner Email:
Owner Name: pC 1 k-11 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: __ Phone:
Region: Uj 02b
Onsite Representative: " W },-v pJ Integrator:
Certified Operator: l_LL'u e Certification Number: ( (4 0 2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop. Wet Poultry
Design C►a., Design Current
Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
ceder to Finish
1
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Drv_ P■ou[tr.
Ca acit P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 IX No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

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

Ficili Number: Date of Inspection: I2 j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No M NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ YesgNo
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Coiihmeii (refe'$to'queshon 4) Explain any'=YES ai swers and/o>r`any addihowtal reeommendations or any other cajr"nents. '
., ty P .. a� �s l
Use�zirawiags of facih to Bette' ibex 'laitusituatious=(6se additional: pages as necessary-}.;
�k 42,1 os +0 sahkrit
oiac S S cIn Kc�Yd� 1nl�s � j2 r 7.
a WASH d
x � ra.� s Y�tRc�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: —7
Date: 6
214120 S

Type of Visit: Q Cance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 2 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: !! Title:
Onsite Representative: 5� G- 4, I
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: ��►� L
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design C+urrent
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer I
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D P■out C1 aci P■o
Layers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
[:]No
[DNA
❑ NE
❑ Yes q No ❑ NA ❑ NE
Yes : - No ❑ NA ❑ NE
❑ Yes 9-5-0—❑ NA ❑ NE
Page 1 of 3 21412015 Continued

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

Facility Number: - Date of Inspection: /6
24, DiJ the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EF�❑ NA ❑ NE
./ 7
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑1 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes
E:fNo
❑ NA
❑ NE
❑ Yes
.EfrNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: I
2141245

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:/ (Arrival Time:'-f� Departure Time: (4 zp County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: L-e S It e �•— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: p
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish FLa
Design Current
Wet Poultry Capacity Pop.
er
Cattle
Dai Cow
Design Current
Capacity Pop.
Feeder
o Finish
o Wean
Non -Layer
DairyCalf
Dai Heifer
D Cow
Design Current
!Farrowo Feeder
FinishLa
D , P,oultr, C•_a acit P,o ,
ers
Non-Daio
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow111111
urkes Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ffNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

h'acili Number: '3t Date of Inspection- j P Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C
Observed Freeboard (in): 3_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No[_]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ETNo
❑ 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
Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
hTo
❑ NA
❑ NE
m m enncor
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 L],Ko ❑ 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
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;J-?-o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 [a 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 21412015 Continued

Facili Number: 21- 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?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No []NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ff No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ff'No ❑ NA ❑ NE
❑No ❑NA ❑NE
No ❑ NA ❑ NE
�No❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility. to better explain situations (use. additional pages as necessary.):: V
54e_
Gc n,�a SIC
Reviewer/Inspector Name: V_-a _ r `' KVt I Phone:
Reviewer/Inspector Signature: ��--- Date: n ��
Page 3 of 3 21412015

Type of Visit: � Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency Q Other 0" 'Denied Access
Date of Visit: y Arrival Time: 1 Departure Time: County: Region:
Farm Name: 1 T T&b-- A Al K ► XW- Owner Email:
Owner Name: 1 �5LjC Q • U�►� i Phone:
Mailing Address: C9) —1 "1 ) c- 55 OWyIFe , • C_ C�S3V5
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Integrator:
LDS (�. off S
Certified Operator: C.y � ��t� 17TF� Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
) & L�OQ
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
C*urrent
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
I) . P"Tu-I
Layers
Design
Ca aci.
Current
P,o ,
Dairy Heifer
Dry Cow
Non-Dan
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q€he
OtherI
I
Turke s
urkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes x No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes Ig No
❑ Yes& o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: - 5 -1 t-1 Date of Inspection:
y
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?
0 Yes
No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (,ArX3DN
Spillway?:
Designed Freeboard (in): �q• S
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
X,
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
+bl�
12. Crop Type(s) �[�► L-E1�I Y b� E�-'7
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes V� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropriate box. !�
QWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ Vte Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q 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 21412014 Continued

Facili Ni mber: - S -4 Li I 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 gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes VNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes V No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any"other continents.
Use drawings of facility to better explain situations (use additional pages as necessary).
S LupC, St.�R, u�� ` p�c �0► y �� 7S H NCH -_wG4. N�(z cAu,/�v4
OEL 60 01 4: 0-((
�qb * ?pA(W_ Q074
CPO
�l
NAur
OL>�.M��i SP SED � 0A1 u�CIASt
BS�- P�"'UPFJ``!Tz
Qu i
F l X _o G l
u Yv-t1�
L/
7X� 6- Ad-r� D� F ic�rc'G' /N rho Pia T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R1o_1ib 1*0
Date: q rX'/L/
21412014

Type of Visit:
Reason for Visit:
ompliance Inspection 0 Operation Review 0 Structure Evaluation
outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency
0 Technical Assistance
0 Other 0 Denied Access
Date of Visit:
L Lrrival Time:
; eparture Time:
ounty: Region: L_j/16
T
Farm Name: ) S d 11 r_ - 3 Z
cj�l _ Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: m 1
Certification Number:
Certification Number: ,
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , P,oult , Ca aci P.o
ILayers
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Other
Other
Turke s
Turke Puults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes n No
❑ Yes ZfNo
[—]Yes �No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

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

Facili Number: - Date of Inspection:
e
24. Did the facility fail to calibrate waste application equipment as required by the pen -nix ❑ Yes ;No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ETNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes/ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P�rNo ❑ NA ❑ NE
❑ Yes [�J`Ro ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ETNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �o ❑ NA ❑ NE
Comments (refer.to question ff): 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).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
1/4/207I

(Type of Visit: Q Compliance Inspection V Ope on Review taStructure Evaluation (-_)Technical Assistance I
Reason for Visit: Q Routine O Complaint Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: 6 Arrival Time: I—,L ='� Departure Time: ZY County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pap. Wet Poultry Capacity Pop.
Layer
Design Current
Cat#le Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
i) . P,oultr� Ca aci P.o ,
La ers
Dairy Heifer
Dry Cow
Non -Dairy
lBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [;io ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E(t;�i
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
rj1No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of inspection: 10x /
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?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 6No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
If any of questions 4fi 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 2NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA EfNE
(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 dNE
maintenance or improvement?
Waste ARiflication /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
❑ No
❑ NA [/NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA E?jE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑�NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA DE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA fNE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] No
❑ NA E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
D Yes
❑ No
❑ NA ffNE
Page 2 of 3
21412015 Continued

Facifi Number: jDate of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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:
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 Signatut
Page 3 of 3
1
❑ NA NE
❑ NA [�E
❑ Yes
❑ No
❑ NA
4NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA eo'RE
Yes
�NE
❑ ❑ No
❑ NA
❑ Yes No
0 NA ONE
❑ Yes [] No ❑ NA ,'NE
❑ Yes ]�No [] NA
Yes I� `" ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Date: 10A4 l6
21412015

Division of Water Quality
Facility Number �j - m Mo. Division Soiland Water Conservation
Other Agofency
Type of Visit: Wompliance 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 0 Denied Access
Date of Visit: F - i Arrival Time: = (, Departure Time: ; v County: if Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative:
Integrator:
Certified Operator:
�}-
� .
�_ �i*1�
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Swine C►apacity Pop.
Wean to Finish
Design
Wet Poultry C*apacity
Layer
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish WO
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Di, P,oul C_a aci
Layers
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes FfNo ❑ NA ❑ NE
[:]Yes [:]No
[—]Yes ❑ No
❑NA ❑NE
❑NA ❑NE
[]Yes ❑ No- ❑ NA ❑ NE
❑ Yes 0 No r ❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

F.citit,y Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 F1 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes K
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [?(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PTo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vf No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VrNo
TT
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [;rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

_ W.
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes (2rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ 'hT Yes �o ❑ NA ❑ NE
Other Issues T
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 VfNo
[:]Yes 9fNo
❑ Yes ?] No
❑ Yes Pff No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
VNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:���jr?'G`
Date:��
21412011

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time:-�=--� County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: q—. WH1771ktS
Integrator:
OG 1
CertificationNumber:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultr3 Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Design Current Cow
Dr, P,oult . C•_a aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turke Poults
10ther
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes YesINO
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes t o
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
❑NA ❑NE
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?
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA FINE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ 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 1No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): SG i ' OyLw
13. Soil Type(s): N(jOL-tiL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JK No
❑ NA
❑ NE
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.
r❑ WUP ❑ Checklists Q Design 0 Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
,' Waste Application Week/ Freeboard Waste Analysis Soil Analysis W to Transfers
❑ pl? ❑ Y ❑ Y ❑ Y ❑
❑ Rainfall M Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �_9(No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes A N
o
❑NA ❑NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - ,-tDate 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
th b 1
e approprrate boxes) a ow.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? • ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes '( No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 7�
❑ Yes No
❑ Yes No
❑ Yes No
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5_CA_r_X" VcA
,A.
('Pofio ), I/
5P!jjQ ),s
M-7,04 V � 8
Reviewer/Inspector Name:
Reviewer/Inspector Signature: -
Page 3 of 3
Phone: "7/6
9j Date: v�
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:� Arrival Time: Departure Time: County: 11r.(. X.1N Region:
Farm Name: 1 ITS i — �C I l�f C1 FA (uv, Owner Email:
Owner Name:TT iU - - Phone:
Mailing Address: d I L ! u C SS E I► C)CQf4 i 0(_/Ufa/AK— cOR 3 b S
Physical Address:
Facility Contact:
Title:
Onsite Representative: Loso & LJL__)H 1� J el�,
Certified Operator: LE5 (,4 6 V`- d w i--"' 111(r—A�N
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certiffiic itrion Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design Current
D . P,oult , C•_a acitV P,o ,
Layers
I
Dairy Heifer
Dry Cow
Non -Dairy
113eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes x
No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of inspection: J
Waste- Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )!� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in): _ g,
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? IX
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? %
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Po ❑ 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): S( 3-) r
CQa-1�i W i4eA"r SA,
13. Soil Type(s): Ww"C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 04No ❑ NA ❑ NE
Q Waste Application 0 Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall Q Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q 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 9No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 1 - 5 Date of Ins ection: 1
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 ���j�"` No ❑ NA ❑ NE
the appropriate box{es) below. 7�
❑ 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 9NO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No OCNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �NO
❑ Yes 0 No
❑ Yes ONO
[:]Yes g No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments
Use drawings of facility to better explain situations (use additional pages as necessary).
�fl4r� SUGw���jf�l► 7T 11Cr 'off L{
;�16 ; > c oVE 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 90
7to 0
Date: Ig-4 j 11
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ©rr Departure Time: County: L-I N Region:
Farm Name• — II C�77 C! N C 1— iZM Owner Email:
Owner Name:
l GSLI G_ V� L^ )" I TTt=—� Phone: (Lc) el 9 66P - uCa3
Mailing Address: 91 " 1 + / y C s s E M6[AN T 0u u Nc DO 3& s
Physical Address:
Facility Contact:
Title:
Onsite Representative: LEsc-1 E w1.1 t TTEI�,
Certified Operator: LES c-1
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
0�)1Q)
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = « Longitude: = ° a d 0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish (9
❑ DairyHeifer
Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
El Brood Co
❑ Farrow to Finish
❑ N Layers
❑Non -La ers❑ Pullets
PGilts
Boars
Numher of Structures:
❑ Turke s
other ❑ Turkey Poults
❑ Other ❑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)
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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facilitt Number: 31 —S4y
Date of Inspection okJ !O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L44 oo f
Spillway?:
Designed Freeboard (in): /Q . •S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes INo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes ANo ❑ 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 gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 19
4. 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 ElNE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes '51No ❑ 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 W_in�d�owr El Evidence of Wind Drift El Application Outside of Area
12.
Croptype(s) 7Q LS.�L-/�1 WPEA
13.
Soil type(s) / V 0 "C _A<_
_
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 4 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,1�3 No ❑ NA
❑ NE
17.
Does the facility tack adequate acreage for land application?
❑ Yes J�No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes pftvo ❑ NA
❑ NE
Comments (refer to question #): Explain anv YES:answers and/or any recommendations or any other com�rients� "` t
. ,
Use drawings of facility to better -explain situations. (useadditional pages as necessary}:
V.S•
AL
ONF wl(t,5,
Reviewer/Inspector Name M� Phone:
ReviewerfInspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 I — -4 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 'El Yes No El NA [I NE
the appropriate box. El WUP El Checklists ❑ 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 0 Soil Analysis ❑ Ate Transfers ❑ lAual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections ED Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
X No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
4No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
���/1111
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
ENo
❑ NA
❑ NE
Additional Comments, and/or Drawings:
L %w-r I oN ap l 1
L.141300N IN (=AI9- s6/4PIE - sr -OP ?WMP )5 L-i8, j or, eC-Tr'�- 70
pAU6 Lr4FocvvCc-o5" TO Sroe pkmp rnr pGLEpig (Z -T701v F,09Z yLe�cA-
SeA-5c*V -- gEI9A4 (/ /vvw
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint XFollow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ! Arrival Time: ® Departure Time: County:
Farm Name: AV 1TTO--K IJ Owner Email:
Owner Name: Lznuc �Z• � I T'1"E't�:. Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 = r Longitude: = o E_-1 ` =
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
ID Layer I
1 ❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer I
I ❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
Non -Layers
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
ElGilts
El Boars
❑ Pullets
❑ Turkeys
Other
❑ Turkey Poults
❑ Other 1110
Other
I umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 4No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
t&No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 —Sy Date of Inspection 1 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? XYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes XNo ❑ NA FINE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (_PGOCW
Spillway?:
Designed Freeboard (in):
!f
Observed Freeboard (in): Ll
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
X
ElNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �(NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
�j NE
15. Does the receiving crop and/or land application site need improvement?
XYes
❑ No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA10 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
A NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
�( NE
Comments (eeferAo questroi ft 'Explain any°YES answers and/or any.recommendationsouany.othevcomments :. � .� �w ., _
,Use drawmg`s of'facilityto.lietter explain situations. (use -additional pages as necessary)"
�i• ['�1Q. wit BIAS A Qp�ON FILC- NEF-bS TC> GEr P1V6MGf_01VC _ -o
C3 �u S_r 1(._c__ 1l� �E� A �i �t� SC7 �)a`�5
ylj. �EAN S n 1(_oN THE FtF-Lb S - NIrel-I TC) 6 Ei T1�SC- c�Fr C5Q 1T W�t✓�
(3C C) LpTE To AT! T AN�'�fl//►r�' 71
Reviewer/Inspector Name - iJ�"i / /� Phone: !Q q�o`
Reviewer/Inspector Signature: Date: ] {�` , 1 " 0 1_
12128104 Continued

Facility Number: 3 j Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
W NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
ONE
the appropriate box. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps
p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
A NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
El Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
kNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA jX NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
[(NA
❑TNE
33.
Does facility require a follow-up visit by same agency?
xYes
❑ No
❑ NA
❑ NE
Additional Comments and/orzDrawinQs::_:
l��lcr� 1 phi ►UED aN 7NF F-Aem
1*�S JAI io SEC
1,�11A� Cr�S �C>4)V ©A'-
}{ 0V7 aN TO E LA6S WNE2E.7Nf-_BkAuS PZE- - HIm
L-DI oaf dr y f71A(�S 740 i C F_ 1
LAN1E� wt�IN ,3C� DA�S.
HOGS HAD1N ^- �uaEEIS�`31.�7 5/NEE t-i5 p} i S�EgO��a
T NaAU0l/l6' Td C-ACCCf
- $EAws n�,✓� R-�ma Rom ELb f I F ij1SCED I N AwlPAty
'?"j:�ASE me t"woQmED <2SF PA��C'40-)VGE-s
12128104

I/
Type of Visit I ompliance 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: �tt j __� `` � Arrival Time: 1rJOC)o Departure Time: County: ` Region:
Farm Name: t J I 'T7 rG — l—IJV C^ P7 1 -A� Owner Email:
�SL I L�._�. i..`��I I I -re 9r9- Cos8-4(o 5 we
Owner Name: r ! � f /� � Phone: %►� Q ?S/
Mailing Address: of )�� r Y L 5'3 E �1'1 % CJ —1 UE _ , v C o` " 6S
Physical Address:
Facility Contact: Title:
Onsite Representative: L�Su G C,,_) t4,LnC t�,*
Certified Operator: LisS L1 ra f?'
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: _ V-'«
Back-up Certification Number:
Latitude: [� o 0 f Longitude: [= o =1
Design Current
Design Current
Design Current
Swine
C+apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Laver
❑ DairyCow
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish � C�
❑ Farrow to Wean
❑ Farrow to feeder
❑ Farrow to Finish
❑Gilts
❑Boars
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
VNo
❑ NA
❑ NE
❑Yes
El No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
q] No
❑ NA
❑ NE
❑ Yes I No ❑ NA ❑ NE
121288104 Continued

f
facility -dumber: 1 --S 4y
Date of Inspection I I I W
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: L 4v:Jt/
❑ Yes XNo
❑ Yes ❑ No
Structure 4 Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Is
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 9
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? X
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 10 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 ElV
No [I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes ANo ❑ 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 El Application Outside of Area
12. Crop type(s) 'SC-) (2pV_jA/ (�i &4 T L�
S
13.
Soil type(s) Natf-cy-<
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
o
❑ NA
[I NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
tNo
ElNA
ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYeso
❑ NA
❑ NE
Commemfs (refer to'quest 'on #) `Eirplain aity YES'answers and/or any recommendations*or any other camments
..
Use drawings: of facility.to better, explain situations.- w(use additional pages as necessary)
1 U Gw . 0 5 SOON 95 - t3 N C) NI - o i c
Ooc,v,lSOwt r '7U 5 ; pu_� o `' S �Q �C .
� 70 � cAu�.
SIGNS FrcAf¢IN g Ci5X6
GL�7T�NC (P'j�Cl� !/SITa Cows
Reviewer/Ins ector Name'` "` /� ! ��3�
P MA'VD 6� /Ve S `'� Phone: O
Reviewer/Inspector Signature: Date: I i V0 9
12128104 Continued

lFaciUtpNumber: "3 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes A No
El NA
[I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes ,ANo`
❑ NA
❑ NE
the appropriate box. ❑ %Up ❑ Checklists ❑ Design [3 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
✓✓
❑ NA
El NE
El Waste Application El Weekly Freeboard 0 Waste Analysis ❑ SoiI Analysis ElY(aste Transfers❑)eme ual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections El
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 4No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 50 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes gNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes V No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
X NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes )4No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concem?
❑ 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 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes Lo
❑ NA
❑ NE
Additional. Comments and/or Dcswin s "
g
.
y
CAA NZA-7-10N �S DU � 13c� r� D d C= _1
l2/2&04

Type of Visit qk Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit Q Routine 0 Complaint `Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: ( Arrival Time: ® Departure Time: County: t-% / Region:
Farm Name: i 7� — �1 a-m Owner Email:
Owner Name: C��S a +A�' • ' Phone: f (1 r�
Mailing Address: o` r , V L'_ `-' E I' ►ail 7� 7 Ou U r,/ r C d d J(D S
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 d = Longitude: 0 ° = . = ,`
Design Current R Des�gr C Trent
`� `Y
Swine
Ca aci P© elation Wet Poi,lt ry ;Ca aci P ulghon
P ty R
Cattfe
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
.10 Non -La er
1
❑ Dairy Calf
❑Feeder to Finish
'"+,�, p
❑ Dairy Heifer
❑ Farrow to Wean
;._
Poult
�l)�ry ry �.�
El Dry Cow
El Farrow to Feeder
�
❑ Non -Dairy
ElFarrow to Finish
El Layers
El Beef Stocker
El Gilts
❑ Boars
-:--
❑Non -Layers
❑Pullets
❑ Turkeys
❑ Beef Feeder
❑ Beef Brood
.
Other -
k_ ��;
_ ❑Turkey Poults
❑Other
❑ Other
Number of
,a•-—
,mod �.
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
P(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
K No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1 No
❑ NA
❑ NE
other than from a discharge?
1
12128104
Continued

Facility Number: —S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Lg600N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
Yes ❑ No ❑ NA ❑ NE
❑ Yes �Io ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes X No ❑ NA ❑ NE
❑ Yes XNo ❑ 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 avo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X 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 Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA XNE
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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
[Dyes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA kNE
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ No ❑ NA NE
Comments'.(r'efer to question #}: Explain any YES answers and/or any--recommendatians�or`any other&comments
Use draIvn s of facility -to better'ex lain situations use additional a es as necessa g
g P
S STl LL IN fr' l EL-5- )NAE Te �C.A i I+C CZ �J� ! T 1 CCU S -- i 4GZ6
I S 14C)7741n) 6 j © ?l,x p 01W . � o&- Rrse GA u_ ME WS S(2)dN
th71t-1- oNL NAu E Sap o GTE
Reviewer/inspector Name T/ r 5 .7 Phone: qx) 7�p
ReviewerlInspector Signature: Date: />rr lob
I2128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA I 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. ElWUp ElChecklists ElDesign El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
D�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1"
Rain Inspections ❑
Weather
Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
qNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
qNE
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
81NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
❑ Yes bq No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes *o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes XNo
ElNA
ElNE
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
.. -... -. .: .�;:.. .. ..R.e :"te. ....,._••e.. as._.,: -�.. :.T;.ax a.:"_.:.�'x::.:;9hs—"��s3,sh'^.yMaL:�'�f "_
Fr`_': +�":3�
- .
.1 e_caueb 13� t—rr} �jc,� Av So L� AT GiZ/,9 j 14 109 c� f n GM,`ac
rn TO C�5WJ_C- ON L-4G-03/\J $TPT(._S
12/?9104

n7,
.Drgsjonaof,Wate Quality
O Divtston"of Soil apd Water'Conseryatton:+•
�-..
-06
her Agency .
Facility Number��
Type of Visit
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
)0 Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: �rr� --�p Arrival Time: Departure Time: County: Region:
Farm Name: lW 1f17TC-D — Kj VC Tpy-rn Owner Email:
Owner Name: LCS u E V_• ��1 l 7?E �] Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = A = Longitude: � o � , EJ
��,�Design � Cum
ovine Capacity nPopula`
] Wean to Finish
] Wean to Feeder
] Feeder to Finish .
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish
Wet Poultry
" ❑ La er
;c
❑ Non La er
f ;Ur,� Poultry
J Boars ��-
Other"
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Cow
Heifer
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 KNo ElNA ElNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
I2/28/04 Continued

Faciliiy umber: f } t-/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: U600 J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Wo
❑ 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 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 Auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
NE
V
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
El No
El NA
,�,/
L,�$ NE
El Excessive Ponding El 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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
V 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 to question #!)., Explain any YE5 answers and/or any"fecommendahons 6r4anyother comments ._�
Use drawings of facilityto better ex la►n situations. use additional as necessar
,
m
Sc-L�= ��b�� N IC N P4�-SAP-iT+i rs mo(Z�N� -
AL
Q(LOuC HT Po A pPpGZu xxz6 -ra ti 1 S Son/ 'SO -F44RT T+I E C.CLkL)� utter cx�I q-'FILL-
� P 1C1C�TNA?t k N�U54 NC T��1SL �Gtac IA(Z I �CT1C�y ttilq
Reviewer/inspector Name WAIF E Phone: ej �Q 1Co`
Reviewer/Inspector Signature: I Date:
12/ cY/04 conttnuea

Facility Number: 3 , -- 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 4NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
J4 NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
" 1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ZNE
'27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NANE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
❑ NA
,y�
1�J NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
CkNE
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
W 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
OkNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
V NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
El NE
12128104

4 0 Division of Water Quality
:Facility Number �j S� 1 Q'Division of Soil and Water Conservation
- - 0.Other Agency .
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I� County: C-IN Region:
Farm Name: n Owner Email:
Owner Name: LE S LI c Phone: _
Mailing Address:
Physical Address:
Facility Contact: [� Title:
Onsite Representative: C �S L 1 En 1� • (A3 H l T i C PN
Certified Operator:. L Cr S L I C V` _ (A3 H t7T6•1�,
Back-up Operator:
Location of Farm:
Phone No:
Integrator: l_
Operator Certification Number: w
Back-up Certification Number:
Latitude: = c = d Longitude: = ° = 1 = LI
Design . Current Design. Current Design Current
1.­S'vine, . Capacity Population Wet Poultry Capacity Population Cattle Capacity; _Population ,
Wean to Finish er
Wean to Feeder � 1. rEPINon-Layer
Feeder to Finish (0 CST & SCE i
Farrow to Wean
Dry Poultry
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
❑ Layers
El 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 Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Numberof Structures:v.,
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
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
UqNo
❑ NA
❑ NE
12128104 Continued

L
Facility Number: — y
Date of Inspection MQ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 6 /GO OA -1
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes .0 No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes _J�'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
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes -TNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes i 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
4� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYeso
T
❑ 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):
ReviewerlInspector Name X6A Q [ 14 F Phone:
Reviewer/Inspector Signature: Oj� Date: q 4
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I� No ElNA ❑ 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 AIo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ''o No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes fi�'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 9No
❑ NA
❑ NE
29.
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 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 �No
[I NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 4No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Fdcility Number S') ( O Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,Coopliance
(;Routine O Complaint
O Follow up 0 Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: V Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: LESLI. = _ WIMP
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ c =' = Longitude: = o = 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current I
Capacity Population
❑ Daia 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ElNA ❑ NE
ElYes 2rNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L✓j 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: LACy" tJ
Spillway?:
Designed Freeboard (in): «�S
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
/No
6. Are there structures on -site which are not properly addressed and/or managed
[:]Yes
❑ 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ZJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ON' o
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
O�No
El NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,
TKI o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
ff No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
f Use drawings of facility to better explain situations. (use additional pages as necessary):
0(w UACrGOti DESZ60 DoA)E .
OX) WASTfo APftTL4T.1GW AP LL(cD ON aSS nNJ J:OCAL S`WD 6F &R-of 0FG, zv6fo. ►Jciir'
-(Cp" O"Pao.% ArAe#vDM.E►­rT FroA-- CA.0e A ll Que-smo&A CAij- Dw4
� P �J►TL 1�.2.aP `�Sk LA R� Lo2DS . e,r
'r4 u
Reviewerllnspector Name J 14Phone: �'j l p) 7 1G �— 7W
Reviewer/Inspector Signature: Date: u
12128104 Continued

Facility' Number: Date of Inspection I T/t
Required Records & Documents ,—,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ,DNo El NA El NE
lK
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ��,, ��
21. Ram
ord keeping need improvement? If yes, check the appropriate box below. D'Yes ❑ No El NA ❑ NE
e Application ❑ Wee Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[TN_
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2,90
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
,0,No
ETNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0'9-o-
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
To
❑ 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
-.to
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
,El,
L`"fNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of water Quality
Facility Number �� Division of Soil and Water Conservation
-. _ - _.. Other Agency
Type of Visit (Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ids Uz- tl, 01TT60 _
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o ❑ t = Longitude: ❑ o = ' =
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
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
❑ La er
❑ Dairy Cow
❑ Non -La er
❑ Dairy Calf
-` -
Dry Poultry
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ La era
❑ Beef Stocker
❑ 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?
JL! Beef Brood Cow4 1 11
gg
k pb7
um of Structures p.I IF
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 6No' ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L2(No
❑ NA
❑ NE
❑ Yes [DN/o ❑ NA ❑ NE
12128104 Continued

Facility Number: y — 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: G-W/J
Spillway?: W,
Designed Freeboard (in): a4
Observed Freeboard (in): 1
❑ Yes /No ❑ NA ❑ NE
El Yes ❑No El NA ❑NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LQ 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 2eo ❑ NA ❑ NE
maintenance or improvement?
Waste Application --
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes QTo ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)n}�
13.
Soil type(s) tj
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
-ETNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E; N
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
El Yes
ElNA
[INE
18.
Is there a lack of properly operating waste application equipment?
El;NoYes
❑ 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):.
20.) 5l'N11 bt,/o COY ar' ntEl-�) LAG 6oAJ kJ fv 9,6V-ZOJ
IV ANO rrAE_(f3on1e40 "V&C OIL REs&r LC-vEL RU(,Z)
z5,) leC-C,t ,op oG rLaoGC SSdaVf tVZM R-6LOrlb, SCND cof? AL4d& wz719
0 & aov Q c ,fx(N .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
L�Gu I Phone:
A.. Date:
12128104

Facility Number: —124 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Y s VNIo ElNA ❑ NE
20. Does the facility fail to have all components of the CA readily available? If yes, check Yes El El NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists esign El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WN El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
L� o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Ld Yes
❑ No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�eo ❑ N
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No fA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,.[Xo
LJ o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
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
El"'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
EVo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9!1 �� Arri� al Tim/e�: 2i eparture Time: 2r OC, ounty:
Farm Name: ( ,'fF r��Q — i[ ,-"4 �. Owner Email:
Owner Name GE�Z [rTTef� Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: Zs.Sz rc 44r- y' SS'a Integrator: &/.t oe /_5;71'�Ll
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 [ Longitude: ❑ o ❑ d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -Layer.
Other
❑ Other - -- - - 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA
❑ NE
❑ YesxNo
❑ NA
❑ NE
12128104 Continued

Facility NumberO/
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 '0 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 ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /JZNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VrNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L/.. &21Jt�J
13. Soil type(s) �Ql�
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 ElNA [INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ YesP No El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes YNo ❑ NA ❑ NE
cry=s7 70'_ t4t2Fa=- rW
�rj� �i�st/ fir✓ ���`' %��,.D� � �� ��/�JOr/.�.
Reviewer/Inspector Name 63t4,: /Q i Phone:
Reviewer/Inspector Signature: Date:
12129104 Condnued
Lt

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P"'o ❑ 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. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No [I NA El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
[:INA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
eNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�dNo
❑ 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
ONo
❑ 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
jNo
❑ 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2INo
❑ NA
❑ NE
(Additional 'Coruments.and/or'. Drawings
lU T
I212&04

]Type of Visit 0 Coopliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O(Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: Tune: 2 D
Facility Number
Q Not erational Q Below Threshold
Permitted Certified © Con�.ditionally Certified Q Registered Date -Last Operated or Above Threshold -
Farm Name: . _ . %f-�Q ...$NI_ _ , County: Ail P I/vj
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ____ _ _ . _ _ _. Title: Phone No:
Onsite Representative: .. l,S l+l Integrator.
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • U As Longitude • 4 �u
�Destgij
t ; t >
'Curren r `Garrett — uD
- t -
Curren
_ r
Swine =i~Ponitry 'tin Cattle
_
spa-Po
Wean to Feeder
Layer Dairy
Feeder to Finish 2,,25
b Non -Layer Non -Dairy
Farrow to Wean
"
t
Other
Farrow to Feeder
El Farrow to Finish
To#a�
Gilts
Boars
�� a; " r JL6bFSSLW
_
ar
Namber olf
�_
,�r,;�
_
..... _.. ,.,_ yam.....';.^"
Discharges & Stream tin acts
1. Is any discharge observed from any part of the operation? ❑ yes Imo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- I -- _ . ---- _ M__.... .. _ _ _ _ _
Freeboard (inches): 24
12112103 Continued

Facility Number: 31— 57 Date of inspection W d
5. :Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
El Yes
]�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
F'Ko
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
1.1wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
LSN/o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
M'1VO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C 5W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes lmo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes UNo
c) This facility is pended for a wettable acre determination? ❑ Yes GKo
15. Does the receiving crop need improvement? ❑ Yes To
16. Is there a lack of adequate waste application equipment? ❑ Yes Lh"No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes E:CNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EI(No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Fo
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 VNo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
23,) APP L_tr.AT",,,/ otJ ca- rw l C"i' wM +r h SUP196SCO tb 8(c Coo -IV Au n A
-ra gjusr_ eAR-APhrz (,A-FEMJ 6-f N;7OG(d,
P ru, 6� a fin-, =�' S�-c.Y} Q.�m ,�v 6"-V MW Cn'dN �k,Urstl. N1 qz 1.
� Ej_,_A 7T(tV`1�, eAg-0 L.C`CT.
a'.►� W-T-t-^tJ6-'i�It TbalaJ fA
Reviewer/Inspector Name t,
Reviewer/Inspector Signature:
Date: 1 ti t'
UtUtu1 LAnunaw

Facility Number:
Date of Inspection # •► 0
Rom. aired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Doe ord keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cattle noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes
❑ Yes �No
OYes ❑ No
❑ Yes
❑ Yes
lJ I
❑ Yes
N
❑ Yes
❑ Yes
FNo
❑ Yes
Yes
❑
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

i
Is
Type of Visit 'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Z 1S O Time:IQ I
3 t S 4
Not O erationat 0 Below Threshold
[] Permitted Q Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Q �' 11 G di Y_� hc, -r4r "`. County: , nw e)1►1
Owner Name: +' e S)'G W � ` -A Phone No:
Mailing Address:
Faeility Contact: Title:
Onsite Representative: &S a 1A
Certified Operator:
Location of Farm:
Phone No:
Integrator: e boo npfe hl
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude 0 6 IJ K
Wean to Feeder
Feeder to Finish I / 2- A I 6, / D
Farrow to Feeder "LJOthcr
Farrow to Finish
Boars
Subsurface Drains Present jjU Lagoon Area
No Liquid Waste Management Svstem
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 galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Freeboard (inches): 2
05103101
iWW1'
❑ Yes Y(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes,"No
❑ Yes �No
❑ Yes ONO
Structure 6
Continued

M
Facility Number: 31 -5 94
Date of Inspection Z l5 D Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 'ONO
❑ Yes ONO
Yes ❑ No
❑ Yes O'No
❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0No
12. Crop hype C a rv+114 A. -A 6e_e, Y•s _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;;rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes VNo
15. Does the receiving crop need improvement? ❑ Yes'0No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes,ONO
l8.
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
l9.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
, /ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
,["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
j'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JZ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refe�r�to queshon#} Egplatn anyYES answers=andlvr�any recvmmend.ahons ats;any otlier'c'o'inments y., . , h
�
Use drawings of facrlityFto better exglam situahons (use addihonaLpages as necessary) �
,; "� ,, ° ❑Field Copv ❑ Final Notes
T TI ere are Sowte looks c? ' wAs+r, 4ke hag kac.'-Se .
yet^ need Jo _�';)e 4t ese tea ks , J
14, We; able'Acecs �Ctse 6ecen chine as o-' NOvern6e,r ZOO].
N eed 1..,r;11 oLd ; vtSCt_+) 04..3 q n d ►'ri 0 foal t ti� �,cC►v+�v� G�!' c �t� }' �,
Reviewer/Inspector Name '' ` j) z-: �k �,S
Reviewer/Inspector Signature: Date: 1 O Z
05103101 Continued

r
Facility Number: -3 1 --5 741 Date of Inspection Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ff No
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the lagoon? ❑ Yes f'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes E'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 XNo
5100

L ti.
Division of Water all Qu ty
_.. Divrsiori of Soil and Water Consesrvatroa r
Other A enc -
- - 0 g y
m N
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: [--= Printed on: 7/21/2000
NNot Operational Q Below Threshold
13 Permitted 4-certified © Conditionally Certified © Registered Date Last Oper d or Above Threshold:
Farm Name: ...... .!!.1r4... ...1.' ' ..................I.. .................................. County:... .... .f / 1.....................................
OwnerName:........................................................................................................................... Phone No:..................................................
Facility Contact:..................................................................... .... Title: .. ..... Phone No:
MailingAddress:..................................................................... ....................... ...._............._................................................................................... ..........................
Onsite Representative:.. �,,5�/........... UR,� Integrator.......
.............. :....
Certified Operator:....................................................................._.......................................... Operator Certification Number:..........................................
Location 'of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
D A' Curreul
Svidne , _Ca a -Po uladC
Wean to Feeder
ceder to Finish
Farrow to Wean s
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nttiubetr of Lagoons
HbMini Ponds'PSohn Trai
PS..
❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
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 cstirnated 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: ......... Iiz.(4.......................................................................................................................I.............................,
Freeboard (inches):
5/00
❑ Yes 9No
❑ Yes ❑ No
❑ Yes
A //❑ No
✓vq_J
❑ Yes ❑ No
❑ Yes 14 No
❑ Yes r 0
❑ Yes KNo
Structure b
Continued on back

Fa ility Number: Date of Imspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,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 )kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IVNo
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 )ETN0
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 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �00
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,'VNo
5100

FaONty Number: 1— Date of Inspection r/ Printed on: 7/21/2000
1 5. Are there any immediate thre s to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
(VTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�,,
kNo
,r
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
'"�\'�i�
11. Is there evidence of over pplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
o
'
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment? ❑ Yes AFo
Reauired 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?
(ie/ WUP, checklists, design, maps, etc.) ElYes KNO
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes J�rNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes <N0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 15r-No
23. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative'? ❑ Yes JAio
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )�INo
: To-yiolatioris:or deficiencies •were hotted• during this:visit. • Y:oil will-k& ive 1i0 furthgr
- eorres o deik' ahotiti this visit. .
.,ommenfs (refer to" question ft Explain any YES answers and/or any recommendations 6r any other comments .-
Jse drawui of facility to better.explain situations. (use additional pages as neeessary)^
,:. Its.. _ _ � . = _ ., r _..
00 RA C w
Reviewer/Inspector Name
Reviewer/Inspector Signature: �' �� n/I I Dri-,�i� Date: L D&s U1Wz5/pp

_ .E3 Division of Soil and -Water Conservation �-Operation Review : , -
w; rvrsion of Soil and: Water Conservation Compli nee Inspection
0
Division of Water Quality ;Compliance Icpectiori { ` .,• R , „0 Other Agency Qperation Review
E
-
ISERoutine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 Date of Inspection
'Time of Inspection 0 O 24 hr. {hh:mm}
❑ Permitted afied © Conditionally Certified Q 13 Not Operational Date Last Operated:
Registered �"
1
Farm Name: ~ County:._........- t.. I,i_............................ I..................
Owner Name:
Facility Contact: ...........
:Mailing Address:..-.-.
................. ... .......... ...... ..... ........ .............................................. ....... Phone No:...................._.... ...................
.............. ....................................... _ Title: .... .---- -........ ............................ I................. Phone No:
Onsite Representative:. 1,,+` Q! .....,,..-
Certified Operator;
Location of Farm:
.....................................................................................................................................:... ..........................
Integrator:... ......................
....................................................... Operator Certification Number:
Latitude �� Longitude • �° �=
=- Design Current Design Current.. Design Current
v... , .. :. ...
Swine _
v Canacity Ponulation Poultry_. Canacity Podulation Cattle CanacltV Pooulatron,,
❑ Wean to Feeder
Feeder to Finish
' 'a-0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ElLagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/ruin'?
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
Identifier:
Freeboard (inches): _..........a. y ..�.............
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes
❑ No
❑ Yes
PJ No
❑ Yes
9No
❑ Yes IxNo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ��No
Continued on f back

aciliOOumber: — Date (11• Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
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?
0: Rio •yiblaliEgns:or• &hcje.ncies were noted• during tbis'visit: • Y:oik will•r. eeeiye iio further "
correspoiidehc' e' abauti this visit.
❑ Yes VNo
❑ Yes VNo
❑ Yes b�No
❑ Yes D�(No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes Nf No
❑ Yes 9No
❑ Yes No
❑ Yes No
❑ Yes NtNo
❑ Yes N'No,
❑ Yes IRrNo
❑ Yes Wo
❑ Yes [yNo
❑ Yes P(No
❑ Yes j0No
❑ Yes No
❑ Yes 0 'No
ar.
❑ Yes _�O
-Comments `(refer to-questida #) Eacplarn any -YES answers and/or any recommendations or any, other--'-'cmments
Use dr-a. w_i.n o_f facilrtY to'better ,ilain situatibnsi �.u.se.addi-tt o�n._al a s_ as_mecessaryex _
1
1 1 f �G.�'2 rytre �1[Y>�� ii� i� y'� `7`� ►��� CC'�C.l �_ C � W�3' � Q `
i S -
Ale,—
� y
3/23199

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
gNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
RNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XfNo
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
t`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
19No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
�No
AdditionalComments and/or. Drawingsc
J
3/23/99

Division of Soil and Water Conservation [3 Other Agency 4 z
®Dtviston of Water Quality ri
Routine O Complaint O Follow-up of DIVQ inspection O Follow-up of DSWC review O Other
Date of Inspection t ��
Facility Number
Time of Inspection L.[J 24 hr. (hh:mm)
'Registered © Certified 13 Applied for Permit © Permitted 113 Not O eretirsnal Date Last Operated: ,.,,,,,,
Farm ]Name �;�;il<i�.'.���.►`g �1;; rr. ....................... ... County:..... pw�>) } c......................................... .......................
`.
OwnerName: ....... Le. -La ......... 11 kiiij........................................................................ Phone No:. r' 19i..�i.S. %... L.Z.............................................
FacilityContact: - } . Title
.....�t.Sift........W�rl,:�a�fJ...................................D.:.As�..................................... Phone No: .61..11.k5k16.41........
Mailing Address: ... .,t'19.3......... N.L,..55skn..................... .......
OnsiteRepresentative: ....... PfS i. .....'!?�i. at ........................................................ Integrator: ....... 1.n�.t. .>.............................................
Certified Operator:........ Lnkc.............. 9 .............Gj................................ Operator Certification Number, .... J1j...&.P4..................
Location of Farm.
�Y.L....Ihay...y ..-r..... x .... .-.!�R.! �. a�rr...... e.......t1.r�....SR.1.F�,.. F.arm...... a.s........A.,.l...miLt ...(�5.1 ......S&J.111..I......
4.n .....>a a s.... 4 L...... !..:......................................... ............................................. ....................................................................................... ......................... F,
Latitude 0• 04 46 Longitude • 0° 44
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 12 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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 lagoonstholding 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?
7125I97
❑ Yes P No
❑ Yes
® No
❑ Yes
No
- T
❑ Yes
No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
❑ Yes
® No
❑ Yes
ER No
Continued
on back

Facility Number: — 5
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (L oons,Holdin2 Ponds Flush Pits, etc.I
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:
Freeboard(tt1-L., ...................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes [9 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? Q Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? Yes ❑ No
Waste Application
14- is there physical evidence of over application? ❑ Yes ® No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ...........S9, )V 4A!s................. lr_O.r.1.A................. W1.1 .. A ................. ........................... ............... .............. ........................ ..................... ..............
.-.
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 5d No
18. Does the receiving crop need improvement? ❑ Yes N No
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a fallow -up visit by same agency? ® Yes ❑ No
2t. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes 10 No
22. Does record keeping need improvement? ®,Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
0 No.violations or. deficiencies were noted during this, visit. :You4ill receive''no further
` correspondence about this.visit:-' ;
Explain:any YES answers and/or any reromrtiendattonsor any -other comments.
�r.+ -re � - - r - - - :a ri -- _ .+ Fes•, F' a,X„� '„'�"as
1 Z. r -0c,18-r, (,_ms o„ ►, l �ntr rOv�ta� dlke Wfr if c S�cv� x �i ��C� u;i e u�.d wsee�{�t
Tfcrs �_a:r 6�4ur del& w,,11,. anl, c.+ S�►ou�r� 1t rccPeJt��.
�►"(Ak y %. S�. -e cvj� I),-,. t, -ex d c -,?-�cs iocmaoq l�Ck - llN 1 to, k r icar cl.,t2 t,,-1e-e ed
13. i.•Cteppn i�dulit ljU� �lF*V►� t,c.wt� yy,gr��.�,
Ifs 5at4�ran S f1WA frl' iA Pit11)t atZ� Ttd �r �Irr+ owuJ hi�n►WL�.
ZZ. ?J nvt.6 . a-f Ert(iV t. A�iti;ts#►,:r-fat 14 Yay r,
wtu rosvij hAct
Reviewerfinspector Name ,
Reviewer/Inspector Signature: µ - Date: I l h-7 q7

•
Site Requires Immediate Attentio
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: / , 1995
Time: i33o
Farm Name/Owner:
Mailing Address:
County: LAG/ nl
Integrator.
On Site Representative:
Physical Address/Location:
W141
, -4/ng,
Phone: J (5 4yN
Phone: �/ y G
=S_e�q)
Type of Operation: Swine ✓ Poultry , Cattle
Design Capacity: �IJrJ Number of Animals on Site:�Q
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude. /� ' �" Longitude: -72—' _Q2_LL" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes q9 Actual Freeboard'x� LFL Inches
Was any seepage observed from the lagoon(s)? Yes N� Was any erosion observed? Yes No
'%
Is adequate land available forj� my? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C1_D19 ST^t-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es, r No
100 Feet from Wells?(5 r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional C 1pments: el �P�1�77al
LeOiCS MtUN- -F. RLTf9R 30 i�)ifVW_
41
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
Site Requires Ittunediate Attention:
' Facility No31= ;Ez<
DIVISION OF ENVIRON-iMENTAL MANAGE:yIE�`"I'
ANI`T%/ AL FEEDLOT OPERA;MYE
VISITATION RECORD
DATE: 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
� Inteato,'
0
Phone:
On Site Representative: Phone: -
Physical Address/Location: J
Type of Operadon: Swine Poultry Cattle
Design Capacity: i Number of Animals on Site:
DEM Certification Number. ACE DEM Ce:dficadon Number: ACNEW
Ladnide3i ° �_' /i " Longitude: % 0Y- ' ��—" Elevation: Fee:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient ueeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for st3rav? Yes or No Is the cover crop -adequate? Yes o No
Crop(s) being utilized:
Does the facility meet SCS minimum setback, criteria? 200 Feet from Dwe'.IinQs? Yes or No
100 Feet from Weis? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Swam? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS I'Viap Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -trade devices? Yes or No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes o; manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: � a
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c { IC<�'r 17..L 4i1 Vvi.�
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Inspector Name Signature
cc: Facility Assessment Unit
Use Anachrni nts if Needed.

Site Requires Immediate Attention -
Facility No. 3 $
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD_
' DATE: .1995
Time:
Farm Name/Owner: P&LIA:t Pu,(aw,
Mailing Address: _Q [ "�t LfL 06t 1i��e,t r C rib'S'c�
County: r-
Integrator: Phone,,.
On Site Representative: ke/ . C,�ti „_!_ Phor v i�— a -
Physical Address/Location: S A KI I2 v ` e—C �
Type of Operation: Swine Poultry Cattle
Design Capacity: LqLQ _ % Zv ( � Number of Animals on Site:. two Sv L's t a 6cx> S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: T) L(3' 3 S " 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) r No Actual Freeboard: Ft. ® Inches
Was any seepage observed from the agoon(s)? Yes o& Was any erosion obs�Yes 010
Is adequate land available for spray? or No Is the cover crop ade'q�u. }at Yes or No au S`
Crop(s) being utilized: Lo war [_.__.-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USES Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or" other
similar man-made devices? Yes orC11
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:
- 1%w` /
Inspector Name
Signat
lb
cc: Facility Assessment Unit
.,
Use Attachments if Needed.