310675_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

'Rb Ivi`sMEW f Water Resources
Facility dumber ©- Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
season for Visit: JeRoutine O Complaint Q Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: j�2 -�j Arrival Time: FC '" Departure Time: 0 3y County: l lA Region:0in��
Farm Name: ��T_&�TCax'#�, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �, �D Title: Phone:
Onsite Representative: ' e4 �a'ms Integrator:
Certified Operator: Certification Number: ! f r s
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity op.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle t!apaeity Pop.
Dairy Cow
Wean to Feeder
]Non
-Layer
Dairy Calf
Feeder to Finish
Design Current
D . P,oult , Ca aci P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
I
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
Od No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
KNo
❑ NA
❑ NE
of the State other than from a discharge?

Facitity Number: -7 Date of Ins ection: 2�0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [XNo
a. If yes, is waste level into the structural freeboard? ❑ Yes [-]No
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
DNA ❑NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): — 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JKNo ❑ 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 &f No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement? !�'►
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [VVo ❑ 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 [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V No [] NA D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes tdNo ❑ 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
�d No
❑ NA
❑ NE
❑ Yes
IdNo
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes No ❑ NA ❑ NE
Page 2 of 3 214,12015 Continued

Facility Number: jDate of Inspection: Q f '�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1VNo ❑ 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 W No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No I' " ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes X No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes EDNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes rw No ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other: pj
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
Reviewer/Inspector Name: 9-b A W &W Z Phone: `T It — Z`t 1.e_—13d 7
Reviewer/Inspector Signature:
Page 3 of 3
Date: 17-170117
21412015

Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z h Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
jj Title: Phone:
Onsite Representative: 4( C_�CQ�` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1 7rSZ
Certification Number:
Longitude:
Swine
Design
Capacity
C*urrent Design
Pop. Wet Poultry C*apacity
Current
Pop.
Design Current
C►attle Capacity Pop.
an to Finish
La er
Dai Cow
can to Feeder
Non -La er
Current
P,o .
Dai Calf
Dai Heifer
D Cow
Feeder to Finish
Design
1t , Ca acit
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
ers
Boars
fiLayers
OthPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes F]"Nq� ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility iNumber: - Date of inspection; 2—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `(f
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 rent, 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? ❑ Yes6'Z,❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &/ o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/ N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
0 NE
Page 2 of 3
21412015 Continued

[Facility Number: >I - G j7 L13ate of Inspection: 4A
24; Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El"No . ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 4A ❑ 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
ffNo
❑ NA
❑ NE
❑ Yes
�
❑ NA
❑ NE
❑ Yes
[] <o
❑ NA
❑ NE
❑ Yes
M/N o
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
(3/No
❑ NA
❑ NE
(Comments (refer. to>question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings o6acility to -better explain situations (use additional pages as necessarv)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/'Cc.9 �G S (04 �C pa
�- X
vl jg,-.t
Phone: { V � 731
Date: Z/1-j- /�
214r 015

Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance j
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Time: Departure Time: 2 9 . County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �} f Title: Phone:
Onsite Representative: e— Integrator:
Certified Operator: Certification Number: I ? 5­1 ?
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
W nn to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
oI
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
I)r� P,oultr� Ca aci. P,o .
D Cow
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
IN
I
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Na ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑
❑ Yes
❑ Yes LJ 1Yo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): 4�
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 ["No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LJ "o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes dNo ❑ NA ❑ NE
maintenance or improvement.
] 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E(N o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?I No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes % No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes El 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? 0
❑ Yes N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24, Did tfie facility fail to calibrate waste application equipment as required by the permVVC
❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-],No- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No [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 fait 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 E ] No
❑ Yes ENo
❑ Yes ffNo
❑ Yes ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes
No ❑ NA ❑ NE
0 Yes Zi 'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
V f 1�1/ Q ��'�' It
Phone: 4 10 _79G 73 0
Date: ) I Z'3L �
2/4/20l 5
Page 3 of 3

(Type of Visit: O CCopliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: , Arrival Time: Departure Time: ® County: �_ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A DA
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 4 —7 1 S h
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
C►attle
Da' Cow
Design Current
Capacity Pop.
Wean to Feeder Lj
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D > P.oul Ca aci P,o ,
Layers
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes VNo
o
❑ Yes
❑ Yes [No
❑NA ❑NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Fdeili Number: - Date of Insection: It
Waste Collection & Treatment
4.`4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier: LAGEA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): }
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
dNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta 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 1Vo ❑ 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 Y - o ❑ 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 I__I 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):
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No .
Ff
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes F/o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes dVNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,3 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 2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6"No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Factlity Number: jDate of Inspection: 11 t
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑NA ❑NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ 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)
❑ Yes EZ"No ❑ NA ❑ NE
❑ Yes O7 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
�No
NA
NE
❑
❑
ErNo
❑ NA
❑ NE
[3'No
❑ NA
❑ NE
PNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other .comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:(9 to —
Date: 11 111, Aq
2/4/2 14

s - ivision of Water Quality
Facility Number ','� � - t?J� 0 Division of Soil and Water Conservation
® Other Agency
type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Season for Visit: Q> toutine 0 Complaint Q Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: 3 Arrival Time: dV Departure Timer County: Region: U
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Integrator: �
Certified Operator: yvW.,I, z _ S Certification Number: 1,11151
S1115 D�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry C►apacity Pop.
Cattle C►apacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P,o_ult . C•_a aci P.o P.
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Puilets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
73 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
j�No
❑ NA
❑ NE
of the State other than from a discharge?
r
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
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 [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ra
T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7 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 Z 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 Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Vf 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 wrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LEI -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;I -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ -No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes _.,Efr No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PrNo
❑ 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
gj 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 7No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
r
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�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 to provide documentation of an actively certified operator in charge?
❑ Yes
Z No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�Z 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
jT No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ZrNo
E] Yes VT No
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:'����'�
21412011

Type of Visit: compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: © County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ��c (� �p�MS Integrator:
Certified Operator: VLO/`IJS�I A S _ _ C:ertifi iation Number.
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
rT-,Sa
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Fop.
La er
Cattle
DairyCow
Design C►urgent
Capacity Pop.
Wean to Feeder ypC3
Non -Layer
Da' Calf
Feeder to Finish
Dairy_Heifer
Farrow to Wean
Design Current
D , P,oul Ca aei P,o ,
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Qther
Other I
Pullets
Beef Brood Cow
Turke s
Turkry Poults
Other
i
M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[D Yes
[] No
❑ NA
❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes v No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - -45 ID2te of Inspection: tj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
6460clw
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3�
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ 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
❑ YesNo
❑ 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, et I.
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Windows ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
ep �
12. Crop Type(s): & �
/�
13. Soil Type(s): U) u OeA f_eLa
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 PNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
'
QWUP ❑Checklists ►❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ["] Waste Analysis Q Soil Analysis
❑N>4ste Transfers
Q Weather Code
❑ Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections [D Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
[DNA
❑ NE
Page 2 of 3
21412011 Continued

)Facility ltlmber: !) - 61-rj Date of Inspection: F511D
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 )kNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No NA ❑ NE
Other Issues A
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No I —]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. T�
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) ►►►���CCC
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 F, No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes rNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
M
) �c
Reviewer/Irispector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone: qJ6 6 93-r�
Date: H�—/
21412011

S
Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: _ZZ�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: J J Departure Time: County:
l r
Farm Name: `A� S NJ fL 1 Owner Email:
Owner Name: `�)_w_e_ ADA to Phone:
Mailing Address: 33 �s I f; AR-s 0 J g 39 g
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: ��} A DRA-A S Inte rator:
l\
Certified Operator: _ Lam r A Djg MS Certification Number: _ � 4 1 5 a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D , P,opl_ , Ca aci_ Plo ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes j No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesJ�No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 31 - (p S Date of Inspection:
4�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L4%4
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): _ a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
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): S' G �ne 1 ` f N
13. Soil Type(s): f -}(AT 401 LA-e (_Dq- }-A(6 E ir, (
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?
0 Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents 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
N No
❑ NA
❑ NE
the appropriate box.
Q WUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
[] Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ W,�Ste Transfers [] Weather Code
Rainfall ❑ Stocking Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall IInspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - S Date of Inspection:
R.� . . r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA 0 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 hNo ❑ 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 �4.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 �j j No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. T�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0
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 1� 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?
No
❑ Yes§No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments., I Use drawinns of facility to better explain situations (use additional owes as necessarvl."
16,�►oN Dui �-4�3
tj31111 a'L1
UI 5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-j�U���
Date: a gi I
1 1
21417011

IDnston of Water Quairty ,�
FLiltumbWy :Sinsei`aho""n k
016 ther Ageney ��
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit xRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: © Departure Time: C] County: N Region:
Farm Name: a ALZ �(N� t FAQM Owner Email:
Owner Name: _ )LA
_ C'fflF}m 5 _ Phone:
Mailing Address: SSR 614�zs a [q- J
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: ALE Afl .3
Certified Operator: q_CW1,J r 6 IS ' Aop r A S
Back-up Operator:
Integrator:
901 0
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = =Ig Longitude: = ° = C
Design Current
PJ
Design Ctirr�ent 'g Destgn 'Current
-swine.'Capacity
Population Wet Poultry
;.CapacityPopnlation'Cattle Crap ty�Population
❑ Layer
El Dairy Cow
{
❑ Non -La er
_ ❑ Dai Calf
' Y "' ❑ Dai Heifer
! ,
D Poultry �� t ❑ D Cow
- F ❑ Non -Dairy
'.:
ElLa Layers
❑ Beef Stocker
:' ❑
I ❑Beef Feeder
-� ❑Pullets
:.
❑ Beef Brood Cowl
❑ Turkeys
w ....
Other-.
�. .,
"= ❑ TurkeyPoults°
❑ Other
6 ❑ Other
m e;M&3s ructures:El
❑ Wean to Finish
Wean to Feeder
�
�{�
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
�No
❑ NA
ElNE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
oElNAElNE
tNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

Facility Number: j — (F� Date of Inspection f
t
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 l Structure 2 Structure 3 Structure 4
Identifier: L AC Oa14
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 ANO
❑ Yes ❑No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes X No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
El 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? ElYes 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? - \
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window` ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ tom 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?
o ❑ NA
❑ Yes tNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Comments refer to question # E� lain an YES'answers and/or an recommenda�o: { q ) p y y. ' �ns; pr any other comments
Use drawings of facility to better explain situations: use additional pages as necessary):
g ty P { P g t'3'):
•
T
Reviewer/Inspector Name Phone: 916
Reviewer/Inspector Signature: Date: !
Page 2 of f

Facility Number: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes �KNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
❑ NA
ElNE
the appropriate box. 0 WUP El[] Design El El
Checklists
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ANo
"'''"I
❑ NA
El NE
0 Waste Application E] Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑�aste Transfers rlinual Certification
0 Rainfall 0 Stocking E]Crop Yield 9 120 Minute Inspections 0 Monthly and I"
Rain Inspections G
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
�NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes No
[3 NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No 0 NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ] No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Wo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ANo ❑ NA ❑ NE
Additional Comments and/or Drawings:
gin 0 V b9A C- C'YiI I
W•A
�)gL
Page 3 of 3 12128104

Type of Visit 3SL Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit )� Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ti 9 Arrival Time: ® Departure Time: County: Ll N Region:
Farm Name: AQ T 'SU;R-1 ipp_F Owner Email:
Owner Name: 't>ACC_— pS Phone: 9/0 —�
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: _hou- Gl►'1�
Certified Operator: 96NN I V_ )� • 6
Back-up Operator:
Location of Farm:
Phone No:
Integrator: 11
Operator Certification Number: �4
Back-up Certification Number:
Latitude: = 0 01 = Longitude: = ° = 6
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish I 1
❑ Layer I 1
❑ Dairy Cow
Wean to Feeder iz t%00 IS i
❑ Non -Layer I I
❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ ers
❑ Dry Cow
❑ Non-Da'ry
❑ Beef Stocker
❑ Farrow to Finish
❑on -La on -Layers
N
❑ Beef Feeder
❑ Gilts
❑ Pullets
ElBeef Brood Co
❑ Boars
El Turkeys
❑ j urkey Points
10 Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑No
❑ Yes tNo
o ❑ NA ElNE
❑ Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 1 — 5
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?:
Designed Freeboard (in):
Observed Freeboard (in): i
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0No ❑ NA ❑ NE
❑ Yes Wo ❑ 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? Cl Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl 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 O.No El NA El NE
❑ Excessive Ponding [I Hydraulic Overload El Frozen Ground [I 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) (Se
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
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
gNo ❑ NA ❑ NE
Wo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #) Eiplain' any YES. answers and/or, any recommendatfunswor"any'other comments.
9: 8-' e— 4y "a %i 4! 'k* h
Use drawings of facility to fie#ter ezplatn sitnations. (use°addttronaI pages as necessary}:»
Reviewer/inspector Name mNis jN ES Phone: �—
3
Reviewer/inspector Signature: Date:
�i 9
12128104 Continued

Facility Number: 3 I —(vas Date of Inspection i1
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
. A No
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
ElNA
❑ NE
the appropriate box. 0 WUP El Checklists Design El El
Checklists
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
No
El NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis El Soil Analysis ElJ// ante
Transfers .441nual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and V Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
% No
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Pq No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ 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
K f No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ 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
J;TNo
❑ 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
;9�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
'KNo
❑ NA
❑ NE
Additional=Comments and/or Dravmgs .�°�: �, 4n .,...,'�,���'��°,� ;,-�v.� T �'� -"�= — •� s� ,� �'��. �.i,;'.
041c')16 I ]- Lo
12129104

7FaciliTNumber ] (9 5
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Rf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: b ique- A8 A (n S Phone:
Mailing Address:
Physical Address:
Facility Contact: y(� Title:
Onsite Representative: A\ A LE
Certified Operator: R cwy I. r • -AA A fl_S ._
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 5
Back-up Certification Number:
Latitude: = o = 4 [=64 Longitude: = o = 4
Design Current Design Current Design
Swine. Capacity Population Wet Poultry Capacity Population Cattle 'Capacity- Populati
❑ Wean to Finish
Wean to Feeder
J9LiQ0
OC'1
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
�`❑Layer
❑ Non -Layer
Dry Poultry,
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures."']uf
t
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
*o
❑ NA
❑ NE
[]Yes
4No
❑ NA
❑ NE
12128104 Continued

Facility Dumber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�XNo
❑ 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: OC-"v
Spillway?:
Designed Freeboard (in): .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[(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
ko
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JkrNo
❑ 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
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
, No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Dallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[[No
❑ NA
❑ NE
46A mS 1 IV i OUC H w f J001V
5 e14A-�ou-f Nj',AD t)fncHCs IN F1 E-L!� CAuSC-t'�' Q�
SCS Nt _ o N e_ 174 b 15 p,LA c� 1 _ . V 1'_; �
Reviewer/Inspector Name I R1Vl A N o q. 141 F. I Phone: t3 ,-.9--
ReviewertInspector Signature: Date:
Page 2 of 3 12/28104 Continued

FacilityNumber: 1 —(p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�10
❑ NA
❑ NE
E ildltlonal-Comments-and/or. Dr$wln
Page 3 of 3 12128104

Facility Number 1 3 (
%w utvision of water quauty
O Division of Soil and Water Conservation
"a
tl f)thvr AoPnry
r
of Visit Cpliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9 p Arrival Time: Qod Departure Time: �� County:Region:
Farm Name: Owner Email: '
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f = u Longitude: = ° = & = «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Weanto Feeder I (64 o o I I p
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Design Current : i
Capacity Population;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LI No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes ❑
ElYes
❑ NA
El NE
El Yes Zo
❑ NA
❑ NE
12128104 Continued

Fac(lity Number: ( — (,r} Date of Inspection
`. Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (AGoon1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNNo ❑ 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? El Yes i �f No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [,lo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJKo ❑ NA ❑ NE
maintenance/improvement? El"
I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E,_._, �To
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,[3'//
L4'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D<N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �nNN �� Phone 916 -M -10 $
Reviewer/Inspector Signature: Date: 7 AR/c,
1 12128104 Continued

Facility Number: 31 -b?S Date of Inspection
�4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'I No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Designs ❑ Map ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ 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? El Yes El"No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Lid, NNoo El NA El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes BNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes ❑ No ❑XA ❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
El'/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
El Yes
;7No
❑ NA
❑ NE
12128104

A
Division of Water Quality"
Facility Number ��,j 0 Division of Soil and Water Conservation
- O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�0 Routine z
Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
�
Date of Visit: I.'S/1�Tf� Arrival Time: '1; (J Departure Time: ' County: ��Gzi✓ Region:
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: LL Integrator: 4."-" 5P-,0
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = « Longitude: = o = 4
Design Current Design Current Design"Current
Swine Capacity Population - Wet Poultry :."Capacity -.-Population , Cattle 'Capacity Poulat,o%�`
❑ Wean to Finish
Wean to Feeder O
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer 1
❑ Dairy Cow
❑ Non -Layer ❑ Dairy Calf
- - - - - - - ❑ Dairy Heifer
Dry'Poultry ❑ Dry Cow
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Mirkey 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?
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of _Structures �r
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes )No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]NA
❑ NE
[]Yes
❑ No
❑ Yes,pNo
❑ NA
❑ NE
❑ Yes���'
1111XNo
❑ NA
❑ NE
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 XNo ❑ 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): frp
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes XN
o ElNA El NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9 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 to No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 /j1No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes ;!rNo ❑ 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 7Kf�$�a0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�ONo
❑ 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
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
"0No
❑ Yes 'VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f CF_p Oml�G�7 +¢GG .�&45if u.✓.✓tiv� FG.✓ya,yzy
j y.¢o /�7ADF -Zr-o �f �a,9 ® !.a
Q,P>S�R�/F� �F..2F_ Somme y
s
Reviewer/Inspector Name F— Phone !% 2
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents ��((
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ILA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA I�NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA io NE
❑ NA �NE
El NA o NE
❑ NA ONE
❑ NA ZNE
❑ NA E
❑ Yes
'ONO
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
X0
El NA
El NE
ElYes/ICJ
No
❑ NA
❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
Additional Comments and/or Drawings: w' 0 f' I t- k 0 <N ( Hf / =F C.rO
1_1� 3'_4 - , vz_
w fl/�GZ Z,Q � A 141V -541,19 6
D�
f Li /� cli✓D��
L
Page 3 of 3 12128104
, /

0
Iv
[Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9a o Departure Time: County: _auPL-_TAJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 1 JFiL C— Ankon5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
J❑ Farrow to Finish
❑ Gilts
[__1 Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: = e❑ t 0 u Longitude: ❑° 0 d=
is
Design Current,. Design Current Design
Capacity' Population Wet Poultry Capacity Population: Caltle.;`Capacity
1 $"❑ Layer
JE] Non -Layer
Dry Poultry
�.:Oth'er
❑ Other l
❑ 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?
❑ DaiCL Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures -.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes CX0 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes eNo ❑ NA ❑ NE
❑ Yes E54O ❑ NA ❑ NE
12128104 Continued

Facih'ty Number: 3 i - 60 ' Date of Inspection
'Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA (7'01�43
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 V
5. Are there any immediate threats to the integrity of any of the structures observed?
,�
El Yes E 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 ZNo
❑ 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 environmentalth at, notify DWQ
7. Do any of the structures need maintenance or improvement? [IYes I 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 d/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If 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) &_ H.) S G(7
13. Soil type(s) A0-re 4 j3 k-t-(: 0a_P , &c-_Qu
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2rNo
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[;2/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations orany other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
er'ot 'W u0ir- GOCAN,
t7 5?�E OVEIL CAWn L)WA&,& 00 G033JCG W/ SASE&,, Ww4tC PL'AO Fpao.& WA5
1JbT gC_6ak1rc5T" ZY OALG AOAMS. Dk-4-* cowTzm0rj -t'
?r1aN E c rtiU ru rAXItC SoG. S 11T �Aer+� . �E2E D To pr.toZ'�t Q S�LJ.
c.opTm C-. Uszmcr 7.6a WUP UvrLL �Z,-'K zoAS FESoWCO. GrALL 17 W
Reviewer/Inspector Name t+J Afi.rJc(A. - -y -� Phone:010) 776 - Tw
Reviewer/Inspector Signature:
Date: t b j s (o
rage c vJ J —... I.—

Facility Number: Date of Inspection
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ET
,�.J,/No [I NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes L/J No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2 I No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
(J/ 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
ZNo
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
D 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
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,E3`No
IQ 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
LJ 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
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
En"
NNoo
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
,ham
91 o
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

ITypeofVisit Qf Compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency
Date of Visit: O Arrival Time: r/S Departure Time: County:
Farm Name: Tires_ S&ZR2r- *? Owner Email:
Owner Name: 1014a b 5 - _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Integrator:
O Technical Assistance
O Other ❑ Denied Access
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region: W
Location of Farm: Latitude: = c 0 6 = u Longitude: = ° = t = u
Design Current
Design Current
_ 911
r
,.. , �. ::.
Design Current
Swine
Capacity
P,opula"rion
.
aa�'�u�t�rY ='tCapacity Population
Cattle
Capacity
Population.
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
can to Feeder
Q
Q
❑Non -La ei
❑ Dairy Calf
❑ Feeder to Finish
44, 00
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stockei
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
• ❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Puults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;xNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ONo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: �p
Date of Inspection
`i
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T''
Spillway?: O /-
Designed Freeboard (in): 1 % '15
Observed Freeboard (in):
❑ Yes 71 No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Vj 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 JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 No ❑ NA ❑ NE
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 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) i!f
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
J
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
oNo
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
G.7
00
,_mz 4aae0 zi
Reviewer/Inspector Name I Phone: 10- f
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 314 74T Date of Inspection
+ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X 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
W(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
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
X A Etional Cc, ommand/orrDrawings `` ��" +idents.
AMP
� r�0 �F-fi✓ ��T ��/ l v2 loyeOD Lc�,bA�! a `��D�! �97� 3/l ��OS
kl)
,4,V0 &64eL�l
lCOOD, 40ao S AA?_7
12128104

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
(Reason for Visit A Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number Date of Visit: EVM Time: �()
O Not Operational O Below Threshold
///F��rmitted�Cert<fied © Conditionally Certified © Registered Date Last Operated o A bove eshold• ..__. �. ..
arm Name: ..... ...... � �.. .1 �!...... 9�lm..... ._...._._. County: ......
OwnerName.................................................................................... _»........_ .__ ..... Phone No: __ ........ .
Mailing Address: ............................... _. _. _..W�...W -� �.
Facility Contact: ........................................... .......... Title: ... ............. ..... Phone No:
Onsite Representative:........ ....... Integrator: _. iZEmtiwAl ............
Certified Operator : .................................. .... _ ....W___ ..... _ ..._ _..._ . Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0" Longitude • ' °'
Design_ : -1
=Swine - Canacrtv,.- Pc
�" '-Desithi .: Curren
Wean to Feeder
❑ Layer
Feeder to Finish
-,
❑ Non -Layer
El Farrow to Wean
s
Farrow to Feeder
Other
Farrow to Finish
= - .r TAtal Desij
ry
s �* 1."7
Gilts
Boarsstir
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
"Ci
❑ Yes
0<01
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
0'1Vo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �---- ---------_-
Freeboard (inches): 3 Z
12112103 Continued

FaWity Number: 1 — 675Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ErNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 0 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes /No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes rNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �Io
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type R roz^UlAQ 14S&L)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWIvIP)? ❑ Yes /o
14. a) Does the facility lack adequate acreage for land application? El Yes
b) Does the facility need a wettable acre determination? ❑ Yes 70-,
c) This facility is pended for a wettable acre determination? ❑ Yes 15. Does the receiving crop need improvement? ❑ Yes;Zo
16. Is there a lack of adequate waste application equipment? El Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below [] yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 03
<Nq
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
791
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 El Yes No
Air Oualitv renresentative immediately
CaQnrnenis (refer to questiron #jam Fat}rlarn aeiy YFS answe s and/or airy yrecomnnendabors or a_ny other comments.
ruse drawings of fscelcty tc► better explaru sitnatrons. {use tiorial pages as necessary}: ❑Field COPY []FinalNotes s
di,j�jfr— t4As sPKAYFD a<o2. wftaS (TA/ 04s�✓ rXt�c.o .-F.rCc.a 1 tJEES.S s'oME s
F'c,,,j BALLS df /JAY" ►ueEo ro &C jZEMo✓IEp.
Aw, PeR-mr T jJeO A 93E & rTN QEG6&9Ss &c--r w/
x r cAd ajar F-rWD .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
t12ir12inz

Facility Number: 3 —7SI Date of Inspection
D
Required_ Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
rNIO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
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 Genera! Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
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?
❑ Yes Q N
❑ Yes DV/O
❑ Yes To
❑ Yes Olzo
❑ Yes 26o
❑ Yes 0<o
❑ Yes
hTo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ]--]Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

0
Type of Visit Compliance Inspection 0 Operation Review Q Lagoon Evaluation ` I
Reason for Visit Routine Q Complaint 0 Follow tip O Emergency Notification Q Other ❑ Denied Access
Facility Number 1 31
Date or Visit:
0 Permitted [3 Certified © Conditionally Certified [3 Registered
Farm Name: �r4A. ._. �2/%►.
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operat r Above Threshold: _
County: G�
Phone No:
hone No:
Integrator: 4.1' [l/YI__ p,
Operator Certification Number:
Vf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' k " Longitude 0 6
Wean to Feeder 0 1LJ Layer LJ Dai
Feeder to Finish J�❑ Non -Layer ❑ Non -
Farrow to Wean W:
Farrow to Feeder ❑ Other
Farrow to Finish F ,iTntalillPrian [`sanari
Boars
Subsurface Drains Present
No Liouid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area JLJ Spray Field Area
❑ Yes VNo
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes O No
❑ Yes /P'No
❑ Yes No
Structure
Continued

Facility Number: 31 — Date of Inspection--F�FY-�—i
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?
(If any of questions 4-6 was answered yes, and the situation poses an
❑Yesyo
immediate public health or environmental threat,_ notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
Xi
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste � ecation
any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence f over application? ❑ Excessive Ponding ❑ PAN ❑Hydra is Overload
El Yes
�No
12. Crop type i/
13. Do the receiving crops differ with those designated . the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
IV,
Wo
b) Does the facility need a wettable acre determination?
❑ Yes
No
VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
XNO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
X,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
001"
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
o
24. Does facility require a follow-up visit by same agency?
El Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,(refer to question #)-Eaplaln any YES answers andinr:any recommendations ar any;gEher comments :'•
gUse drawings of facility to better, egplam situations 3(use additional pagesFas,'necessary) ;' Field Covy ❑ Final Notes ,
. :... in :..
9r��7yill�.
f.�Cl.��c �OF d �p,�/Tieo� ltJf_FPS.
Reviewer/Inspector Name n
Reviewer/Inspector Signatu Date:
05103101 Continued

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 at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ElYes ,,X—ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IL! No
roads, building structure, and/or public property) F/
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.) ❑ YesXXNO
No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes ❑ No
Additional _Comments and/or Drawiu s: y ,yy yi�
r 4 e + f `F ..?r ^.. t . k *. g , � 'r 1 ; '' xis $ . ,
�5
Z!�2aph /L �>.�o 114P
y
eel
A--r AV
05103101

(Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O FoHow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
© Permitted 13 Certified 0 Condidoonally Certified © Registered
Farm Name: ........... a ....;�A ��7 � 'r'"'!
} /�........................................................................
Owner Name: d?...C,.. I r
1. .......�.. �:�...........................................................
v r i Time:
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ... ...
County:.. V✓1...................................fl-
.......
PhoneNo: ................. ............................... ............... . ........ . .....
FacilityContact: .............................................................................. Title: .............................................. 6 ................. Phone No:...................................................
Mailing Address:
"......... �.1Onsite Representative: L.or�.�rn5Integrator:...r,....P.::.�......�!_ f�. ......
Certified Operator:.... ............................................... ...... _6 ......... ...... ........... ................ Operator Certification Number: ... ..................................
.....
Location of Farm:
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
Current
Design Desigp Current
'apac►tY -Population ; Poultry Ca iacitY_..PvPulatioa -, Cattle =(
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Ntillsber' of i,agoons In Subsurface Dramres s Pent P Lagoon Area I❑ Spray Field Area � 'g
Bolding Ponds I Solid Traps. ❑ No Liquid Waste Management System
W.. :. _ ..:.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes"jNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes-A�fNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes &RO
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 'J�rNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -&No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes_,ENo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................................. ..................................................................................................................................
Freeboard (inches):
5100 Continued on hack

Facility Number: _? ! — S Date of Inspection
r 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Pondingg ❑ PAN [IHydraulic Overload
",It12. Crop type 4ee0",Itj
VdG r J"],,V l 116 ''a t1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�'VQ yiQl i4tis;ot. defc}eticies were ngteti ding ihis;visjt; • Yo0 witl•reeeiye o urtht.. .
cories0ov ideik abaul� this visit+ •
❑ Yes Q(No
❑ Yes 2� No
❑ Yes ErNo
❑ Yes ITo
❑ Yes XNo
❑ Yes _,O'No
❑ Yes eNo
❑ Yes-,E!fNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes JZNo
❑ YesZNo
❑ Yes fJf No
IETYes ❑ No
❑ Yes No
❑ Yes J2140
❑ Yes ''No
❑ Yes LErNo
❑ Yes ONo
_011Ces ❑ No
Coriuments (refer to;;questeon #) Explain anyYES answers and/or any'recommeadations ur arty other comments.3;
Use`dra of facility to better -ex situations. (use.idditlo"`p'ages as n w
wut$4
t q, 13 e sure *o vs e weis¢e gn4bys i s -re.- en l y 40id� ys �ro>�l 4he do/e •
o ,'-� 7L C 7�GUl4�i �`le �1� 1Q Z' S . �Ce4 -tr �d1 �e Wr"r4C Q.'iR� Sil
e i t
r ip -fie. s ,,^a ,., hQv e a vqt � d w6.e4 q�
A
�sv�lj04^1 di-f i0e rvm%^-1 n
Z S. G✓c+r �0�01 i ad 6 lbs. S �tll r'R;.-1 2040�' 7-�4� j tjr�7i t>rd�r
rep r_tgre -Ilwij r tjam- svrc 12:11,ow -Ae ylAq! j .
Reviewer/Inspector Name S�p6,yt/G)
Reviewer/Inspector Signature: Date: 5100

Facility Number: 3 — Date of lnspection EM,1.707
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ;;�<o
• liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 2rNo
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.) ❑ YesIffNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an or. ravings. _
o4ev-,4 of-r'&iA5.
O 1/erctI, ►� ke r
5/00

0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other. Agency
c1
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 3KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: 3 G Printed on: 7/21/2000
Q Not Operational Q Below Threshold
*ermitted ©C�ertified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
1 ��•� , Nt-.?� Count':.... ...............
FarmName:......................................\............................................................................... 1.......................................................
OwnerName : ................... ................................ ........................... .......................... .................... Phone No:.......................................................................................
FacilityContact: ............................................................................. ... Title................................................................. Phone No:.................................................
MailingAddress:..................................................................................................................................................................................i.......................... ..........................
Onsite Representative: L-!! ' Q.!� .. 1 ?� 11................................. Integrator:.... .. l'iaj d
....................................................................
Certified Operator: ...................................... Operator Certification Number: .............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �6 .. Longitude ' 6 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca aci Population Cattle Capacity Population
Wean to Feeder e3C1 ❑Layer I 1 ❑ Dairy
Feeder to Finish 10 Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lag—n 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?
Discharge originatet: ❑ d aLagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is ohserved. did it reach Water of the State? (If yes, notify DWQ)
c. II'discharge is observed. what is the estimated flow in gai/thin?
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
❑ Yes )4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes A No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number:'3 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 gNo
seepage, etc.)
` 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes '0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
9 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
KNo
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
4N0
11. Is there evidenceof over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
ElYes
D<No
,
��
12. Crop type S�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�fNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
fi�"o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc-)
❑
[KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
(�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C<No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
D<No
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
M No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1V(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
qNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
:: K'd •violations :or- deficiencies -were poted. during 4his:visit. - Y:oii :will -receive lio further
comes' oiidenke: mauh 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):
CX
tkse& w N_" /ec, i,- c�.ce� c� j �►� v� Imo, E7"--q
Reviewer/Inspector Name D ^3 ,L3 �(j t oL%_
Reviewer/Inspector Signature: Date: 1 --10 —QQ 5100

Facility Number: — Date of Inspection U G Printed on: 7/21/2000
• Qdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
+ liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4No
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 y
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes '�INo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 'EYNo
Additional omments and/orDrawings:
Vll";[ C�"\ o-1
U +
5100

"- Dwisionof Soil and Water Conservation = Ope'at�on Review a
D:Dtvision of Soil and Water Conservation -Compliance Inspection =
bDivision of Water Quality Compliance' Inspection
9ther Age ncy.= Operation Review -
Routine 0 Complaint 0 Follow -lip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
3 ` ?� Date of inspection I 21qj
Time cif Inspection 24 hr. (hh:mm)
❑ Permitted Wertified 0 Conditionally Certified © Registered JE3 Not'Operationall Date Last Operated:
Farm Name: -.... TT0.+( kit ^^►1►+.... Z' County:{1��IA^..................
Owner Name: ...................... ns 4.....---..-.......---1`1dur,S............................................... Phone No:.... g�.�1�.. R3.`. .� .................
FacilityContact:.............................................................................. Title :................................................................ Phone No:.....................................
Mailing Address: ........ A113.....Tfte...... $W.1(-k.......... N ........................................ ...��,��.�....
Onsite Representative: ........ VQ. ............................................................... Integrator: ..........Q�.........................................
Certified Operator:........Operator Certification r0.illhS,,:,••,,,•,,,,,,,, Operator Certification Number:............................
.& ....................... .............
Location of Farm:
0 Lltm.. ...... 0A...... : �!K... ... Ia A ....................................
r................................................................... ................................................................................ , _
Latitude �• �� ��° Longitude �• �_°_ �^-
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 15600 JE1 Layer PE
Dairy
❑ Feeder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity SLoo
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Dischiirge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made"
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated slow in valhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 52 No
❑ Yes ER No
❑ Yes, No
❑ Yes' 09 No
❑ Yes [g No
❑ Yes RINo
❑ Yes PNo
Structure 6
Freeboard (inches): Ll
�...
1/6/99 Continued on back

facility Number: 3` (�-IC� Date of Inspection
15. 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)
T Do any of the structures need maintenance/improvement`?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
11'. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crop type [.muc� ....... V4,q ................... ! ..............r-t7...........f,tLI.............
.....
3 99
❑ Yes 0 No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement`?
16. Is there a lack of adequate waste application equipment`?
Required Records & Documents
IT 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?
0. M)'violations:oi deficiencies:were noted: Burin'g' iis.visit;' Y.oti wiil:rec'eive 'no hirtliei-' -' -
.... po... a.... this visit ::::::::.. : :.... ........
❑ Yes Q No
❑ Yes ® No
❑ Yes �No
❑ Yes (kNo
❑ Yes ® No
❑ Yes ® No
❑ Yes (0 No
GZYes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ES No
❑ Yes ® No
❑ Yes WNo
❑ Yes 23 No
❑ Yes ® No
❑ Yes Zj No
❑ Yes 10 No
❑ Yes ® No
Comments (refer to question #): Explain any YES answers and/or any -recommendations or anyother comments
Use4rawings'of facility to better explain situations. (use additionalpage's as necessary)c,
►�. ''au 1 i w 1l be �[oae �dr 04CJ b - A-cv-ts m j trot � a,n [Jwlres s I•i o w : 44.
�e rov�ch W tvri.I At, 4� ' a LJ
P.
Liss i-AC.. 0-c;r<0.gc— �Y- ea.i,
r+��o�� {`avtctsSP z i rt�` it&�(on .t �Se- C,O tV rOjSSe% Shat�pf j j. (P p.crec�
��S V 0� aY-O - 1yr ml- S�C.F� vc� kJAk �OQ. Winkfo a'f 'tt�Llr `>r
1tcA-i Ck ak44 �rocrd�srt s s 4w��� �e � 1(o ed or small grn•1r` e a 1-6 LAJ a PA
IReviewer/Inspector Name Nll lA ),-e I
Reviewer/InspectorSignature:� � f1� Date: 19 I1/6199

Y' Division of Soil and Water Conservation Ottter A enc
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number S ��
Time of Inspection Imo. 24 hr. (hh:mm)
❑ Registered Certified 0 Applied for Permit 13 Permitted 10 Not O erational Date Last Operated .
FarmName: `� .............. County:..................i..-..................................... .......................
...................ii.... . -..... ............................................................
Owner Name. n4� .^!`�Sr......--•--•....................................................... Phone No:.�. .. .... .... a...5.���..........................
Facility Contact:.................................................................... .. Title:
Mailing Address:S ��,....
........................ .. .......... .............
Onsite Representative:..GW-.':+
CertifiedOperator;.....................................................................................
Phone No:
.......... ......................... ....... .... ...................... I ............. I..... ..........................
Integrator:...-. !.... t..............................
... Operator Certification Number .........................................
Lpcatiop. of F
ti
5 i........................................................................-- .. ' •.-- .I.. ....... --........... .......................:........
......-..... R.-. ......... 1............ ....................... ...... 4...................................._..._._......_.................................................................................................. 7 1n . .. d � t �� per... 5' R psi.
Latitude E=' 4 " Longitude r_�' �4 "
Design '.> Current
Design Current Design Current.
Scene
; Capacity 'Pomotioa „ Poultry .
Capacity : Pgpulation Cattle Capacity, Population;,
Wean to Feeder
40d
:
❑Layer
E.
El to Finish
❑Non -Layer
JC��airy
❑ Non -Dairy
❑ Farrow to Wean
g w`
❑ Farrow to Feeder
❑Other
; ,y
❑ Farrow to Finish
�
Total Design Opacity
❑ Gilts
❑Boars
Total SSLW -r
Number of Dons I Hol Ponds : ❑ Subsurface Drains Present ❑ rea Lagoon Area ❑ Spray Field A
,�
JE1 No Liquid Waste Management System4'
m
k
es
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is obsened, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
0
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
(M No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
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

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 1XNo
Structures (LaQoons.HoldinE Ponds Flush Pits, ,.etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes % No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: A—
................................... ..... ........... ................... ....... ............................. ............ ................. I..... ...................................
............................
I......
Freeboard(ft):........... .,................ .................................... .................................
10..
Is seepage observed from any of the structures?
❑ Yes
"No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
f rNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type .....:`..... 5a.......�............................................................... ....................................... ....... .................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AAW)?
❑ Yes
9J No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18.
Does the receiving crop need improvement?
� Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
5TNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
OfNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
22.
Does record keeping need improvement?
❑ Yes
ff No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
Do No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
❑ No. violations-ordeficiencies-were,ntited during this'. visit'. You.m.itl receive-' ' Airiher
crime 006dehO atiout this:visit:-::
r (i " S- 4�, W
bar Sa t�, �-e.�`, � �C (-�-►,1 � +� he,
�P
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 01 Date: 1� ( 9 1 V

{ ❑DSWC Animal Feedlot Operation Review��q
DWQ Animal Feedlot Operation Site Inspection
:au -
Routine OComplaint O Follct-*;,-u of DW( ins ection O Follow-u of DS%VC review O Other
Date of Inspection I
Facility Number 3
Time of Inspection � 24 hr. (hh:mm)
Registered Wertified [3 Applied for Permit [3Permitted � Not Operational I Date Last Operated: ....................
l_
FarmName : ............ .T{ea,..... klx..T....... ..Z............................ .......................... County: ....... huflih ....................................... .....
�,�.f�.�...................
OwnerName:...... ........l�Illt'ms........................................................................... Phone No:..�y1D)Ar13.-?3.Q�..............................................
Facili€y Contact: .......11L...... heftS.................................. Title:.......JoLi �A........................................ Phone No:. ai.Q�.2°L .� 29 LS...........
Mailing Address: ....... 331...... T�4 ....A.. ,1r►�i+-f.................................................. .......�wm�f�4 ...}....-......................................1.73.1.1...
Onsite Representative: ........
��L....... W'O'mS...................... ..... :.............................. ... Integrator ...... .�lf5ltlQ03......................... ............I ............ ..........
Certified Operator;.............hatit.......... M-40,5........ ..................................................... Operator Certification N'umber..........1.. .1. Z-
.............
Location of Farm:
..s..... .....t.......rki t..S:....-leg .
Latitude Longitude Q' �' ��' ffh nor" -fast- Side 1-11101 -
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder I0 Layer ❑Dairy
❑ Feeder to Finish ❑ \Ton -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
2. Is any discharge observed from any part of the operation? ❑ Yes 10 No
Discharge originated iw ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. if discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes ® No
c. If discharge is observed. whit is the estimated flow in-al/min? / A
cl. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ERNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Doe_ s any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
Mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes GrNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0 No
7/25/97 Continued on back

Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be property closed:' ❑ Yes 0 No
Structures (Lagoons,Iiolding Ponds, Flush -Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes t] No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(tt): K!(e........ .................................... ................................... ............ ... ..................... .................................... ............................... .....
10. Is seepage observed from any of the structures? El Yes 0 No
I 1 _ 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 ?erYll.J......................... 5itaco.11 .... �!r'ttY.lk..............................................
....................
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?
2L. Did Reviewerhnspector 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?
No.violations or deficiencies. were noted -during this.visit.-.You.will receive no further
. correspondence: about this. visit
❑ Yes C] No
❑ Yes ® No
❑ Yes [9 No
❑ Yes W No
.... ..............
❑ Yes IN No
❑ Yes [R.No
5& Yes ❑ No
❑ Yes 14 No
❑ Yes P9 No
❑ Yes 1$No
CS Yes ❑ No
C9 Yes ❑ No
❑ Yes 19 No
❑ Yes IN No
Comments (refer toyquest ion #):.:Explain any YES answers and/or any recoenmeindattons or any other cotnmeots.
Use drawings of facility to better explain situations (use additional pages as necessary)
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7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature:
Date:

r�
Site Requires Immediate Attention: A)d
Facility No.
��
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIQNS SITE VISITATION RECORD
DATE: 1995
Time: 119
Farm Name/Owner: D'41�_e A)- �3'�'� ' ?-7w kllev— F*eA
Mailing Address:
County:
Integrator 1 Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche 2'g'oon(s)?
or No Actual Freeboard:°^�Ft. Inches
Was any seepage observed from Yes o NgWas any erosion observed? Yes Q19
Is adequate land available for s ray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: i
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings es- r No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters 9f the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain_
Does the facility maintain adequate w e management records (volumes of manure, land applied,
spray irrigated on specific acr
e with cover crop)? Yes or No
Additional Comments: /fT�ii m '/cqr
Inspector Name Si!
T �
cc: Facility Assessment Unit
Use Attachments if Needed.
n