310588_INSPECTIONS_20171231

NORTH CAROLINA
Deparbnent of Environmental Qua

i�ision of Water Resources
Facility Number - L O Division of Soil and Water Conservation
�her Ageney
Type of Visit: GrCompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: _ r D 1 % Arrival Time: Departure Time: ,'3p County: Dad: „,-- Region:
Farm Name: Vr5 K z U WY l%S �'th'- Owner Email:
Owner Name: % ( l� t _��,� !� t Phone:
Mailing Address:
Physical Address:
Facility Contact: �j l-/ rjJ/�� Title: 252/,
Onsite Representative:C�'U Y�'s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:r���
Certification Number: �`� %
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultsy
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
De, P,ouIt�.
La ers
Non -La ers
Pullets
Design
Ca aci
Current
P,o
DairyHeifer
D Cow
Non-DaITY
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
arrow to Feeder
Farrow to Finish
& (��
Gilts
Boars
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?
❑ Yes [a 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
0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
10 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

f, Facili Number: - Date of inspection: -- /
r Waste Collection & Treatment
;4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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: _k •�41r.._
Spillway?:
Designed Freeboard (in): f C-F
Observed Freeboard (in): vZq .3G
5. Are there any immediate threats to the integrity of any of the structures observed? D. Yes Q 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 allo
❑ 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 0 No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes n 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 0 No
❑ NA
❑ NE
maintenance or improvement?
I I - 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
aOutside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): u1
13. Soil Type(s): la 0!
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 allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ 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?
Rea uired Records & Documents
❑ Yes [2FNo ❑ NA ❑ NE
❑ Yes fallo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[2,No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
VLNo
❑ 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
rzA,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C2 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection: _ 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ LagoordStorage 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?
'-Tp 1.r`
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Yes [SjNo ❑ NA [] NE
❑ Yes ZNo ❑ NA ❑ NE
[—]Yes No
[]Yes ® No
❑ Yes ENo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: �w �7 G(
Date. S 30
ti
21412015

Dwision of Water Quality, -
ilCllli y Number.._ O: Division of Sail andWater Cons
OtheiA�encv:
Type of Visit -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,(f Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
WPJ?Date of Visit: Arrival Time: 10
; Departure Time: � County: Region:
Farm Name: 1,7-115 �--, S Owner Email:
Owner Name: aC- - 5c;_,/L&_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
M
Phone No:
Integrator
• 6 aoi�
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = i = L/ Longitude:
Design Current_ 4 T, Design Current'�Design Current
Swine: Capicity Population. _ Wet Poultry MCapacE.t}YPopufation Cattle — pacity Pnp>riation
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
_ILj Non -Layer
Pou..
I LJ Dairy Calf
=' ❑ Dairy Heifer
❑ Dry Cow
❑ La ers
❑ 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?
Beef Stocker
Beef Feeder
Beef Brood C
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 ,0 No
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: jDate 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):i
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
;�j No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[f No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
j;31No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JZ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Eallo
❑ 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
J2-�qo
❑ 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
E5No
❑ NA
❑ NE
:lected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
ie 2 of 3
21412014 Continued

Facility Number: - Date of Ins ection:
24. Did the fatality fail to calibrate waste application equipment as required by the permit? ❑ Yes L2"No
•
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ffNo
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)
3 1. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
Eno
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[2'No
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [ D'"No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes _Lno ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [;�Alo DNA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.;
Use drawings of facility to better explain situations (use additional pages as necessary).
/t�o�
.3116146 a, go
6,-1-4.
Reviewer/Inspector Name: Oft. //4/ ee � / -
/ L�
Reviewer/Inspector Signature: y� z
Page 3 of 3
Phone: V14 7q4 7,3;2
Date:
2 4/20 5

Type of Visit: JWCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:, Departure Time: County: Region:
Farm Name: W��, SJ)Nt ZNL. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: UT Ij& M. Ife,14 -
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: q
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. We Poultry Capacity Pop. Cattle
La er DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Fj
DairyHeifer
Design Current D Cow
Dr. P.oulti, Ca aci P,o , Non -Dairy
Layers Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other TurkeyPoults
Other 2ther
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes 7.No ❑•NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:'
a. Was the conveyance man-made? ❑ Yes V'No ❑ NA ❑ NE
b. Did the discharge reach waters of the Statd? (If yes, notify DWQ) ❑ Yes PNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �� No
❑ Yes U No
❑ Yes .I No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �5
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 P7No ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VTNo ❑ 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 PeNo ❑ NA ❑ NEmaintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 7No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VTNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes �TNo ❑ 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 P No ❑ NA ❑ NE
❑ Yes �fNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes �allo ❑ 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 jo No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o6 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FTNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .EINo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZrNo ❑ 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.
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 ONo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes PNo
❑ Yes P No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes gfNo ❑ NA ❑ NE
❑ Yes rP No ❑ NA ❑ NE
❑ Yes VTNo ❑ NA ❑ NE
❑ Yes [7No ❑ NA ❑ NE
(Comments (refer to question #): 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 95a-�L- Xft
Date:
21412011

Type of Visit: d Copipliance Inspection Q) Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ZG 3 Arrival Time: `T DD Departure Time: County: DLAOIal Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
On site Representative: G&CKF W%-Q9_F 17E k-AL6 +^ CLL-S
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Pacity
Current
Pop.
Wet Poultry
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design Current
C►attle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
760
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
2,
O
Dr. PoouIt ..
Layers
Design
Ca aci_
Current
P,o t
I Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[-]Yes [yNo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes � o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2141,2011 Continued

Facility Nt}mber: 721 - 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: �A &wA) $eta Qcoyct J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-14 2q
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
E?fNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes �VNo ❑ 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 [2] No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
FA/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
G3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rio ❑ 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 Inspectio�IN)
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Noa ❑ NA ❑ NE
Page 2 o 3 21412011 Continue' d
g f /

Facility Number: jDate of Inspection: 31 zo 113
24. °d t'he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EJ4
❑ 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
[Z/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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O N
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
rNo
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,.
Use drawings: of facility to better explain situations (use additional pages as ©ecessaryj.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( D)
Date: 3 & 13
21412011

Type of Visit: Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up Referral Emergency Other 0 Denied Access
Date of Visit: [ 1 .�_ Arrival Time: Departure Time:® County: D� LIJSI Region:
Farm Name: )�>eK /40l A�e LL.S Ir- A 2 AA, Owner Email:
Owner Name: HELLSg* --joN S ).,VC. Phone: 01I6 c981 `L/ L/19�0 C�
Mailing Address: oD 12j `� ryq Hezal Nc VA 1�-05L `41uL , /V�O1�T ` �� y �3
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: C4fk9_= Integrator:
Certified Operator: K.L}(� 1� . �� Li _S Cet'fif<c�h Number: 1tn—+S 9
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current esign C►urgent Design C+urgent
Swine CI(.maapacity Pop. Wet Poultrypacity P.op. CattleMGapacity Pop.
Wean to Finish airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
W1<20
a'y Heifer
Farrow to Wean
Farrow to Feeder
a
Design Current Dry Cow
Dr, P■Dolt . Ga aci_ty P,o , Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [—]No
D. Yes ❑ No
❑ Yes [:]No
❑ Yes tN
o
Yeso
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA C] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes No [] NA ❑ NE
Structure I Structure 22 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6cJ� 1 1�7M
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA 0 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 j�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I XI No ❑ NA ❑ NE
maintenance or improvement?
i'�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 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):
VLC- • PA e (-Li
'J
u
13. Soil Type(s): .- l j69X�-p(,K- n
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 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tNo
❑ 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.
OWUP []Checklists ODesign 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers [] Weather Code
Q Rainfall ❑ Stocking ❑ /OpYield [] 120 Minute Inspections [] Monthly and 1" Rainfall Inspections [] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [] NA ❑ NE
Page 2 of 3 21412011 Continued

Facility NAimber: I Date of InTection: 3 f 9
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 X1 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
1111'"'T���
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 I ][ I No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other comments. r
Use drawings of facility to better explain situations (use additional pages as necessary).
�.a L"pf A
3I aria 4
cat
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: C)j6--iqty4V
Date: J( p�
21412011

Facili" "Number '
+.�,vg,,.,.: .µmy-.,:. m.r.• �`S_r. rs Hv
Drv�sion of VV tei
Division of Soil a.
Q�Other;:Agency� _„;
e.
rrvation
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A.Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [3 Denied Access
Date of Visit: Arrival Time* ® Departure Time: County: UM Region:
Farm Name: E V_aLR lN, LLS _PPCG M Owner Email:
Owner Name: [_L �1 o } Phone:ry{��
Mailing Address: 3 Tbi, F-awc F (� Vc-caE 14lLC /VC, D(39 SE - � -3y
Physical Address:
Facility Contact: Title:
Onsite Representative: LtIQ"
Certified Operator: M—UA3f=LL%
Back-up Operator:
Phone No:
Integrra�ato��r:
Operator Certification Number: 1 V4 S9
Back-up Certification Number:
Location of Farm: Latitude: E__1 o E__1 " Longitude: E] o ET
Design Current `� Design Current��Design Current
Swine , Capacity
Populat�onWet Poultry CapaciilyPopulat�on�
Cattle Capacity Poptation
.u....,. ,.w .. ....
_
_
-� ❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder
: ❑ Non -La er I I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑Farrow to Wean
❑ D Cow
Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
ElLayers
i
x ❑ Beef Stocker
El Gilts
ElNon-Layers
- El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
rke s
therR,
� rke Poults
w tE
Otherher
umber o tructures:
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes xNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
.No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

�l
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: sok% INjs#
❑ Yes J No
❑ Yes 1❑l No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?: p
Designed Freeboard (in): j `l . -! • S
Observed Freeboard (in): 12
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 3] 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) 0
9. Does any part of the waste management system other than the waste structures require ❑ Yes ANo ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No [INA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3kNo ❑ 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) S f� LPG OF ►nit Gil L(-LcTTM FEx,6M
13. Soil type(s) 1N g
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 qNo ❑ 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 V_No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
Comments (refer toque§lion #)..Explain any YES answers and/or any recommendations or any uthere.commentN
Use drawings of facility to,better:explatn„situations (use additional pages as�necessary)
a
Reviewer/inspector Name
I>✓S
Phone: q 1[} +q&
Reviewer/Inspector Signature:
`11
Date: 5 1
Page 2 of 3 12128104 Continued

,,' 3
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ANO ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box. 0 WUP 0 Checklists !!!!!! ��`��`
� Design 0 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application [] Weekly Freeboard 0 Waste Analysis [] Soil Analysis ❑ Waste Transfers✓✓✓111❑Anual Certification
O Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections 0 Monthly and V Rain Inspections ❑ 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
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yeso
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
jNo.
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYeso
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1ANo
El NA
El NE
Other Issues
✓✓✓✓✓✓ ������
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
?No
❑ NA
[I 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
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
No
❑ NA
[I 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
Tl
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,
❑ NA
❑ NE
Additional Comments and/or Drawings:
w ;�
C A L_ 9Q-ATKW btAfy i
W.H. Sow
1r,^t
S&
-41
So I S Ig C S
TA
19f io - 51lur w 14171N(% 0A1 "gt~L'1 S
Page 3 of 3 12128104

Division'(]
Faetltt -Number 3 � O..:Divasion.a
Type of Visit OCompliance 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: F 47715 1 Departure Time: County: V Al Region:
Farm Name: A C L),)LL 1�704LK Owner Email:
p
Owner Name: ���LLS 'f ` S ram// I C . _ Phone: q16 -p r r� - (4y 7
Mailing Address: eg) !� 1AEO` N6 W V63e 0f� / VC O� `1SR - (�_:, y
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: bf_--jCQ
Back-up Operator:
Location of Farm:
Phone No:
Integrator: pJ [�
Operator C�fifcation Number:
Back-up Certification Number:
Latitude: [—] 0 0' [_—] Longitude: 0 0 =1
Design . Current• Di
Swine
Capacity P,opulahon Wet Poultry Caj
-
❑ Wean to Finish
❑ Layer
El Wean to Feeder
❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean
Dry Poultry=
Farrow to FeederTL
"
❑ Layers
❑ Farrow to Finish:
El Gilts
❑ Non -Layers
Boars
w~ El Pullets
❑ Turkeys
Other
�� ❑ Turkey Poults
M
v ❑ Other
F_; ❑ 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 Brood
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 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
10No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

,U-_
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 ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 5'04--N F1 /V
Spillway?:
Designed Freeboard (in): ! Q . )q, S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes XNo ❑ 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 �1No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ 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? 0
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ElNA ❑ NE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy 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) /Vaf UAC `ice, /,q-s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes QR No ❑ NA ❑ NE
.. ... ,. "r ,•.,: t;.. rw�::c�7-ass:-.e,e. y. _. -:mow+va per' .II i,•R .. ; a
Comments (refer to question #) Explain any YES answers and/or any recommendat onsMrj,any other comments �5
Use drawings of facility to better eiplain situations (use additi6nalpages as neces'siir- Z..
Reviewer/Inspector Name ( w ^le_ .S, Phone: 0 i `J(9'q Sd ;7
Reviewer/Inspector Signature: I Date: �% tfJ/d
12128104 Continued

Facility Number: Date of Inspection /0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes YkNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design [] Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ /aste Transfers ❑nnual Certification
J0
❑ Rainfall ❑ Stocking ❑ 4rop Yield 0 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes -%,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes %No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes *No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
_
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes I No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes �kNo
❑ NA
❑ NE
f A(_t0e44__idH DkE 1%)C)
y
ajgjoc, .`/ ICo
SoM 1, _�> fS
12/2VO4

Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OkRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 10-a9 1 Arrival Time: ® Departure Time: County: D&W Region:
Farm Name: hagAus Owner Email:
1
Owner Name: SONS Phone:
Mailing Address: 1 --T... E 9.�qN6. _ .SE t-L /'JC
Physical Address:
Facility Contact: �` Title:
OnsiteRepresentative: l'Q'f.E i N�{�
Certified Operator: b P,�1CALM
q !' t • V3P_,i-(-S
Back-up Operator:
Phone No:
Integrator• [�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = Longitude: a ° = ` 0 "
Design Current.
Design Current
Design Current
Swine Capacity Population
Wet Poultry Ca achy Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ can to Feeder
❑ Non -La er
❑ DairyCalf
Feeder to Finish
�j
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
0
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turke Poults
❑ Other
Number of Structures:
❑ Other
Discharp-es & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes �Q 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
C4No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
I No
ElNA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

a
Facility Number: 3 — 58K Date of Inspection 10
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: [511,1 S'D L�'.l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 00 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes D(No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
%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)�3�5TtAQ�
13.
Soil type(s) PJ [
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
VO No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[XNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
%No
❑ NA .❑ NE
'• ra2 .a3 �-- ..—m ',1r ".`- - , :.' �° .,. -. '".w _-.-k t�'^:. ».. � `� v'ay is. '�wa#s.Ba
;Cowmen#s,{refer to questtone#) Explain any YES answers and/or any recommenoations06Pany other comments ;
:Use drawutgs oft: cit ty�,to 6etter,explamr.situations: (use additional pages as necessary)
{
Reviewer/Inspector Name I�� Phone: 1 y
Reviewer/Inspector Signature: Date: Q 0'�
Page 2 of 3 12128104 Continued

Facility Number: 131— 5SK Date of Inspection CS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropirate box. [3 WUP 0 Checklists ❑ Design
g [3 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Vaste Transfers ❑,nnuat Certification
Rainfall O Stocking 0 Crop Yield El 120 Minute Inspections 3 Monthly and 1 ° Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JXNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z 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 property dispose of dead animals within 24 hours and/or document
❑ Yes
IM No
❑ NA
[:3 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
DQ 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
QtNo
❑ NA
❑ NE
Additional Comments ;and/or4Drawengs
Page 3 of 3 12128104

ivision of Water Quality
FacrlitySNumber i O Division.ofSoil and Water Conser ahon ' " �Ye
er w
0 Ot 'Agency � t
Type of Visit .Qftompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .0 Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: W i-
Farm Name: / ?43 �z-dq✓► C ____ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / { Title: Phone No:
Onsite Representative: Qe KCr i � „ W>� ,5 Integrator: a P S �c+� A&I
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f ❑ it Longitude: = ° = 6 = fl
7.
esE n Current's ""� "�u g
es g rrent,
,.
Capacity „Population g°Wet;l'oultrvCapacity Population. Cattle pacityP,,op ulation
J ❑ Wean to Finish
,, ❑ Layer
❑ Daia Cow
lit❑
can to Feeder
- % �C.> O ❑ Non -Layer
Dairy Calf
® Feeder to Finish
bC 0 .. ❑Dai Heifer
Farrow to Wean
«Dry, Poultry
❑ D Cow
El Farrow Feeder
_r,
`"" 4
❑Non
to
❑ Farrow to Finish
. ❑ Layers
; -Dairy
El Beef Stocker
❑Gilts.
❑ Non -Layers
El Beef Feeder
E
❑Boars
❑ Pullets
ElBeef Brood Co wl
El Tu.rke s
PoultsOther
FoTurke
Other
Number ofStrucu
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What.is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes X3 No
❑ NA
❑ NE
❑ Yes [TNo
❑ NA
❑ NE
El NA
❑NE
❑Yes ,fN.
❑ Yes gfNo
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

FaciliNumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes [Z No
❑ NA
❑ NE
r_
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes oNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify 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 PK&o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 12rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4!j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

ection:
Facility
Number: - Date of Ins
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 C2 No
iihe 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 [D No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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
Z 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
[2 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
JZ 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
Z No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinEs of facility to better explain situations (use additional paves as necessarv)_
A
3/;-1//
Iry � z
11)/a,3/1y j, o
�•� 2 L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
� F4'rm fi ke6crGe.5 %ak r-,4
Phone: 3
Date:
5
21412015

Division of Water Quality
Facility Number 3 5 8 Ell
0 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 V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % Od Departure Time: County: U Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: /7 Title: . �.W Phone No:
Onsite Representative: 5'� — Z � Wte I � Erjo ! K wIntegrator:
Certified Operator: _)be tr_ 4tz Operator Certification Number: � 5�
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = , ❑ « Longitude: = ° ❑ =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer �I
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
Lj
❑ Farrow to Wean
® Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Im acts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
a
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
-A
No
❑ NA
❑ NE
12128104 Continued

1
Facility Nuin`iaer:
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 Structure 4
Identifier: 'R3w FIN►sri
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t9
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
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes kNo ❑ 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 ❑ 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 VNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drifl ElApplication Outside of Area
12.
Crop type(s) 9jeX&kt✓t1Q)/A [ eS a :5 1A 5C c&6
13.
Soil type(s)jQ,� �!�/�►
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
1 rNo
❑ 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
allo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
57No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
P�No
❑ NA ❑ NE
Comments (refer to questioti #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: Rib
Reviewer/Inspector Signature: - Date: S
12128104 Continued

r
Facility Number: — i%F Date of Inspection 13 J S Q�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes I�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ErNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes -�ZNo
❑ 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 grNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes gNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes PffNo
❑ 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
[INA
ElNE
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 Iq No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes (V No
❑ NA
❑ NE
12128104

Division of Water Quality
Facility Number S8 O Division of Soil and Water Conservation
----Agency
Type of Visit 0��compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 56 Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: > O Arrival Time: i cDeparture Time: ounty:
Farm Name: 5 �/✓G F2� Owner Email:
Owner Name: (/V1�4 i Or �Od'�-s_/"� Phone:
Mailing Address:
Physical Address:
Region: 411A9
Facility Contact: Title: �,� s hone No:
Onsite Representative:llet:����� -- f� antegrator: _ _ e5% f
Certified Operator: f A-f!£ G�— Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 Longitude: = ° 0 = u
Design Current Design Current . Design Current
Swine Capacity Population Wetpoultry Capacity Population Cattle Capacity Population
IL-1 Wean to Feeder I I I
LJ Farrow to Wean
OFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet
Dry Poultry
Non-L,
Pullets.
Other
Poults
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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures. �.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ YeA.No
o El NA ❑ NE
El Ye ElNA ❑ NE
1 /2 I004 Continued

Facility Number: `j — Date of Inspection (G D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA El 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?: NO NO
Designed Freeboard (in): lq.5
Observed Freeboard (in): ; jU
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 9No
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes4No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes o
:9�3
El NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesX
No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ElNA ElNE
ElExcessive Ponding [IHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wi dow ❑ Evidence of Win Drifl ❑ Ap Iication Outside of 3
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes9_'
o❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YeVXNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes YIN,o ElNA [INE
17. Does the facility lack adequate acreage for land application? ❑ Yes YNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes [Z No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
g4) Lf 6,) 41-7= `¢5' _ W v �S"
Sow . 5,46, -7-'— 5/, .3 `,,-10 8'v
7 / le ��7inE.tJ r lZ ea
Ff pp
Reviewer/Inspector Name '�4&9 p�� Phone: 7�� 7�A` 32T
Reviewer/Inspector Signature: Date:
12128104 Continued

t '
Facility Number: — Date of Inspection I OIL 0
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 appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
[I NA
❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste
Transfe s ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain
Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes /yJ 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?
❑ YesX,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 No
X
ElNA
❑ 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
XT
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
//
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/ror Drawings:
/.'.0 2acx'o Soar ��d�e> ---=>
12128104

r
i_
Facility Number E g
Division of Water Quality y
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q 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: 5 /`Q 0 Arrival Time: 9 Departure Time: I Q ounty: Region: ! �O
Farm Name: — S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: /��� ���= Ek Integrator:
Phone No:
Certified Operator: — was Operator Certification Number:
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
[=]" Longitude: = o = ` = "
Design Current
Design ` Current
Swine' Capacity Population .
Wet Poultry Capacity Population
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -La er
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
Farrow to Feeder
Z
❑ La ers
n Farrow to Finish
:" U Gilts
Other
❑ Other
Non-L
Pullets
Other
Poults
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?
Design
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures V
- - W7,
T
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
12128104 Continued

Facility Number: —S8q Date of Inspection !b
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ 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): h ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VfNo ❑ 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 Zo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? Cl Yes ❑ 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) 10
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? /
IL 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 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0� Evidence of Wind Drift ❑ Application Outside of Area /�
12. Crop type(s) �/nL/,0 V`f�f�7.f �[J�-%�S�ri 44, A)A,
13. Soil type(s) /i/Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary)
,$) f jlofo wf� �g �5 �,�
Reviewerllnspector Name ,B I Phone:
Reviewer/Inspector Signature: Date: Jr / ,96
Page 2 of 3 12128104 Continued

225�3
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes
kfNo
❑ NA
❑ NE
❑ Yes
jzfNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )ZNo
❑ 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 ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
X
❑ NA
ElNE
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
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes/-11
0
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

S9T
Type of Visit i3`co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l7 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0{D Arrival Time: 1610 Departure Time: County: DVr &J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: SLOA w tLib
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number: _
Location of Farm: Latitude: = e = ' 0 Longitude: 0 °
Design Current
Swine Capacity Population
❑ Wean to Finish
Wet Poultry
❑ Layer
Design
Capacity
Current
Population
Design Current
Cattle C►►opacity Population
❑ Dairy Cow.
❑ Wean to Feeder
1 10 Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
® Farrow to Wean 1Q
?o 50 Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stacker
❑ Beef Feeder
❑ Gilts
❑ Boars
El Brood Co
Owl
ther
Number of Structures: a
❑ 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?
Page I of 3
❑ Yes JNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
ElYesVN
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — Date of Inspection 8 3 1i
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: CA &C%*J LA&V,4 5919
Spillway?:
Designed Freeboard (in): • ��
Observed Freeboard (in): -3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Elu 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
O 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 ❑Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Apalication
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 ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) z CMG SG a E�
13. Soil type(s) A.,reganug QLA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ll iNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�,,�NNoo ❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes O No ❑ NA ❑ NE
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 E? o ❑ 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):
21,} T-s w5Kd_ U4e O F� Yge-Z P Cgoe Yr6L.P Foot .
Phone-
Reviewer/InspectorName I ,y�l �� C91ty 7�/b -73.
Reviewer/Inspector Signature: i Date:
rage z of j 11&1Z01v1f . ws. _u

r
Facility Number: - 01 Date of Inspection I wwo
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
❑ Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4[l N El NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
❑ NA
❑ NE
❑ Yes
L rNo ❑ NA
❑ NE
❑ Yes
O No ❑ NA
❑ NE
❑ Yes
❑ No E NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
9'NNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12178104

3
Type of Visit jo Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint A Follow up O Referral o Emergency 00 r ❑ Denied Access
Date of Visit: / Q Arrival Time: �� eparture Time: County: �Z­QJ Region:��i2O
Farm Name: O Owner Email:
Owner Name: a . �IQ!)'14 Z C__ 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 =' [_]" Longitude: [= °
Design Current Design
Swine Capacity Population Wet Poultry Capacity
Current
Population Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Feeder to Finish
Dry Poultry
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Layers
❑Non -La Non -Layers
❑ Boars
❑ Pullets
El Turkeys
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?
Page I of 3
❑ Yes
10No ❑NA [3 NE.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
'0XN
❑ NA
❑ NE
ElYes
o
❑ NA
❑ NE
12128104 Confinued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA /11E
[I Yes El No El NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA VNE
(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 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 ❑ NANE
maintenance or improvement? //
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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
P�qE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
WNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
A NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
XNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
VNE
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):
40� UP©�� �o �EC>Y Ow
f-U�9stF �� ks l/a7 o DAi 4�i /os CO pL-L n� s-P E10- 0 A).
�
A/440 1 � �F �-�'�..J � �4A�� /O4
io �� AGE OX .� wee- L��-5'dE1 �,� ue 7;5'
00,
ReviewerlInspector Name I Lj Phone
Reviewer/Inspector Signature: Date: �$
Page 2 of 3 12128104 Continued

Facility Number:3 s Date of Inspection 1L5 /T
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 El No ❑ NA /� NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 4 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ZNE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
Pj"!4E
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
A
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
❑ No
❑ NA
XNE
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 CAWMP?
❑ Yes
❑ No
❑ NA
?I' NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
El No
El NA
/ZNE
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
El No
El NA
,,�(
,�J NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Xyes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
fiIV4 0�9,5 4,
o 7-
Page 3 of 3 12128104

Q
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: lOap Departure Time: County: P t1Pt-� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: 7 F1 d GJt L'L'S CxR(=C rL- M600-C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =f =" Longitude: =0
=6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
i
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L✓J No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ElNA
ElNE
❑ Yes
ElYes
L N ❑ NA
ElNE
ElYes
No ❑ NA
❑ NE
12128104 Continued

! Lv. 2
acihty Number: 11= 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: C_UeE
Spillway?:
Designed Freeboard (in): ?
Observed Freeboard (in): �5
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 [2fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �,.Ji 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 L,J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1 2 No ❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CfNo ❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s) fL.,o` �rryr212� t Ce) �' %0 SA w -
13. Soil type(s) IV 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L]'Kol
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
91 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LTV
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El
�'J Ala
❑ NA
❑ NE
9-61) U90ATle
Reviewer/Inspector Name
LAGS►-) 0CS -rG
Reviewer/Inspector Signature:
,_1 Phone:
Date:
12128104
-ram - 2.2 � S-
a )a - o �r
Continued

acility Numher: — Date of inspection !0 of
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 CAW P readily available? If yes, check
�s
❑ No
El NA
❑ WE
the appropriate box.
❑ WUP ❑ Checklists Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C 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
NNoo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
<
Ekoo-
❑ 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
oo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<o ❑ 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
2rNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Ad`d�hatial'CommentsantU6r,Drawings vy.�m
12129104

s'
Type of Visit Qf Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number Date of Visit:
Permitted Certified © Conditionally Certifiied Q Registered
Farm Name:
OwnerName: ,,._...______._._.............
Mailing Address:
Tune % 266
Not
Date Last Operated or Above
_._.._
County: -- -
Phone No; .. _... _ ,..
Facility Contact: _ ._ . ._ __ ....__ Title: _ _W _ Phone No: ...
Onsite Representative: C IC ALA y4_L-C S _ _ _ .� Integrator J M C
Certified Operator•. , ,.... .,� , , , , _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 " Longitude • 4
Carreat Desga
CQrrent Desiga Cnrreat
:. n v
Svvnne .-;Po"' tion�'��tr3'_;"- _ . �.
� �' � . Po
Cattle
flog;= ,- .. � Po -" `tion
Wean to Feeder Layer
Dairy
Feeder to Fish ❑Non -Layer
Non -Dairy
Farrow to Wean
Farrow to Feeder
n
Farrow to Finish
To#a
CaPaci
Gilts
Boars
Namlier oflagoons
Discharses & Stream Impacts
I _ Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 7No,
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
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / _ ____ . . _ .. W _ _ _. __
Freeboard (inches):
12112103 Conditued

J
Facility Nuinber:3i Date of Inspection r " lmdaw
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ yes
ONo,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
El Yes�/�o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
S. Does any part of the waste management system other than waste structures require maintenan�mprovement?
❑ Yes
30
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 maintenancerunprovement?
❑ Yes
Nc}�
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
/.f
❑'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype J & C R
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)?
❑ Yes
FN9
14. a) Does the facility lack adequate acreage for land application?
ElYes
b) Does the facility need a wettable acre determination?
❑ Yes
[ Z
c) This facility is pended for a wettable acre determination?
❑ Yes
Yes
15. Does the receiving crop need improvement?
E
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
L.d'No
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes [1N0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ No
/
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes L�' 0
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 2<0
11
Air Quality representative immediately.
kLise dra�vmgs of�#'ac�o better.,.lxpiatta a�matiaus..(ia��add��nalfpages as;rYi ❑ Field C Final Notes
Reviewer r Name �' v ,M�«��
Reviewer/Inspector �..��•. '��� - _. _ _ . _ t � _ -y 4q �. ;� � . � �; �z•�:—
Reviewer/Inspector Signature: n Date: 'J O
. r
12fJ2A I -On rnued

Facility Number: Date of Inspection
i� Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie! discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N! TDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
3I. 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 impmvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes o
❑ Yes
❑ Yes No
❑ Yes No
❑ Yes LiN0
❑ Yes No
[:]Yes To
❑ Yes L jNo
❑ Yes No
Yes ❑ No
❑ Yes EJ'N
[:]Yes �Z,
❑ Yes ;I/O
❑ Yes 500V
❑ Yes
12112103

Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O grational 0 Below Threshold
Permitted O Certified O Conditionally Certified E3 Registered Date Last Operate r Above Threshold:
rARM
Farm Name: — L i) �t�IJ�} County: u�zl�
Owner Name: •Q� scar CLL,_e" _ Phone No:
Mailing Address:
Facility Contact: 1 Title: Phone No:
Onsite Representative: w K � �, 0 Integrator: R .5
Certified Operator:
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �4 " Longitude • 1
Wean to Feeder
Farrow to Wean
Farrow to Feeder
Soars
Waste
Non -
Discbarees & Stream impacts
I. Is any discharge observed from any part of the operation?
❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

4F
Facility Number: 3 1 — , j 4E6 I Date of Inspection ! D
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?
(]f any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
l I . Is there evidence of over application? E] Excessive Pondijig ❑ P
12. Crop type \L) UDN t L- -"Z F L LR&2
13. Do the receiving crops differ with those designated in the Certified Animal Waste
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?
❑ Hy ulic Overload
Plan (CAWMP)?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes VI No
❑ Yes 14 No
❑ Yes [;M No
❑ Yes Qf No
❑ Yes [A No
❑ Yes Z No
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
VNo
❑ No
❑ No
�No
�No
❑ Yes 14 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
O No
No
No
No
No
No
No
VfNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #� Explain any YES answers and/or anyrecrommendarions oraayAothercomments ,
x h
Use drawings of facility to;better situations :(use addtbanal'pages asnecessary) '
explain ❑ Field Copy ❑Final Notes
NU'r-s
aOm pLF-1-r Roo �RG-aa�zzF ��col�l��n]D Lp,arCz_,Jc_
StkM KV R ►" t N L k N [-5 nN Stec_ J F_ 5 — i F P cR -r- �2 Fe-s.-o T�
`T �,L-NQ_r �
�� r� � F 0 �,�J 6 a s,N rye e2 �% UN_-S .
r R 5 f= zF_ LD 'S L o D K F 0 & ©O ,, !'1�� LCr aR P,-2_lJ V a F� S j�' F_ p
sae)
.
Reviewer/Inspector Name r -�
Reviewer/Inspector Signature: Date: 2
05103101 1 r Continued

r
Facility Number: `,lj — Date of Inspection
or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O 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 PJNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: r :,
05103101

IType of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit A6Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit:
O Permitted O Certified 0 Conditiionally Certified D Registered
Farm Name: 1)e j-, rj 1t1 jell]S F•,, ,-\
Owner Name: T e T-At& b W e �r 5
Mailing Address:
Facility Contact: 1 Title:
Onsite Representative: De �ct 1 h (,/ell/ s
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold:
County: DvPl"n _
Phone No:
Phone No:
Integrator: _Pre4ot q e
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' u Longitude 00 4 �_Ju
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes V No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SUillwav
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 21No
❑ Yes 'P'No
❑ Yes �No
Structure 6
05103101 Continued

Facility Number: 3 /—Sf3 Date of Inspection r /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or /
closure plan? Cl 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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes F
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 12'+io
Waste Application
10. Are
❑
there any buffers that need maintenance/improvement?
Yes
[�No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
,ZNo
12.
Crop type _ 13ernm UAelT''X4�{_5' cn)I �'►^tom�'h �Sv►+rr,tie� !ihmV0 ,
Wrrje"
i3fV'4
13,
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
WNo
c) This facility is pended for a wettable acre determination?
❑ Yes
XNo
15.
Does the receiving crop need improvement?
❑ Yes
ANo
16.
is there a lack of adequate waste application equipment?
❑ Yes
PNo
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
m No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
8
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
'XNo
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J;�rNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
,ZNo
1.13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to,queshon #) Explarn any{YE5 answers and/or anrecon►mendahons or any other comments �- � r+:. s
Use di•awmgs_of facyy,ility t�o better�explatn situahans:'(u}seac�ciittonai pages as necessarv),� .,- ❑Field Copv ❑Final Notes
rrdjoS, Dine{ r'eCorp(s Arc we
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -7 r7 Z
05103101 Continued

!r
Facility Number: ,3) —StT#J Date of Inspection 3 2 Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ;21�0
❑ Yes 2 NO
❑ Yes 2rNo
❑ Yes 'ZO
❑ Yes ErNo
❑ Yes J2No
❑ Yes ❑ No
Additional, Comments and/or.Drawings:',:
IF
05103101

j�Drvtsian of Water Quality
D Drvision of Soif and Water Conservation _
s
ter_ Q.OtlterAgeney
°s
Type of Visit—,,6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 01Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
❑ Permitted ❑ Certified fQ Conditionally Certified l] Registered
Farm Name:......e��~.(..?....E�f..S...i:./j ..'�'�.....................................
Owner Name: ..................Du!§.. l b..... eL�s........
Time: � Printed on: 7/21/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ..
County: '?.U�, n
Phone No:
Facility Contact: .............................................................................. Title:......................... Phone No:
MailingAddress:.......................................................................................................................................... ..........................
Onsite Representative: sl/. e..LU......t! l..�S .. lntegrator:.�� erLd'1..................................................
f
Certified Operator:,,,____. ....................................... Operator Certification Number:.,,,,_,.,,,
Location 'of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 &6 Longitude • 4 «
Design Current
Design Current Design Current
'Capacity Po ilation
Poultry CapacityPon Catte
lioulatiCPeon
Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish JE1
Non -Layer I Non -Dairy
Farrow to Wean
_ arrow to FeederAr 2-
❑ Other
_ Farrow to Finish
Total Design Capacity
Gilts
Boars
Tota1:SSLW -:
n �r pf j,ggpppg
Subsurface Drains Present ❑ LagM►n Area 10 Spray Field Area
U. Hollmg Poems / Solttd Traps ,
:.
❑ No Liquid Waste Management System ..
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ffNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes-,d'No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes'ONo
2. Is there evidence of past discharge from any part of the operation? [] Yes�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ YesP"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpilIway ❑ Yes J:allo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier........... .......... ........................ ............................................................................................................................................... ............
.......
Freeboard (inches):
5100 Continued on back

Facility Number: f Date of Inspection z C Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage,
yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes,&No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes eNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Vi No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZNo
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes -ONO
11. Is there evidence of over application? ❑ Excessive Ponding PAN ❑ Hydraulic Overload yes ❑ No
12. Crop type &e.-►•►2tIQA Tas4 't_15�r t f l 61 L ,.�+m�✓ rrnu�il �L►1�n-��� i�nvq,)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J;3'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes 111�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ZNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
,0'No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
Yes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes )2(No
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes&No
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes J�kNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes21No
24.
Does facility require a follow-up visit by same agency?
❑ Yes .UNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes _P"No
�'Vo•yioiat ris:ot• defeiencies •Were noted diWirtg this:visit'. • Yoa Will•i-&0*46 do #'. irther
correspondence: aba'uti this visit
in any Y _ , -answer
if • T�eee wqe _<pMe aVcrgtplp�iC,a,�ib''t 7?14rorei, on 41-tc Z400-2tn •
1�. Ttie aver�pf 1,`c `��? �'� W04M above 2,)CLS dve /o
not vs i V GZI id wcr 41 s,`sCgCl Gv l q j� ,^v� ear wl;apal•
�e jvre 0 14se A c�aS fe anal k deded t.v,-ri :h C D d4 �i`e4�1"0
a A Ac �i�'%�� 21-f . re eem �?d 46 ale &.q si s � 1c SAP c � �a�
a
Reviewer/Inspector Name C n,G w14
Reviewer/Inspector Signature: Date: cs 5100

Facility Number: % —s Date of IEispection o wboPrinted on: 7/21/2000
Odor Issues "�"
26. Does the discharge pipe from the confinement building to the storage bond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yesf_-fNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesAgrNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Pt"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -0"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings* 7veil k"(j wka+-;,r leij Tf-,�ed priar -le r
5100

Division of Water Quality
= 0 Division of Soil and: Water Conservation
0 Other Agency -�
E
f Visit Compliance Inspection O Operation Review O Lagoon Evaluation
n for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit- 224 Tune: A Vi d /21/2000
Facility Number
0 Not O erational 0 Below Threshold
Permitted Rk Ce
rtified [3ConditionallyCertified 13 Registered Date Last Operated orAboveThreshold: ......./................
Farm Name: s... �..ly 5 County:................L...Lre�..r.f...h,............L.�.-..........
OwnerName:..... .lb. 1. ............ ............. N". —1.I 5....................................... Phone No:.......................................................................................
Facility Contact: ...+'..,/P1C.41..?............We.& :.............Title:...... .................. ..................................... Phone No:...................................................
Mailing Address: ............ ... .....................--
.. . .
Onsite Representative:. �. 4L1.......��./ZI............... ................ integrator:............Yes-. ..,..i.._.r.................
Certified Operator:.......................................................... ..... Operator Certification Number:
Location of Farm: _
%,5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �=� Longitude �• �' ��
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons j ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream lmpac�s
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man --made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system:' (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............3.77................................... ...---.................
Frechoard (inches):
5100
❑ Yes ((No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes CKNo
❑ Yes Q To
❑ Yes -E5-N.Q
Structure 6
Continued on back

FaciliSy Number: Date of Inspection D Printed on 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse ved? (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 j�No
(If any of questions 4-6 was answered yes, and the situation poses an ' `
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes E�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes QrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application?
❑ Excessive
Poonding ❑f PAN ❑ Hydraulic Overload ❑ Yes Wo
W
12. Crop type A , Is I S 6I. S 1 I 1 l/j yQZ ,t
13. Do the receiving crops differ with those designated in the Certified Animal V6a;te MaWagement Plan (CAWMP)? ❑ Yes ((No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EgNo
b) Does the facility need a wettable acre determination? ❑ Yes ,KNO
c) This facility is pended for a wettable acre determination? ❑ Yes ((No
15. Does the receiving crop need improvement? ❑ Yes J�No
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes VkNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes EP No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 2j'kqo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes EfNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 1<NO
22. Fail to notify regional DWQ of emergency situations as required by General Permit? \\
(ie/ discharge, freeboard problems, over application) ' ❑ Yes AN
23. laid Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 10 NO
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 2fNo
;ivo yiolaiicjnjs;oi- dgfciendes rvgre note# during 0is;visit: Yob will teceiye itid fui�tligr
comes o deuce: abouf this visit
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):
�.
�--
CS A -, � W-/,
4AI; /,Yl� 1,1A, M"_11- Zk� '9 6b
e
Reviewer/Inspector Signatur�r� ! // _• O%�r ,�� �Q Date:

Facility Number: 3 — V V Date of Inspection 4RPVPV
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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes X[Np
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .TNNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes PLNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JNNO
Additional:Comments and/orDrawings:
AL
5100

.I
t #� Division of Soil and -Via rto'li�iei'v�itioh . Operation Review . '
tI i _ .Division of Soil and -Water. Conservation - Co`inpliance Inspecti©ii
®'Division of Water Quality ,Compliance Inspection ,
_.
Other Agency Operation Review - � � - =
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection $
Time of Inspection 24 hr. (hh:mm)
® Permitted © Certified J3 Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
FarmName: ........ e..!...-s... ....`....�...�............................ .................... County:..... /..../�1........................................ I.............
` /j� �, 1f
Owner Name:....... �" k-A) We ! f S Phone No:
............................................ ............ ........................................................
Facility Contact: .............................................................................. Title:................ .. Phone No:
'failing Address: ...............................................................
Onsite Representative: ..�. .. e.I. S .. !G .. j ,7k. Integrator:.... �e.s ... 0..............................................
Certified Operator: ....... : .............................. ... .................................................... . ...... Operator Certification Number:..........................................
Location of Farm:
Latitude �� �� �•' Longitude ��• �� ��°
Design Current - "Design Current_ Design Current
Swine Ca achy Population"' Poultry -_ Ca achy , Population Cattle Capacity Population
❑ Wean to Feeder Mayer I I JE1 Dairy
❑ Feeder to Finish ❑ Non -Layer 10 Non -Dairy
Farrow to Feeder �2 ❑ Other
❑ Farrow to Finish7.
_ Total Design Capacity
❑ Gilts,
❑Boars - Total. SSLW
,, Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance Oman -made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $1 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: . I
Freeboard(inches): 2 .`.......................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23199 Continued on back

Facility Number: Date of Inspection
6.�Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,9 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? JK Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintena6ce/improvement? ❑ Yes 91 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 29 No
Waste Annlication
10.
Are there any buffers that need maintenance/improvement?
-❑ Yes
,N No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
54No
12.
Crop type ago
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
UfNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
W No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
t8.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wl3P, checklists, design, maps, etc.)
❑ Yes
ja No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
g No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [ffNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes 50 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9 No
�• �Vo yt..... or .... enc#e5 mere n e dur#ng �h�s_visit; You will reeeiy . #. further
COCrespOIld(ence. �6 ' t111S V15I . ..' . ' .
Comments-(irefer to question #): Explain any YES answers and/or any-reeommendations or any other comments'>,
Use drawings of facility fo _better ex lain situations` use additional Dag& as_necessaJ
7- �ookl� malls.
Iles•,) t�A.4e etY)q s1s t1eeh- • IAA 0 0 e 4A 2 1���9
Reviewer/Inspector Name C
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: 3 — f3 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 0 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '� No
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑.Yes 5d No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/ternporary cover? Yes ❑ No
ton : ommenEsan or rawings
3/23/99

+='L, ,%
3y� _.� - Y- -�" ,.F�_.`�a-.: ,., e.�; •.:--.�,. �ae'�i`s'�..'f�'�.;�. ,. ea::na �. .- - a-ra �' �� uk e�
�a; ❑Division of Soil and Water Conservation ❑Other Agency �,„�`� .6� _
Routine O Complaint O Follow-up of DWQ inspection 0 !+allow -up of DSWC review 0 Other
Date of Inspection
Facility Number ci
Time of Inspection ® 24 hr. (hh:mm)
Registered Id Certified 13 Applied for Permit © Permitted 113 Not Operational Date Last Operated: ,
FarmName:......11v \V'... .. -4.' .� Z.................................................... County:...... .. 1�k....................................................
Owner Name: Phone No:
......................................................................................................... 1.. `�.......[..,...............
Facility Contact:..................................................................... .... Title Phone No: ...�� ``..........P:.....
Mailing Address: , a�3......].�r`-� ... ....... ............ ciS�......�\1.......aC......�`�...� V....... ................... I ........ I ................
Onsite Representative:.. '�i iQ Integrd(or:......t V�.�"` ........................
...............................................
CertifiedOperator;............................................................................................................... Operator Certification Number ..........................................
Locptiork of Faff
%UK..... S?:..... J..... x...................... `.................... Cl``�............ID
................. 4
........:............................................
....................................
. ,....>n �s........a..►��e..Q..-�-.........R.a�.`5.,................................. .....
Latitude 0• 04 46 Longitude • 4 0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes W No
2. Is any discharge observed from any part of the operation? ❑ Yes CqNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? _ -
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [XNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [YNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes .0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 19 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (I No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0No
7/25/97

•
Facility Number: —SS�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures [LaQoons.11oldin£ fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) Iess than adequate?
Structure 1
Identifier: A—
...................................
Freeboard (ft): ..........g
...............
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes 9No
❑ Yes D, No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of Wor runoff entering waters of the State, notify DWQ)
15. Crop type ...... t..f......... ..{.... 9.........................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
...........................................
❑ Yes
No
❑ Yes
No
[:]Yes
No
❑ Yes
No
❑ Yes
RNo
No'viulationsor. deficiencies: we. re -noted -during this:visit.,_You:will receive•nti-furilier:
. correspandebO dboid this: visit: • :
1 9)► <
..............................I
❑ Yes El No
❑ Yes J91 No
1AYes ❑ No
❑ Yes El No
❑ Yes t9 No
❑ Yes N No
M[Yes ❑ No
❑ Yes CgNo
❑ Yes ER No
❑ Yes (3 No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: \0_(j 8

Inspection�� ❑ DSWC Animal Feedlot Operation Review ____ _._.M,� �-�� ��P
®DWQ Animal Feedlot Operation Site
. . . . . . . . . . . .
10 Routine 0 Complaint 0 Follow-up of DWI) inspection 0 Follow-up of DSWCrevievv 0 Other
Date of Inspection jel/I
Facility Number
fl q-1
Time of Inspection Et=24 hr. (hh:mm)
DRegistered MCertifled [3 Applied for Permit OPermitted j[3Not 0pera Date Last Operated: ..........................
Farm Name: Wt'.Lis ....... County: ...... V�J..VL . . . ..............................
Owner Name: .... ...... ............. ...WA..Phone No: o .) ...Z.....t..
k —q1
.............................................. ......................
FacilityContact: ......................................................... Title: ................................................................. Phone No: ...................................................
IMailing Address: .. ....... ........ f--'6..V4 ....... ..... C'
..........................
Onsite Representative --A) ................................................................................ Integrator:........ ........................................
Certified Operator. ............................. ............................................................. Operator Certification Number..... .to] ..
Location of Farm:
L-1 . ..... a ...... .S.. . . .....
..................................................... -- .....................................
............ : ....... I .................................................................. ..........................
Latitude EIC, Longitude
,wine
El Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
Far -row to Feeder
El Farrow to Finish
El Gilts
El Boars
Design Current
Population
Design - Current Design, Current,
Poultry Capacity Population Cattle Capacity. Population
10 Layer [I Dairy
10 Non -Layer ELI Non-Dairyl
❑ Other
Total Design Capacity.
I -
Total SSLW
ze,
Number of Lagoons/ Holding Ponds I[] Subsurface Drains Present I0 Lagoon Area JE1 Spray Field Ar—e—al-,
❑ No Liquid Waste Management System�'
.. .... . . . .... . . .............. ...
General
1. Are there any buffers that need maintenance/improvement? El Yes 60 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon [I Spray Field El Other
C
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 gaUrnin?
J. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
ElYes M No
0 Yes El No
0 Yes [F) No
1A'.K
0 Yes &No
El Yes 91 No
E]Yes fiff No
El Yes 0 No
C1 Yes P9 No
El Yes 16 No
Continued on back

Facility Number:3 —
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,floldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes EK No
❑ Yes 0 No
Structure 5 Structure 6
Identifier:
............................. I..... ..... .............................. .................................... ................................... ................................... ...................................
Freeboard(ft):............. 2 . ........................................ .............................................
10. Is seepage observed from any of the structures? ❑ Yes 0-No
t L Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 10 No
12. Do any of the structures need maintenance/improvement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �O f V........................ ............................. ...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes M No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement? O Yes ❑ No
19. is there a lack of available waste application equipment? ❑ Yes C4 No
20. Does facility require a follow-up visit by same agency? ❑ Yes ® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [9No
22. Does record keeping need improvement'? CKYes ❑ 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 [d 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 9 No
No.violations or deticieitcies.were-noted-during' this:visit.-.You.will receiveno ftirtlier
correspondence ANout this',visit:
Comments (refer to question #): Explain any YES answers 'and/or any recoenmendations•or any gthc
Use.dmAings of facility to better explain situations. (use additional pages as.necessarv)
%0 r� S re k o Vn b a -PDtLf Ir.
I% . Lit r �3 o r. e.a r e-L-, - I Lnrf -� S � ra" j l t t�cL{� w if r nR-esi d `
Zz • CY e ( a4 c,v .r,-� -mot s c , I S a .... + 4- I
1 i iL a.% d_L#_-jL to o Y- L.J r o.f f t b Le. .
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: , , 1A 0 .emsR r Date: 9 19 i' 9

0-
•
Site Requires Immediate Attention:
Facility No..:?/ -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: _
iQ /,_� l� -e-1 S
1LJp
Mailing Address: `2 5­7
i 2) 4
I-<
County: '• r
Integrator: P�U5 If - Phone:
On Site Representative: T�i�- U, - � _- Phone: � _ ` y am -F
Physical Address/Location: &&V, _ 1l-7,S A:a6A� 0. S
Arn; I c ,� _ ,vr s 00 3 FWIC— fl L_` l
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: ���rr�il Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 4' � Longitude: _2_�( ° 6 _� ' _" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot +.25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: _ L Ft. _;:�_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? 6820r No Is the cover crop adequate No
Crop(s) being utilized: i �� ! , n jj J t / re{6,_( - - - -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 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 Comments:
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WO Fax:[phone] jui 20 '95 8:46 P.08/16
•
•
0
Site Requires Immediate Attention
Facility Number: 3 1 S0
SITE VISITATION RECORD
DATE: _ r7 15' ' 1995 -
Owner. -- c, �,� � ,r Farm Narne:
County:
Agent Visiting Site. Rv� ri e �4 � T3�T • Phone.
Operator; -- ... . _ Phone:
On Site Representative: Phone:
Physical Address: gvti Y �`) t d _ ,N= �� i
Mailing Address:
Type of Operation: Swine _ Poultry Cartle
Design Capacity: Number of Animals on Site,
Latitude: Longitude: c
Type of Inspection: Ground Atrial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or ID Ac--I31 Freeboard_ Feet Inures
For facil;ties wi.h more than one lagoon, please address the other lagoons' freeboard under the
cornMents section.
Was any seepage observed from the Ia. Qon(s)? Yes or No Was there erosion of the darn?: Yes or No
Is adequate land available for land application? Yes or No Is tbr- cove: crop adcauate? Yea or No
Additional Comments:
Fax to ()] 9) 7 1 5-a559 Sigr stare C_= Aga st