310668_INSPECTIONS_20171231

NORTH CARCLI NA
Department of Environmental Qual

f�
Date of Visit: Arrival Time: Departure Time: County: Region: 1=zy
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: L►t /�f/� Title:Phone:
Onsite Representative: Integrator: 5� /d
Certified Operator: _ ��.u1� 07&/Pif2 _ Certification Number:
Back-up Operator: � n sf' Certification Number:
Location of Farm: Latitude:
Longitude:
Design currenE
Swine capacity MEMO
Wean to Finish
Design Current
Wet Poultry C•apaeity Pop.
Layer
Desigu Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Bry Cow
Farrow to Feeder
Farrow to Finish
D , P,o_ult , C•_a aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑Yeso
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C?�.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
J2�,No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

' Facility Number: f - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (B-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EgNo
[DNA
❑ 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
[&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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes qNo ❑ 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 JEJ_No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes f&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 3,No ❑ NA ❑ NE
❑ Yes [' za—No ❑ NA ❑ NE
Required Records & Documents
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 .0 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 ja No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Ln ro
` Facility Number: - jDate of inspection:
�. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E[ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ®..No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes 1Z No
❑ Yes Ey [No
❑ Yes [D No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer. -to question #): Explain any YES answers and/or any additional recommendations or any. other comments.
Use drawings of facility to better. explain situations,(use additional,pages'as,necessary).'-' .
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ?t.�
Date: 6";
21412015

Facilitu Number. 3 �kRm
ivision of Water„Quality
.0 Divtston ofSoil and�Water C
Qa
Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,-10<utine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /41 Y Arrival Time: `Qd� Departure Time: County: Region:n
Farm Name: E� � Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: Mixte,
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator: �Q - �,
Operator Certification Number:
Back-up Certification Number:
Latitude: = o 1=1 I = 11 Longitude: [= o = A
Design Current Design Current ; .Des�gni�Current
Swine Ca ace -Population Wet Poultry �Ca ace Po ulat�on-�. Cattle
_ P.. _, t3 P _. � k __ r p .�.L! '_. p �. C P la
M
❑ Wean to Finish
Wean to Feeder
Q
G
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Y❑Layer
❑ Non -La er
4
Dry*Poultry
Other �r
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood 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 Q Rio ❑ NA ❑ NE
❑ Yes
6No
❑ NA
❑ NE
❑ Yes
�allo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
VNo
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
1. Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
)Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
En 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
J2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes L2^No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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 allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes k!rNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .Eff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [E]No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
❑ NA
D NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[ o
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
C'`No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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 .f No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2-No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .0 No ❑ NA ❑ NE
25. Is -the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes dNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes []'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C"No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes E!fNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
VNo
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [/To ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of f
acili
ty tobetter
explain situations (use additional pages as necessary).
e'j orrp
� �%m �' % frJr�.� r✓� ate'
Reviewer/InspectorName: ✓ Phone: T-
Reviewer/Inspector Signature: Date: J�z Q 1�
Page 3 of 3 21412015

f ype of visit: i0 compliance inspection U uperanon xevtew U btructure Evaluation U I ectinicat Assistance I
Reason for Visit: �WRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 O Arrival Time: eparture Time: County: Region:
Farm Name: d- r'5? rw) Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
�/�j Title: Phone:
Onsite Representative: � l eer - I � � a o Q
Integrator: /Y1 �%•�
Certified Operator: Certification Number:
Back-up Operator: Certification Number: 1(121
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oul
Layers
Design
Ca aci
Current
P,o P.
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑/'No ❑ NA ❑ NE
❑ Yes 13 No ❑ NA ❑ NE
❑ Yes 12'No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ZNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Pr&o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �(No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facitity Number: - Date of Inspection: 6
ti
Wasie Collection & Treatment
4. Ts storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes FZJ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes p/ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 PNo ❑ 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? D Yes 12 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[no
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
ONE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes LEfNo
❑ 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 in No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

i
[Facility Number: - Date of Inspection: '.;t 116/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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 rile 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
[-]Yes �rNo
❑ Yes J�rNo
❑ Yes ZNo
Reviewer/Inspector Signature:

{
Type of Visit: RrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L,+.J Arrival Time: _® Departure Time: County: �W Y
Farm Name: QS Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: M
Onsite Representative:
r�C���-
_
Integrator:
Certified Operator:
.Qil���
c�?j�1(1_
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pop.
Swine L -LJ
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
FI
Layer
Non -Layer
Dai Cow
Dai Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oultr,
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Gilts
Boars
La ers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Turkeys
Uther
Turke Poults
Other 7Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
[—]Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there ,'any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: "' - ..�' Date of Inspection: - - I u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P�rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
DNA
❑ 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
,n No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[;?No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
7No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
9 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
F1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J�] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
e5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
;No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FrNo
❑ NA
[] NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
i❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Jam-' 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

Eacili Number: ' I pate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
,❑/ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Z] No
❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�2 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
[7 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V1 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use dra*in�!s of facility to better explain situations (use additional naves as neeessarv).
Reviewer/InspectorName: �tAsh LJ/GVj�
1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: c 5ds - A b'I - "Zp
Date: �� - 14
21412011

31
Type of Visit: 0 Co pliance Inspection (:)Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: 3 I z- 13 Arrival Time: 9 3U Departure Time: County Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
GIz«a- AAO-tz
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: zoo 40
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder 66b 3000 1 INon-Layer
I
EE
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder Di. P,oul
Farrow to Finish I Layers
Design u en
C•_a aci. P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Nan -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility -Number: l - $ Date of Inspection: 3 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L &ozgj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoO ❑ 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 CJINo ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7 /No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E
❑ 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
❑ 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 ❑ YesE�<o
❑ 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 dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3/No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
� o
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 3 - Date of Ins ection: 1Z—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes dNo ❑ 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
C
[DNA
❑ 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
0 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
C3/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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments. ;.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3o wj
Phone: �%) % e7 3 li U
Date: 3 1
214,2011

� Division of Water Quality
acilily Number 1 - (c�(s� Division of Soil and Water Conservation
© Other Agency
Type of Visit: Acomptiance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1J—���`J Arrival Time: ® Departure Time: 1 I _� County :/y_ Region:
Farm Name: Owner Email:
Owner Name: 1(z� . �r�N �LY� Phone:
Mailing Address
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �Q �� �O+p[ZG Integrator:
Certified Operator: 1" D [ t_qM /q �OH N SGN Ceriitica�tio� Number: �Q� lg
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
C►urgent
Design C*nrrent
Design Current
Swine Capacity
Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
RNon-La
Layer
er I
Dairy Cow
Wean to Feeder CAD
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
1) , P.oult . Ca aci P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TUTkey Po Its
Other
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes k
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Nu ber: 1 -t9 (C Date of Inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LOynbev
Spillway?: �+
Designed Freeboard (in): `!• 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 77��
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? TT��
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes kNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
bl
12. Crop Type(s): S
1
13. Soil Type(s): ! YGU--bI✓V_-
_
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 ,�j No
❑ NA
❑ NE
acres determination?
°°CC
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP'readily available? If yes, check
the appropriate box.
Q WUP Q Checklists E]Design Q Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
Q Waste Application 0 Weekly Freeboard El Waste Analysis Q Soil Analysis
Q Rainfall ❑ Stocking ❑ C/op Yield 0120 Minute Inspections
22. Did the facility fail to install and maintain a rain gauge?
[] Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ W/ste Transfers [] Weather Code
0 Monthly and I " Rainfall Inspections
El Sludge Survey
❑ Yes �ANo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 71
No
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFacility Nueaber: [ - Date of Inspection:
24.' Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes 9No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
[ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes No
0
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �] No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T[
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 ft Explain any YES answers and/or any additional recommendations or any other,comments.1-
Use drawings of facility to better explain situations (use additional pages as necessary).
CptGtG LRT)or/ I>U& OQd/9-
LA-).A-
�lyl�� I ' s
SunRM+v� a Ca � C- AVGCi-AGE 1N �y4o�E M T tc3��C-o �
A�Prz(a.0�34
r cu�SSq►�ac
)—s4V.P(_6- W}5 No p�
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: / % OC
21412011

FacWty Number �Q[�o
Division -of Water Quality �
`Division of Soil and Water Conservation, ;
'0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Hate of Visit: �Arrival Time: [' Departure Time: County: Region:
Farm Name: /S Owner Email:
Owner Name: j 1 �-1 r Phone:
Mailing Address: 1 C�r0
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Gu&(2_ Integra
Certified Operator: j�-a�N� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 c 0 d = « Longitude: = o = i =
it
Desi n Curren# Desi n Current:W`
g g Destgn Current
Swine
Capacity; 1'gptiiation, e Wet Poultry
': Capacity Population' Cattle ^ CapacityPopulation
_.
❑
Wean to Finish
❑ La er
El Dairy Cow
Wean to Feeder
❑Non -Layer
❑ Dai Calf
.
❑
Feeder to Finish
=
' _ "
❑ Dairy Heifer
❑
Farrow to Wean
Dry Poultry
*.
. ❑ D Cow
❑
Farrow to Feeder
❑ Non -Dairy
❑
Farrow to Finish
;,
❑ Lavers
a ❑Beef Stocker
❑
Gilts
❑Non -La ers
❑ Beef Feeder
❑
Boars
Pullets
❑ Beef Brood Co;
---
Other
�,
❑ Turkeys
r
Turkey Poults
❑ Other
-r
Number�of Structures
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 1 Date of Inspection
V(aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L,960cw
Spillway?:
Designed Freeboard (in): 0.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo
❑ Yes ❑ No
Structure 5
El NA El NE
[_3 NA ❑NE
Structure 6
ElYes No ❑ NA ❑ NE
❑ Yes LY] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo [I 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? '
t 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) SC(L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ElNA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 4No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or anyrecommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name} Phone:
Reviewertinspector Signature: . Date: 9 Q ]
Page 2 of 3 12128104 Continued

acilityj!umher: Date of Inspection
Required
Recerds & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ANo
[INA
[INE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes� No
❑ NA
❑ NE
the appropriate box. 0 VAJp ❑ Checklists ❑ Design Q Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 'kNo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ jyaste Transfers ❑ Xnual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections El Monthly and V
Rain Inspections 0
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 ((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?
Cl Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
*A
❑ 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
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
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 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 4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facili Number` IQ Division�of Soil andvtatei conservation
Cato
�FOther;Agency`�
Type of Visit )& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 14 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1f �O Departure Time: County: N1 "A/ Region:
Farm Name: a _�qPA Owner Email:
Owner Name: 9-A 1�>f LAMA �bH)USnA/ Phone: Mailing Address: ) 0 yC) C'O" W A Lo S 1CA l eigcm GL� /Ve cal � y 6 (4- CTG 5 a
Physical Address:
Facility Contact: //n J� y - Title: Phone No:
Onsite Representative: ,6LFE(L pfLE Integrattor:
Certified Operator:. 1 kZA ELAN, , �Or) 1VS0N �)0)0 p CQ0�98
Operator Certification Number: _
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c [= & =ds Longitude: = ° = t = If
Desiign Current `
Swine, Capacity .Population Wet Poultry ' ;(
Wean to Feeder -(00
"T] Feeder to Finish
❑ Farrow to Wean
>. ❑ Farrow to. Feeder
❑ Farrow to Finish
;.ILI Boars 1 I l
Other
g, ❑ Other
f_
JLI Non -Layer
L..I Dairy Calf
^. . ~
Ury Poultry
❑ Dairy Heifer
❑ D Cow
Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
.—.
� El Beef Brood Co
Other
Poults
Discharges & Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'19, No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3
Date of Inspection "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
El NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __ ac-cooIV
❑ Yes X No
❑ Yes ❑ No
Spillway?:
Designed Freeboard (in): 1 S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel 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 N$�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fi No ❑ NA [I 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 Y No ElNA ElNE
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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13C
13. Soil type(s) N,004"C-
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 id No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes J6 No
❑ NA
❑ NE
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 VNo
❑ NA
❑ NE
Comments" refer to ueshom# Ex lain'°ari YES ansv%rs and/or an reco meniiat on an other comments,
Use drawmg5 of facility to Better explain situations. (iise,addittonal pages as necessary }
y
AL
Reviewer/InspectorName �' G(.�1 GS^k Phone:
Reviewer[Inspector Signature: Date:
12128104 Continued

Facility Number: } — Date of Inspection �O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists 0 Design
g 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
[] Waste Application ❑ Weekly Freeboard [] Waste Analysis 0 Soil Analysis ❑Haste Transfers ❑ Aual Certification
❑ Rainfall ❑ Stocking ❑ /op Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections B Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes 9No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNO
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
XNA
❑ 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
*o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
A No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
$_No
❑ NA
❑ NE
Additional Comments aif( or Drawings
w. A • y
12128104

Type of Visit I& Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit o Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r Arrival Time: ib Departure Time: County: Region:
Farm Name: ��� S t� A2m Owner Email:
OwnerName: �� �E�-ANA )k30N SOS _ Phone: '0QV9— a9tD
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: cmaa (\&Coge_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = 1 0 „ Longitude: = ° = , =
Sd
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C++opacity
Population
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder (POO
PE
❑ Non -La er
❑ Dai Calf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non
❑ Layers
ElNon-La ers❑
-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
FE1Gilts
Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Otl
urkey Poults
❑ Other
10 Other
I
Number of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 JxNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

FacilitrNumber: —lap Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAcood
Spillway?: n
Designed Freeboard (in): 1 '7 - S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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.)
r`
[:]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 e- JL, C QA ;� S G1
13. Soil type(s) 61A &FO Lr-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes]
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
{ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
x., - @ - .^ " ".Y.."u `- i ,xv . ,. ,, y `ism ,� w,
„Comments (refer to questiop;#) Explain any YES=answers and/or any recommendations or=any. other comments
;UseFdraw�ngs of faWity to better explain:situations (use additional pages as necessary)" ` +€.
Reviewer/Inspector Name A/V WAA:—S Phone: 9
Reviewer/Inspector Signature: �t. Date: 2>11/bq
Page 2 of 3 12128104 Continued

':.
FaciH4 Number: 3 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. El WUP ❑ Checklists 0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
[] Waste Application 0 Weekly Freeboard 0 Waste Analysis [3Soil Analysis ❑ Vaste Transfers❑ �Aual Certification
0 Rainfall O Stocking E]Crop Yield r] 120 Minute Inspections 0 Monthly and V Rain Inspections E]Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
FJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
r'O 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
9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
06No
❑ 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 ReviewerfInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (YRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: D Arrival Time: No Departure Time: County: Region:
11
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: GME(Z�,A- f"1 _I.1_�C
ELANA CWA13OW Integrator:
Certified Operator:bGLANp► 1" "�014NXW Operator Certification Number: A03479
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 e = 4 Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder 15&CO 1150 40
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other.
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
l
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — 19LyDate 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: LAG00)y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes "No El 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ 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 [INA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,s� 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 56kC 01 TI , ! , E 9_ MkAj) F)
13. Soil type(s) / joei- I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
*No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question ft 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):
Reviewerllnspector Name rn N D A 1N Phone: 6110 - �a
Reviewer/Inspector Signature: Date: 31 LIP R,
12128104 Continued

Facility Number: 3 1 Date of Inspection �.2J3,1" cam
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K 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 J4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EC No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Pd 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
RNo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,k No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�'No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number g
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency cl-� I
rType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
jl Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:, %J � Arrival Time: 0rrDeparture Time: �County: Region:,'
Farm Name: Owner Email:
Owner Name: LIPA- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: -� Phone No:
Onsite Representative: E /'®Q r /'��� Integrator:
Certified Operator: -���- `�ti J r+! Operator Certification Number: �`r/9 _
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
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ 0 ❑' = « Longitude: ❑ ° 0 ' ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
foo ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
,Design :r . Curren r
Cattle Capacity Populatiou?:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: EL
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 ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
12128104 Continued

1
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
Identifier:
Spillway?: d
Designed Freeboard (in): ,Jr
❑ Yes No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes XNo
ElNA
ElNE
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?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ ye No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
El NA
❑ NE
maintenance or improvement?
///
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
]I.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind ❑ Application Outside o�jfQ ea
12.
�rDrri�-ft
Crop type(s) F G,� ��apNl�ro (mac 10o4e<&,_4D)
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 acre determination?❑ YesNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes EfNo
❑ NA ❑ NE
Comments (refer to question ft 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):
/�
1 IU
AJ") �ieObL�O,�
Reviewer/Inspector Name r a4a Phone: U — .
Reviewer/Inspector Signature: Date:
1212810J Continued

'[Facility Number: —6441 Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
j[J No
❑ NA
❑ NE
the appropiElate box. WUp ❑ Checklists ❑ Design El Maps El Other
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
tA No
❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard [I Waste Analysis ❑ Soil Analysis El Waste Transfers[[[[ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
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
❑ No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
X,No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
YINA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
//�
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
(
YJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
"" No
❑ NA
❑ NE
Additional Comments and/or Drawings:
b w�fF �1"��15z S
•Z q
ll1r�j/D(o /. g
Ab%-
-J/-1r,D� �N .s�oE
12,128104

O Division of Water Quality
Facility Number ?j (p O Division of Soil and Water Conservation
— - - - - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
/ P 2, '.Al
Date of Visit: cp I � Arrival Time: � CXJ Departure Time: / County: Region:
Farm Name: -f ( Owner Email:
Owner Name: Z,-qA �,D c--3�LfDJ �v�) Phnne:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design ::
one Capacity'' P
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
LJ Boars i
Dther ;
Other
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
= Longitude: =' =' =
uri^ent':'Current
iulation Wet Poultry. Capacity, -Population "..Cattle,
JLJ Non -Layer j
Dry Pointe ;
Pullets
❑ Dai Cow
❑ Dai Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ TurkeyPoints _
❑ Other Number of Struc#ures
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/
es No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ Yes No ElNA ❑ NE
1 128104 Continued

x `,
Facility Dumber: — g Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A!fNo ❑ 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?: 4
Designed Freeboard (in). fq_5�
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes A 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 [VNo ❑ 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 El
❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes /�I No ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X
No ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift ❑ `Application Outside of Area
12. Crop type(s)��,tX11 Uf' 6i70� 4�� ae�rvina �f �t _l � _. 6 [ U
13.
Soil type(s) 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((((((
JLd No ❑ NA
!'0
❑ 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
ZNo ElNA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other,1comments
Use drawings of facility to better explain situations. (use additional pages as -necessary):
LOin�lz- (W070_;v
26)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: Uk
Date: 6&
Continued

Facility Number: 3 Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP Checklists ❑Design ❑Maps ❑Other ,_,{
21. Does record keeping need improvement? If yes, check the appropriate box below. El,�J 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
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ye
❑ No�NA
[I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
)6 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 gNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
ElYesNo
ElNA
X
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
21)��w7
Cea
/k,€,o 7d*0 Vogl 6/
J
54177 ��its - 7/j / ZV�6 ao/L),
4�9 .4--ij JVO(3*1
Page 3 of 3 12.128104

L
Type of Visit Co Hance 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: )d a 3' 03 Arrival Time: �� Departure Time: County: DVPL,--'Al Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ��a ''Nr� f� 1L (;REEfV � ,n•tA obi-(-_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = 6 Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
s �Q ❑ Non -La et
❑ Wean to Finish
© Wean to FeederOA
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other T
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Dischart'es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
No
❑ Yes
�❑
E3 Nvo
❑ NA
❑ NE
❑ Yes io ❑ NA ❑ NE
12128104 Continued

Facility Number: e3l — 6100 1 Date of Inspection �o a5 05
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA GaO(J
Spillway?:
Designed Freeboard (in): q , �-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CrNo ❑ 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 environmentaTthrcat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O Flo ❑ 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 > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type�h,
s) C—a ,yp^ C G) s G 0 oocj � L 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N❑
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
VN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
i
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,hd
l�No
❑ NA
❑ NE
, Go�OS
V% A_4u7 6�1,rt. ►w- G --t' g S N A e C,
Reviewer/Inspector Name Ja 3 Phone: �d��y
Reviewer/Inspector Signature: Date: 101,1
12129104 Continued

-Pacility Number: 3 � -�(og Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
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 El Checklists El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
P g P P
❑ 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
" ❑ 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 E NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No D A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
!T No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No ❑ NA
❑ NE
Other Issues �/
2R_ Were anv additional nroblems noted which cause non-comnliance of the nermit or CAWMP? ❑ Yes 9 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo ❑ 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
EYNo ❑ 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
3No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��
BNNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
S No ❑ NA
❑ NE
Additional Comments and/or. Drawings:.
12128104

Type of Visit f$ Com liance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: O Time:
O Not Operational O Below Threshold .
13 Permitted [3 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ...�_.__.__.._.....
Farm Name: ... County: _.� f� _ ..... ------------
Owner Name:
Mailing Address:
PhoneNo: . . . ......... �.__.... - --- •.... �..�_� .. .
Facility Contact: ........................................................ ..--....... _ Title: Phone No: _ ..... ........................ ........
Onsite Representative: ,1/,� Integrator•. � .7.t'.1W� .. s11t,�c�..a..lca kt r.ra .. 1e ?N �e_ z
Certified Operator:.... ....._.......... _ ....__.. _ . _ ._.___...� ___....... Operator Certification Number:.W. .............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �° ss Longitude • 6 it
Des€gn `.current} Des,gn l:nirent Design l.urrent
- Cattle Ca,
5wiine Ca`aci Po ulatian.... Po�lItry Po' Po alahon.._
�.
r city illation . aq
can to Feeder 6-1060
rdo 0 (] Layer ❑ Dairy
7.
El Feeder to Finish
[I Non -Layer ❑Non -Dairy
Farrow to Wean
Other zf
Farrow to Feeder
Farrow to Finish
Total Design Capacity
:.
Gilts
Boars
a
FTutnll ` nix
Y _
Nuiriber of Lagoons
a -
iiips-
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
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 ETN"o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes OT40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9Tgo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Stricture 5
Identifier: ................................................. ..... ..................... ....... .... ............... ...... ........ ..... _._..... ................... ...................................
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection I D
5.'Are Shere any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ONO
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
❑ Yes
any of the structures need maintenance/improvement?
;!(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes �2No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes JRVo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 014o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes JONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those esignated in the Cerdifed Animal Waste Management Plan (CAWMP)?
❑ Yes ;RNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes ZNo
b) Does the facility need a wettable acre determination?
❑ Yes ^0
c) This facility is pended for a wettable acre determination?
❑ Yes ZNo
15. Does the receiving crop need improvement?
❑ Yes ;Io
16. Is there a lack of adequate waste application equipment?
[]Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes eNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2(No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FZKNO
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 ;3 No
Air Quality representative immediately.
.Comments (re er to gaesuout) xEi pSW any YES answers and/or any i amueendat�ons or, any aver com6ients. _ s
F
��.
Use drawings of €acnlity to better ezplarn sitaat<oris. (ase ho`nal pages as mecessary)' Q Cop
. y ❑ Final Notes A-
_
4 _ .,
7 f �c��se /- //- �'�i�� e bell e7 06ISG
lS� keJ6116 hdS , eee, /-eMovecl'V-
%4 Ce s.S
P
GrJG/� haS
,d�ee;-7
!-cfe"✓/e/n� w/,4h Sa�� A
Awe�'%1%�vG
Clf7Gf%f�C/
e >`C11 >�i;c� 7" 4" 9 9 UV e '' l �'�o 0'101,,
ReviewerAnspector Name � ` <J �� a � � W .
Reviewer/Inspector Signature: Date: l p
12112103 r Continued

Facili"amber: 3 — Date of Inspection
•Re uired 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? I€ 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 reviewlinspection with on -site representative?
28_ Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes E'No
❑ Yes V�4o
❑ Yes ONo
❑ Yes PNo
❑ Yes ONo
❑ Yes &No
❑ Yes R(No
❑ Yes ONo
❑ Yes ONo
❑ Yes ZINo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3/ Date of visit: 2 Time: �S
Not O erational Q Below Threshold
Permitted [3 Certifi e[] Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: —_ d / HdP/)7 _ County:�L
Owner Name: A4eA- `�• r�Oh�r✓SOd) Phone No:
Mailing Address:
Facility Contact: Title: , (Phone No:
Onsite Representative: F_'[ � 0 '� REM Integrator: —^
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0e 4 Du Longitude 0
Design Current Design Current Design Current
Swine Capacity Population PoultryCapacity Population Cattle Capacity Po" elation
Wean to Feeder I S608 ❑ Layer ❑ Dai
❑ Feeder to Finish Non -La er ❑ Non-Dai
I K
❑ Farrow to Wean ---
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Ntimbei-, of Lagoons 10Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdrng Ponds-/MSolid,Traps �:. ❑ No Liquid Waste Management System -.
Disc ar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3
05103101
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
P�No
❑ Yes
XNo
❑ Yes
No
Structure
Continued

l
Facility Number: '� j� — Date of InspectionI IF
S Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) /(Q
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes P(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? El Yes XNo
(, o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ElYes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
1 t. Is there evidence of over application? I ❑ Enessive Ponding „❑ PAN ❑ HydrauliF Overload, ❑ Yes ZNo
12. Crop type 1:L:5d4E
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Aan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15.
Does the receiving crop need improvement?
❑ Yes
[ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records &Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
,�/No
L,q No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesNo
21.
Did the facility fail to have a actively certified operator in charge?
ElYes
P/No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
,�f
l No
TXNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
24,
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refertb_queshoa Explain any YES answers'ati&i it any recommendations: or any of er comments: .
Use drawings of facility to better explain n situatios _(tional pages as necessary)
use addiField Copy ❑Final Notes
?6 .r/ E2.m,�o�
�
�oo44
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 1 Continued

Facility Number: Date of Inspection %Epk
Odor Issues ,,__,__,,//
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El 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 o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes /No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ YesNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: -,
) G ZGC 6,0 t4a T C.49RA-c--o 7z
r
�iJ S��GTLo�%
7J
r
/.¢K�EIJ,
I"D /Y 7%�G" ?,tn/c,E
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 011outine O Complaint Q Follow up O Emergency Notification O Other ❑ [Mnied Access
Facility Number (Q Date of Visit:
0 Permitted © Certified ©�Coonditionally Certified © Registered
FarmName: ....... ? �.........`�. r' I ........................... ........................... .. .........
Owner Name: -1 L � `t h, j
............................I...... .................. �.'......................................
Facility Contact:
Title:
'U l J Time: I I EiEl
Not Ouerational O Below Threshold
Date Last Operated or Above Threshold: ---..._
County:...v-11............................... ..._ ........ ..
PhoneNo: .................................................................... . ..... . . .. .:.
Phone No:
MailingAddress: .........................................................................................
6 rve�'
Onsite Representativ.. . ._`y.. . Integrator:.. '.5la?f .
_..
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 9 «
Desig
n Current Design Current Desiigni Caret.
Ca ci . Po elation Poultry Ca a6 Population Cattle Ca aci Pv iilatEoa ';
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts :
Boars Total'sSI;W
Number of Lagoons 1 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps "" ❑ No Liquid Waste Management System
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed• did it reach Water of the State'? (If yes, notify DWQ)
c, If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3- Structure 4 Structure 5
Identifier: • ---•-.........I ................... ..................................1.......I......I.
Freeboard (inches): 2-18
5100
❑ Yes P(No
❑ Yes ZNo
❑ Yes �No
❑ Yes
)No
❑ Yes XNo
❑ Yes10
❑ Yes No
Structure b
Continued on back

Facility Number: 3 I — Date of Inspection 4
5. ire 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? ❑Yes �lo
(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 _j2(No
9. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J2(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes RfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JYNo
11. Is there evidence of over application?❑ Excessive Ponding PAN 0
1 Hydraulic Overload �/ Yes ❑ No
12. Crop type Fe-e 144-W . Ze-^vWdA �y`a a[ V✓'41-
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)?I Yes To
❑ Yes JzNo
❑ Yes Xfgo
❑ Yes XNo
❑ Yes,,dNo
❑ Ye�,dNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie! discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
i� viQlat�ignjs;o ff d�f c�e��i�s mere ni te�i d ring ih4s;vjspt! • yo0 wiii •t�eegipe Rio fufthgr
correspondence. al)6 ' this visit: : ; ;
#)::Explain any YES answers`and/or any recomr
❑ Yes )?fNo
❑ Yes &No
lzryes ❑ No
❑ Yes ,ago
❑ Yes J�kNo
❑ Yes ONO
❑ Yes P'No
❑ Yes)allo
*Yes%No 1
/V OI
sue•
use arawm of r�cut[y.us .Deuer exptain stumuons; {use aamnonai, pages:as :necessary:)
11• Tat e a�f e�tl'S �d be evev l 1 oo a� f4Aez>r resCVe eraf.•
&ret"c � shettl A ,Scr A new wA 1fe AnAlys i f 7 WASH Plan k
��. rip +0 me 9b @ n 1 � 31"2.Da) at Z(� t�� jl - ,qke gn1�4C.- look.
Keep v da4c a Icvc] r>•co�ds AVq�I ble H"Ive -11 - 2's
I'
Ir'eAP,Ne l 'Grop l FAN e4r p rleed -�o use fh� 5 ✓'d=
-Tr Z 2 • GreWG•-sh&LJd keep -t-Tc1 -2-'s t 00,44evfGO4i,V4%t.5� y
Reviewer/Inspector Name L-Jri
Reviewer/Inspector Signature: _ Date: r7l V 0 I 5100

Facility Number: — Date of Inspection !
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes'XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ YesR!rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes'ONo
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/lNo
34. 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 'PI"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/temporary cover? 0 Yes ❑ No
AdditionaMomments an or- rawin
1q-6Pn+) Sp yo t-, kn4t.,/ ren-LA'i Y)CePI
R� re n I fl k) 4,0 jT yc t4 Ge! kl Sprc 1 Arlo 050
Jn-dead 4� Z.o ��J r't �'ui ,'+1► � �� �� e L,/a ��e �na l S1s
10a � h � r y
Long y Sp h � Ire reco+nme PiX
-�-� -��ke waS4e &I viQ1 y'S;s sve% Prrdr 4v q-'^ 1^l(,} �e t,-.,A
✓ o rti +V e
13.
yje cA ' - 6 b-e re oto,7e 4o s-%�ow Go,r ree,+ era p)
be fm Udq �,� �'e s e ve, o n "41'1 OC Ae -fv " S .
04ke/VAasn I's4ed GCle-vP, -Ae �e,Ny %s hea417 kerp
5/00

Division of Water Quality
to Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit ofRoutine O Complaint O Folfow up O Emergency Notification O Other ❑ Denied Access
Date uF V (sit: a { (`� 1'i�ne: � Printed tm: 7/21/2000
Facility Number
10 Not Operation. Q Below Threshold
© Permitted E3Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: .1-........ ....... :.................................................................. County: ........!'........ ..................... .......................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility- Contact: ............................................................................. . Title: ................................................................ Phone No: ...................................................
MailingAddress: ................................. . .............. .I.........................................---................. .... I .......... ...........
Onsite Representative:.G."A --.�:1.. `"e"� 1 � `\ .. Integrator:...... ?.�.W...�1
Certified Operator: .......................... ........................ ............................ Operator Certification Number:......... .
Location of Farm:
I\
[]Swine ❑ Poultry 0 Cattle ❑ Horse Latitude �~ �j ��� Longitude a 0«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 1❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present ❑ Lagobnn Area I0 Spray Field Area
Holding Ponds / Solid Traps I ❑ No Liquid Waste :Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
z a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No'
b. If discharge is observed. aid 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 [N�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IN(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes CKNo
Structurc I Structure 2 Structure ; Structure 4 Structurc 5 Structure 6
Identifier: .................................... .
Freeboard (inches):
5/00 Continued on back

Facility Number: — $ Date of Inspection Printed on: 7/21/2000
` 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 6No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
KNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
CNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
NNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
1 I . Is there eviden a of over application? ❑ Excessive Ponding AN ❑ Hydraulic Overload
J�Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
b(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
JXNo
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
O;No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available`?
❑ Yes
tRrNo
IS. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
MYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
)9rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�S(No
Na viblafions;or deficiteucies vt�ere noted• diWing this;visit; • Y:oi) will-teoeiye {io. fu> they; •. -
corres} 6ideirce. about this .visit.. . . .. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
(�� U}�j� ��-`"� \\3�f �^ S`'�►'^'^-Q+� e-r,t-.(,,��� eI.SC'-�5-���r `�`-`�—',��c� i�..`�lc�
✓vtcp4s- rer, 4
Reviewer/Inspector Name ` 1Q ��C.— 3c(6-- 00-
Reviewer/Inspector Signature: Date: Q^ , 5/00

f /
+� $acility.,Number: 3 — bFi� Date of Inspection Q " 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 gYes ❑ 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 P<No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
O NG
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
P(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
[�(N0
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
;�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
[�(No
Additional Comments and/orDrawings: _
i q �
�Cc>res �
h2� �Q•-= er^1
LJ
5100

1Ej,Divisi6n of Soil and Water.Conservation -Operation Review
© Division of Soil and Water Conservation - Compliance Inspection
sion of Water Quality -.Compliance Inspection �'Diyi
er,A Agency O eraton Revr
r 13 Ott, g y p iew _
1® Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DS«'C review • Q Other
Facility Number 31 g Date of inspection I bd
I'inie of Inspection 1 W,40 124 hr. (hh:mm)
Permitted J1 Certified © Conditionally Certified 13 Registered Q Not Operational I Date Last Operated:
Farm Name: C� S County: �7;1t`...............................................................
..................�................_. Xr R..._..........1l....jj................._...........---...................... ......pp.
Owner Name: ................................. Phone rN'o:.....`5���
Facility Contact . ............... ...... Title: ................................................................. Phone No:................. .
Mailing Address: ....1.010..... bio.!i'A. 4%..�.....0.................... ...... .......................................... .ak........
pp
Onsite Representative: ......... i�%IDAI ......... stlth.............. ............ Inter=rator .. ..........................................................
Certified Operator:...... ............ . .... ...... ................................. Operator Certification Number:..........................................
Location of Farm:
........................................
r..................................................................................... ........................................... ........... ......................... r .
Latitude �r �' Longitude _.
Design Current
Swine Capacity Population
Wean to Feeder
p�
❑ 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 ElNon-Dairy
❑ Other
Total Design Capacity _41,pD
Total SSLW -
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made:' "
h. II• discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if dischan-e is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon--rystern?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .......2;6...I..............
1 /6/99
❑ Yes]
No
❑ Yes
® No
❑ Yes
No
N
Cl Yes
® No
❑ Yes
[XNo
❑ Yes
1� No
❑ Yes
Ei1 No
Structure 6
Continued on back

F6c$ity.,Number: 3 1 — (, & 4e Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes 19 No
❑ Yes [9No
❑ Yes 0 No
❑ Yes [4 No
11. Is there evidence of over application'? ❑ Ponding ❑ Nitro ❑ Yes [W No
12. Crop type ........ ...... Cara........... W�lL ..........�Itbel-:.........................................................................................................................................................
13. Do the receiving crops differ with those desi+onated in the Certified Animal Waste Management Plan (CAWMP)? El Yes A No
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & .Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
�. Njo.vialatioi s- or. deficiencies were noted. during Ais:visii:' IV-o' i wilfre�ceive noftirit.iier .:.:
etirtrespondeizce; about; this it.; . . ... : ... . . : .
❑ Yes No
Yes ❑ No
❑ Yes C4 No
❑ Yes qj No
❑ Yes No
® Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes M No
❑ Yes No
❑ Yes No
Comments:(refer to.question #): Explain any YES answers and/or any recommenda6ons'or any other comments..
Use diawings:of facility to better expfain situations. (use additional pages as necessary)
1� Crab( _plvt nir, .W dajs 6� <�v�. Z` , Dill om a ko ons.,
tk 1�L(Z� 1L_` �nrrr.s �or G.3aS�c. ot,� k(c,6m ►sr• �v�y �AU� S�u�i] �Q
eori+ � U (� b o Q
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 71 qQ
1 /6199

L 0 Division of Soil and Water Conservation [3 Other Agency
VIDivision of Water Quality
Routine O Com taint O Follow-up of DW2 inspection O Follow-u of DSWC review O Other
Facility Number Date of Inspection —3--
Time of Inspection 24 hr. (hh:mm)
0 Registered [3 Certified [3 Applied for Permit MPermitted 10 Not Operational. Date Last Operated:...„
Farm Name: J AS Count 1t�
.....L.Iu .'---...................................................... Y' ........]1....... ...............................
OwnerName: � `1 Phone No: �,, _ . 1 ... _.......•-••......................................................................................... ... (�....... .-----------.....................
Facility Contact: ....................................................................... ... Title:................. ...... Phone No:
Mailing Ad dress: Jo w��l.l.%....`.j...........7r. .. ��"lid,f........................................... .......I..................
jt ..........
Onsite Representative:.(1 1.. + .�.. Y7'�'-� 1�..... Integrator:...... a�� �—� C 1. ..............................
Certified Operator;............................................................................................................... Operator Certification Number:...................
Locatio of arm:
.Sr......................'-J............ ................................ ........................... ..:........ ........ ..................
.................................4`�...: ..
%....�le...... ..fin ....................�-� .... r�.i.......................................
Latitude =0 =` 46 Longitude =' 0' =11
r Design Current
Design, Current =
Design Current
4
Capacity ° Population - 'Poultry
'Wean
Capacity Population Cattle
Capacity_ Pogulahon
to Feeder
Q
❑ Layer
JE1 Dairy
❑ Feeder to Finish
10
Non -Layer
❑ Non-Dairy
M
❑ Farrow to Wean
LZFarrow to Feeder
❑ Other
y
: R
}
Farrow to Finish
T©tal Design Capacity
a
❑ Gilts
❑ Boars
T otal SSLW
.....
:f
` Numb er-of L,Agoopas / Holduisent g Ponds: ° ❑ Subsurface Drains Pre
© Lagoon Area
10 Spray Field Area
# x 4
-
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 54 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EB�No
c. If discharge is observed, what is the estimated flow in gal/min? Ix A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EgNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes - 9No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes UNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes D�No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

f Facility Number.
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures, (Lag_oons.Holdine Ponds, Flush Nts, etc.,)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identi f er:
Freeboard(ft): ........... r�1......I......._................ ...... ....................I.............4.......... ........................
10. Is seepage observed from any of the structures?
11. Is erosion, or any -other threats to the integrity of any of the structures observed?
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 kpnlication
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ....... .5�(
❑ Yes
P(No
❑ Yes
,xNo
Structure 5 Structure 6
❑ Yes
No
❑ Yes
No
Yes
❑ No
❑ Yes
P(No
❑ Yes
C;No
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?
0• No.violationsor deficiencies were,noted,during this:visit:- You:wiR receive'e-noIuriher, : -
ctifrespbndeuce Ei oiit -this: visit:- : : .
❑ Yes No
❑ Yes No
❑ Yes [21 No
❑ Yes No
❑ Yes No
❑ Yes EgNo
UYes ❑ No
❑ Yes M No
❑ Yes D(No
❑ Yes O, No
l -1 f�er ��e �1-A s talk �� p 4, ti �° '''�� U S �,., e s 4P rep-ave VV
G+�ss �.--s fees-� ,.r�-`.G�: k- �:� , t'���� c����'.i•-. �•�-r-,
�� 1'�te�-s� �e wee k 1�lsccr c s ►- L-�S Gy r er
+
acn
7125197
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

11 DSWC Animal Feedlot Operation Review w�xt
E.
DWQ Animal Feedlot Operation Site Inspection ; f
::ems �.:-
Routine O Cum laint O Follow-u of DW ins ection O Follow-up of 1?SWC review 0 Other
Date of inspection
Facility Number 3
Time of Inspection 6 0 24 hr. (hh:mm)
© Registered © Certified © Applied for Permit JO Permitted JE3 Not Operational I Date Last Operated: .
FarmName: ......... E.*S........��`ifjr................................................. ........ ........................................................•-........................ County: rr 1t1�?�M............................. ........ .......................
Owner Name: .....r.......1?,..a65on............... ....... Phone No: gt��289�..9.�6. ............................. ................
.
Facility Contact: ... D6.i7k.......... ............................... Title: ........M)1V.x......................................... Phone No:...��f
TMailing Address:.....( '{.1�.......CorrttAla1li........
Onsite Representative:.....- .................................
Certified Operator: ---- ln�........ ................................
Location of Farm:
...................... ......T., Y.r..M.L................................................ .. V..44......
Integrator: ..... Doy ......................
Lva�i�...................... Operator Certification Number:......... ...........
lit!.s.....,-�1...1................xr.......lal.[acef....Tur....r..1�1n .....11.....F�artxx....ix.........r>,.i.�f�t...a.n...................
......CY .................................................:...................................................................................................................................................F
Latitude 64
Design.. Current
Swine Capacity Population
® Wean to Feeder
7(, Q
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude �• �0«
Design Current Design Current
Poultry Capacity Population Cattle Capacity,. Population:
❑ Layer ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑ Other
Total Design Capacity .
Total SSLW
.Number of Lagoons / HoldinlfPonds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 04No .
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, w•as the conveyance man-made? ❑ Yes No
b.- If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in w'aUmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) El Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes V] No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes -0,N0
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes `RNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes JgNo
7/25/97 Continued on back

Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes (9No
Structures (LaQoons,11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes JO No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ........... ............... .......................................................
10. Is seepage observed from any of the structures? ❑ Yes [RNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers.)
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. parr`.......................WLtli.611 ..........................................
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 Qnly
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?
i� No.violations or deficiencies were` noted- during this:visit..You.will receive -no further
correspondence about this`visit:
❑ Yes [SNo
29 Yes ❑ No
1$ Yes ❑ No
❑ Yes MNo
❑ Yes M No
❑ Yes ® No
❑ Yes ® No
0 Yes ® No
❑ Yes No
❑ Yes No
Yes ❑ No
%Yes ❑ No
❑ Yes No
❑ Yes No
_Coin t is (refer.to question #): 'Explain any Y)ES answers artd/or any recouurrendations;or any other ci mrnents x .
Use dT7!ngs,of facility to better explainsituations (use additional pages as necessary}
r
5 Ba carp a� rN Di4Th ►nal be f4ild in [nct^C45e �Jex;Wli�.x..r�
d rZr� 31(1t' V }
17- 1_4�cor. taa.,5 be. #x0jdcJ- N6&s 0.+ 4�,_ r-cc jc� pu" 4 %� shoul� I e__ fiLu N-*,_
c.Liwv 4n� lrtstfer�
�3r l.IagooA iv\04 "Vi. 44AA mo-rvcx: .l- +�o� Sa►v���S
7-Z. CiA4,-t,�io,• farm s6A b.- er 5i4, sail
st*j cu.ards ShouJ� be, 1* 61 Irvr, AUVK�-er 4.VJ Ado mobtr.
23 . Na (" C-CA1 4 ea+ice on s-V c.-
7/25/97
Reviewer/Inspector Name x
Reviewer/Inspector Signature: ,r, _ Ar� Date: 16 /T h 7

Site Requires Immediate Attentio�
Facility No.
T:�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD �A
DATE: q11, 1995
Time:
Farm Name/Owner: IS44AIAI.4 dui AISO
Mailing Addre s: l�LU1'�riG!Cr
County: 7-
Integrator Phone:
On Site Representative:—jl Phone:
Physical Address/Location:
,OP) AJ,
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Ce cation Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon Have sufficient freeboard of 1 Foot + 25�year 24 hour storm event
(approximately 1 Foot + 7 inches es r No Actual FreeboarA( Ft. Inches
Was any seepage observed from the agoon(s)? Yes No as any erosion observed? Yes r No
• Is adequate land available for ray? Yes or No Is e cover crop adequate? Yes or No
Crop(s) being utilized: 4/497- 4-1 /r C_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es No
100 Feet from Wells Yes No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? 'F'6s- 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 of`No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific aeage with crop)? Yes or No
Additional Comments: �iW c aev Ll Os J l> Q !'✓' 1 �`✓l t
104 NO
Inspector Name SjgAre
cc: Facility Assessment Unit
Use Attachments if Needed.