310768_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qua

Type of Visit: QrCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: l �Lf�/! f I Arrival Time: d 3D Departure Time: © County: Gr v1 Region:
Farm Name:✓'1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: _ /> / � � . 'a o S
Certified Operator: J � l r/ D�i I S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: T /&?5
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
ILayer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
C►►urrent
Pop.
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Drjyj1R,%uIt .
Layers
Non -Layers
Pullets
Turkeys
Pouits
10ther
i
Ca aci_
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
OtherI
,.Turkey
I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Q No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes Q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes [S31L ❑ NA ONE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fac' i N+ tuber: - Date of Inspection: / 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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):
d p"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ 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
ETNNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
El -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
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste dip Cheation
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):
-�SG�t-� . Cv✓n
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
<No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M <No❑
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNoo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
4E]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
ErNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: !
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Er -lac ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �No 0 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 E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes 0No ❑ 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 EJ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E5No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 521 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question #):. Explain any. YES;answers ;and/or any additional recommendations �Or-any other comments.
Use drawings. of facility,to.better explain situations (use additional'pages`as'necessd6j.�'
Reviewer/inspector Name: 242LJ2 r 1` Gj/� S f-'1 '( 5+1 A
ReviewerlInspector Signature: YC:5�� Aar',L
Page 3 of 3
Phone -
Date:
21412015

Type of Visit: GrCom ante Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: q* Arrival Time: ® Departure Time:=J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 Z-L C 014 L,4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: r V95 r
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop,
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P.ouI_.
Layers
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Mowlen
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
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 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 ❑ NE
❑ Yes EJ`N_ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

k'acility Number: I -971 jDate 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [D No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 dNo ❑ 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 C!5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [j"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA 6NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [—]No ❑ NA �rNE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA VNE
❑ Yes ❑ No ❑ NA El]
[:]Yes [:]No ❑ NA FNE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes ❑ No ❑ NA [�] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No ❑ NA [3"-NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA CJNE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: Z 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA NE
❑ NA &"
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
❑ No
�A
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA ,❑"NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes allo ❑ 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).
4 IA I [ IL` t' 9 F y t q-% 1 Me
�CCQ� 5 Scan �1c`F�7 4�'If
rce'Oe'('$' . � e&P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

P
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 1 1,2 - Arrival Time: Departure Time: County:
Farm Name: %,3'5—o _ � Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �evzx'v_(( Do // % Integrator: r/�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
OF
Certification Number:
Certification Number:
Longitude:
Region: 44A�s
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder I
lNon-Layer
I
EEJ
Dairy Calf
Feeder to Finish U
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult . Ca aci. P,o ,.
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ot
Turke s
ey Pouits
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 DWR)
❑ Yes n No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [3-Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Y_ es No ❑ NA ❑ NE
of the State other than from a discharge? '
Page 1 of 3
21412014 Continued

Facili Number: Date oflns ection:
Whste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
r
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T� 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes gfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VTNo
❑ NA
NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need E] 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, e c.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No. ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ 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 �No ❑ NA ❑ NE
❑ Yes VNo ❑ 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 .0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes.,, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections :❑ Monthly and 1" Rainfall Inspection
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2INo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili N mber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes O No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r4No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes grNo ❑ NA ❑ NE
❑ Yes VrNo ❑ NA ONE
❑ Yes Oo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ YeslNo
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments, (refer to question ): Eap ainsany:YES answers and/or., any additionalrecommendatioM or any other comments.-,'.
M.
Use drawings of facility,to. better,explain.situations (use additionat pages as necessary): _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2
Date:
2/4/2 l4

Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 976County: uPr'. Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: IL, Datrs
a
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
I jNon-Laer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,ouI Ca aci_ Rio
Layers
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
or
113eef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2 /No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑. NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ N ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesgN�[:] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

/Facility Number: I Date of Inspection: I.IVI U
,j Waste Collection & Treatment r
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
'QStructure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: U+�� CA &a 2,-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —7,
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 ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat,
notify
DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
�10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
io
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 [D Nn ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Nqo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes fo
[:]Yes Bio
❑ Yes raeo
t"v
[:]Yes
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA []NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3'go— ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
i
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 o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection:
g4. Did the facility fail to calibrate waste application equipment as required by the permit? [a Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA D 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 Ejj o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Cnlo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ❑ No
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 WNo
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 En No
❑ 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 U lVc
❑ Yes .7
❑ Yes j J 'NU
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer -to quest►an #): Explain aii YES answers andlor.aiiy additional�.recomniendations or,any other comments ,.
Use drawings of facility to tietter,explain situations (use additional pages as necessary) > :, „..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone p 0
Date q
214 014

I
Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access t ,t
Date of Visit: Arrival Time: j? Departure Time: � County: Region: �/, -
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
C►urrent
Pop. Wet Poultry
01 11-ayer
Design Current
Capacity Pop.
I
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Current
Pop.
Wean to Feeder
I jNon-Layer
Feeder to Finish 6'ri
Dai Heifer
Farrow to Wean
Farrow to Feeder
Dry, Poultry
Layers
Design Current
a c i P,o
Dry Cow
Non -Daily
Farrow to Finish
Beef Stocker
Gilts
Kan -Layers
Pullets
Turke s
Turke Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Qther,
Other[��
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes G;?No ❑ NA ❑ NE
❑ 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
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FrNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
J?I'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: J,
Spillway?:
Designed Freeboard (in):
n y
Observed Freeboard (in): L 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
6No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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 VNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [4No ❑ 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 ?TNo ❑ 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 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes n No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7No ❑ 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 16No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1
t
Facili 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
ro
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
/�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT
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
q!fNo
❑ 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
4No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�fNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..'
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �MJj �,o\
Reviewer/inspector Signature:
Page 3 of 3
Phone:���
Date:
21412011

Type of Visit: IRCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: "" Arrival Time: $ Departure Time: 3a County: lY,l ]UlY
Farm Name: # OL Owner Email: '�F^
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative: 1 -t:4 e Integrator:
Certified Operator: Certi�tion Number: j gd 3CS
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pvp. Wet Poultry
Wean to Finish Layer
Design C*nrrent
Capacity Pap.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
yG0
Dairy Heifer
Farrow to Wean
Design Current
Ca aci $o
Dry Cow
Farrow to Feeder
Farrow to Finish
1l . P,oul .
Layers
Non -Da'
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �!To ❑ NA ❑ NE
of the State other than from a discharge? TT
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: &/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_
Spillway?:
Designed Freeboard (in): �. S }�•
Observed Freeboard (in): .........
� ,,�[
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes y.�J No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 7�
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? �T
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? 74
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 ❑n Evidence`'of Wind ❑ Application Outside of Approved Area
12. Crop Type(s): Cu�E C�� Co(LN 3
13. Soil Type(s): A) n6L`-0l C �C>(Z_CS J d Jy
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP El 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 El Waste Analysis ❑ Soil Analysis ❑ Waste Trans ers ❑ Weather Code
Q Rainfall ❑ Stocking Crop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [DNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes No 0NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes 9No 0 NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No $NA NE
Other Issues �
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes j ] No
6 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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the Yes `` No
permit? (i.e., discharge, freeboard problems, over -application) �
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes No
34. Does the facility require a follow-up visit by the same agency? Yes lt
No
0NA 0NE
[] NA [] NE
❑ NA [] NE
NA NE
NA NE
[] NA NE
NA ❑ NE
Comments (refer to question-#): Explain any YES answers and/or any additional I recommendationsor,any other,,comments.,
Use drawings of facility -to better explain'situations (use"additional pages as necessary}.., rn
5/1 toft Q '�t 14
algqlia 3.1
1,3
I.s
9).0
a
Cs
No5,IAJcC
C N V�, LA-`= N01 k
Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: VRoutine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: L Departure Time: County:` Region:
Farm Name: �j-AGl_/ylS Owner Email:
Owner Name: t ag� C L �� ui S Phone: �1 Q ''�93-y3
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: g /q-7zG GL DQ O) S
Certified Operator: Z 1 '-72 C- LL- � . V .►4'� S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Ceri'ifiction Number:
Certification Number:
Longitude:
IxU3 S
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry' Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish G/00
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,ouIt ., Ca ad $o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes OkNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA D NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA 0 NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

I
Facili Number: 731 jDate of Inspection:
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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Doi I q�W)D Q
Spillway?: _
Designed Freeboard (in): �g• S % g• S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No
❑ Yes No
[DNA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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? rA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement? T�
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): 1K..�� �e5Cu C-63) C09W W (���} 1 '5-r s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ 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.
1
❑WUP []Checklists ❑ Design ❑ Maps [—]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA
❑ NE
0 Waste Application Q Weekly Freeboard 0 Waste Analysis Q Soil Analysis
0 Waste Transfers
Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facifi Number: jDate of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
2& Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes t"-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes 10 No
❑ Yes 4 No
❑ Yes 0 No
[:]Yes bfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 91U T7�v�
Date:
21412011

Type of Visit ?Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ARoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Arrival Time: Departure Time: County: t^ u N Region:
Date of Visit: MM
Farm Name: F71%zms Owner Email:
Owner Name: '1J 1�� L-L J • � 4 Phone: 9)6r o993_j_/ 3013'3
Mailing Address: » gQ (_Ad r r ELd 5 , Ne �8 39
Physical Address:
Facility Contact: Title:
�t��Onsite Representative: e u- S
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
OperaTor Certification Number: Vass
Back-up Certification Number:
Location of Farm: Latitude: = n 0 6 = Longitude: 0 0 0 i = f1
Design C*urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er I
❑ Dairy Cow
❑ Wean to Feeder
I
I ID Non -Layer I
❑ Dairy Calf
Feeder to Finish
CO
❑ Dairy Heifer
[--]Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
fi(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Cl Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
FacilityHumber: — (p Date of Inspection Eagw
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 tthheas�ral freeboard? ❑ Yes ❑ No ❑ NA El NE
Structure 1 AQe tructncture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�J No
ElNA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
I l
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?
1
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ElNA
tNo
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Comments (refer;to,question #).9 Explain any YES'.answei s and/or any-recommendatibnsori any other coinments
Use drawings of facility to better explain situations. (use additional pages as necessary): -„ ^ n:
Moj/o
Ir�aSla9 J . Co � . S
Reviewer/Inspector Name �i9
/ rn
Phone:
Reviewer/InspectorSignature:
Date: �ff��JJCA
Page 2 of 3 12128104 Continued

4
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 4No ❑ NA ❑ NE
the appropriate box. 0 WUP 0 Checklists 0 Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Wiste Transfers ❑ Ymual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections 0 Monthly and 1"Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [j�10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _4;�No ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes );�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ino
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JDJ�4A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
; ' qo
❑ NA
El 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
KlNo
❑ 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
_V/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
CONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional C©niments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l9 !ac Arrival Time: 1® Departure Time: County: )t'l QL11f Region:
Farm Name: (n1�� 1' �AZ m S 1 Owner Email:
Phone: 5—C�rs
Owner Name: �1Q_
Mailing Address: ��gd La1N �lE�� Q-c1 ��Ar`LSv�i-ems /J C QRS9��
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: l�t"L" �A U� S Integrator:
Certified Operator:
Back-up Operator:
I
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = ° ❑ 1 ❑ «
jDesign C►urgent
Design Current
It
Design Current
Swine Capacity Populafion
Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
l
Non -Layers
El Beef Stocker
El Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
JE1 Beef Brood Co
❑ Turke s
Other
❑Turke Poults
FEE❑O❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�y No
/
❑ NA
.❑ NE
Discharge originated at: ❑ Structure ❑ Application Field El 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
kNo
[INA
ElNE
other than from a discharge?
Page l of 3
12128104
Continued

l?kcility'Number:_31 Lo&
Date of Inspection Q O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in): j �. S J� • S
Observed Freeboard (in):
Structure 4
❑ Yes &No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P%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 4No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 ElNA [INE
maintenance or improvement? P
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '[�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1� `-t [.5�^t� Fr_ S l Co O it-,-/ p1 f R TS
13.
.j
Soil type(s) V(S"Far_IC (=OR.t;5 OtV (2eit_f) 55G(L0 � (�AiNS
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J�§,No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
�3 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
4No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
K_No
❑ NA
❑ NE
Comm ots'{refei 6.questiod #) E plarn any�YES answers;andlor any�recntnmendations or any other comtnents.
U}seAdi awtngs of facd>ty, better gxplatn srtuattons: {use addr#ional pages;asgnecessary):
A
'bq) A- VC.- w eCQaDS -
aj17lo9 a?.t-(
l_f
�Cp )mS o1C PC;IQ �
1•5
wecIDS 01V /A51 DE a F VVYE way s. �Av1 s
����� l- �o
�• 7
(�G R-Jt1s TO 5�/ly SocSW
�
Reviewer/InspectorName
XQA f S - ]Phone:
Reviewer/Inspector Signature:
9, Date: Q
Page 2 of 3 12128104 Continued

n
Facility Number: -3 1 -- lj Date of Inspection
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available? Cl Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
0 WUP El Checklists 0 Design El Maps [I Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes XNo El NA El NE
El Waste Application 0 Weekly Freeboard El Waste Analysis El Soil Analysis ❑/aste Transfers
✓✓✓✓✓✓ ❑ /inual Certification
[] Rainfall El Stocking ❑ Q�op Yield El120 Minute Inspections El Monthly and 1 ° Rain Inspections ✓❑ 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
SkNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 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
J�LNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
rA
El NA
El 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
'KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1ANo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
Additional Comments and/or Drawings:
C RC"QW' -TI 0"v X/ ' d9
Page 3 of 3 12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit I�X Compliance Inspection 0 Operation Review () Structure Evaluation 0 Technical Assistance
Reason for Visit' KRoutine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 157j� Arrival Time: d Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: & C—h oV
Certified Operator: ?lw&GL-
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: ! laos�s
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° 0 6 = «
Design , ::Current Design
Swine Capacity Population Wet.Poultry Capacity
❑ Wean to Finish ❑ Laver
❑ Wean to Feeder i"; ❑ Non -Layer
Feeder to Finish L{U3
Ll Farrow to Wean Dry Poultry.
❑ Farrow to Feeder
❑ Farrow to Finish is
❑ Gilts
❑ Boars
-:Other.,> .
❑ Other ! x
01 1r
:Current D`esigd .Current:"
Population Cattle - Capacity Population
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
t Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Co;_
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
'Numb erof Struct
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

laa , ity Nthnber: i —
Date of Inspection '-- I 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?
r Structure I Structure 2 Structure 3 Structure 4
L
Identifier: 46yo,W
Spillway?:
Designed Freeboard (in): 19.15
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes
No
❑NA
❑NE
❑ Yes
VNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 qNo ❑ 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
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o [I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesNo
[NoElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yeso
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo ❑ NA
❑ NE
Comments (refer to question 9): 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 IAW 06S Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:p8 Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ftNo ❑ 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. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
V No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes]
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PINo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ 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
EfNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1;�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
y 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
gNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facitity Number, j
Division of Water:Quality
0 Division,of Soil and; Water. Conservation
0 Other,. geucy
Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: v r
C /Q,�,� Departure Time: aunty:
Farm Name: �r+%� /► Owner Email:
"WnPr Numa• /l Z % %I Lli VJ/7 �4S PhnnP-
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ZzF�[- �✓�i��5
Certified Operator:
�iGZi✓ Region: "1-1214
Phone No:
Integrator: 1XIlvAlIv
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o [ = Longitude: = ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�! ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes yJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� o
❑ NA
El NE
El Yes
No
El NA
❑ NE
12128104
Continued

Facility Number: S —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
�S}tructure 1 Structure 2 Structure 3 Structure 4
Identifier. 2t� ,, I
Spillway?: O r A110
Designed Freeboard (in): 7
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 1;1No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes & ❑ NA ❑ NE
t I' bI t f d 'ts to d/ t t I- (No app kca e o roo a I.,
pi , drys c s an or we sac s )
9. Does any part of the waste management system other than the waste structures require El Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[�No ❑ NA ElNE
maintenance/improvement?
/
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�No ElNA ElNE
❑ Excessive Ponding ElHydraulic Overload ElFrozen 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 ❑/Applic�atiion Outside of Area
12. Crop type(s)
13. Soil type(s) AZO 6o o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
o ElNA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
ma 2
Reviewer/Ins ector Name'_ `" Phone: d!G
p iff�S.T`ti �E3.
Reviewer/Inspector Signature: Date: 5 V-D
12128104 ' Continued

Facility Number: — Date of Inspection O
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? El Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists / ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfe ❑ Annua] 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
v No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
12rNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
PrYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
�
oNo
❑ 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
,09No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
(((
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ 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
Additional Comments and/or Drawings:
I2128104
I2128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 10Compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency
Date of Visit: w
Arrival Time: : � eparture Time: S County:
Farm Name: Owner Email:
Owner Name: A/I5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �ZIGLL 0#vim_
Certified Operator:
Back-up Operator:
Location of Farm:
O Technical Assistance
O Other ❑ Denied Access
Region:
/ , Phone No:
Integrator: Tt/R�/%�J/_
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= d Longitude: = o= i
Design Current Design Current
Swine. Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer ❑ Wean to Feeder ❑ Non -Layer 4
Feeder to Finish QD
El Farrow to Wean Dry Poultry.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
U Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
"Design Cu
CattleCapacity Popi
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:'-. �
__2
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
YINo
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of InspectionZ �pD
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:
A� XZ
Spillway?:
IV19
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) X
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 14
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4 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 > l0% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ A plication Outside of Area
12. Crop type(s)CLI�j¢ZL�
13. Soil type(s) _. AL
14. Do the receiving crops/differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(�' No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
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):
g l) & 5 Ewe
dcr � /dal✓, e
Reviewer/Inspector Name t�e 7. Phone: y% T
Reviewer/Inspector Signature: Date: Y2=Zp(�
Page 2 of 3 1 ?118104 Continued

Facility Number: 3 — Date of Inspection 3 D(c
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No El 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. eyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking oCropYield ❑ 120 Minute Inspections ❑ Monthly and V 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?
❑ Yes 1No
❑ Yes No
❑ Yes o
❑ Yes XT,
0
❑ Yes X No
❑ Yes VNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
❑ Yes ,[ No ❑ NA ❑ NE
❑ Yes VJ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes of No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
kdditional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 14"t Arrival Time: • eparture Time: ty: I ��LZ/✓ Region:
Farm Name:y!S5 0 lh5 ,_Zz� Owner Email:
Owner Name: & ,64L _ _ \0A aZ75 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: t &rz7_6LC' '4gs
Certified Operator:
Back-up Operator:
Phone No:
Integrator:—1L(L/+QIP/��— 660?.9cj/J
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 I = s, Longitude: = c = f 0 «
Design Current Design Cnrreot
_Design Current
Swine
Capacity Population; :. Wet Poultry CapacityPiipulahon
Cattle w C pacity
Population
❑ Wean to Finish
❑Layer
❑ Dairy Cow
❑ Wean to Feeder
n-La er
❑ Dairy Calf
Feeder to Finish
❑ Dairyfleifei
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
'
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cowi
R Film'
MIN Mimi❑
Turkeys
p a
Other
❑ Turkey Pouets
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)ZI No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

►t
Date of Inspection 5//9
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to 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
Identifier: �
Structure 5
Structure 6
1%
Spillway?:
Designed Freeboard (in): sJ
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
VrNo
❑ 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
VI No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![]
Yes
ON.
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
ZNo
❑ NA
❑ NE
ERse
Irawtugslu
ts (refeES answer'sxand/orAancoinmenilations. orany other commenf fac�ty-tofbeuer expiam�srteiabons a(use addEbonal pages as�necesssfry}
�v�2S�p Sp�� �T Ale&#v2T ►�co 1p 2!p 2.3..1 L��.� lam.
B.�,o
/kz e.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: s-/ ELF
12128104 Continued

,V
Facility Number: — Date of inspection Bvl-r&Kl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )zNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ;A No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 21 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 2(No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes JgNo
❑ 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
ElNA
El 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 0No
❑ NA
❑ NE
Addittonal :Gommeot0andhir Drawings'ff +, r�
vn� ,eoL ��� Y . � �
4o4O VIIJ
12128104

Date of Visit: t e Tune: 13. � �
Facility Number 31 ?
Q Not Operation3l Q Below Threshold
Permitted Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: _ D�S43-- _ _ ._. _ _ _ _ _ County: 001P`3J
Owner Name: ___._.__. ... _
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative- ZTL ITI. A, ,,,,. — __.__ , .. Integrator =
Certified Operator: _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 Longitude • 6
Design Currey
Wean to Feeder
Layer
Feeder to Finish
6
s
Non -Layer
Farrow to Wean
Farrow to Feeder
Other
"> =
-� Total
Farrow to FinishGilts
Boars
7
MwAaraes & 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 -fie?
Non-
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: — I Z.
Freeboard (inches):_ y
12112103
❑ Yes [3 tvo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Q 0
❑ Yes LSO
❑ Yes Om
-,/
Structure 6
Con inued

Facility Number: 3 l — � f. Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[�'90
% seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
<O
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
21/yes
S. Does any part of the waste management system other than waste structures require maintenan�mprovement?
El Yes
7No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
0"No
elevation markings?
WasteAPRlieation
Yes
10. Are there any buffers that need maintenance/improvement?
❑
To
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
o
❑ Excessive Ponding ❑-PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C_S W/rrLru 0 %s C-%/(. 560
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVW)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNQ
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
310
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes7No
o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
1) CAJT tJ bbq! ¢as t✓ jj A Rotr 9 t..A &Cm i1 In1i UUS
Iyt) n o e W - FE s f_.0 E. Fzetz ►SSE h� W6E t3 Lo NTR-6 L•,
2ec'4"S 40� D. t Til�,i✓� ^^rc� �xvtiPr�al6b�
ReviewerAnspector Name
Reviewer/Inspector Signature: Date:
1Z/ll./V3 f..aMsuccu

Facility Number: 31 _ Date of Inspection 1 fi
Re&mired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were arty additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Perrnitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes �o
❑ Yes �o
❑ Yes
❑ Yes rNo
❑ Yes
El Yes tr.l N
❑ YesL�J o
❑ Yes rNo
�/Yes ❑ No
❑ Yes p No
❑ Yes do
❑ Yes ❑ No
❑ Yes 7No
❑ Yes
12112103

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified [3Conditionally Certified D Registered
Farm Name: Q-T—
Owner Name: C/� zz�u. _ 4zj; !�
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operated or Above Threshold:
County: zZ
Phone No:
P one No:
Integrator: ff&/Q
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude 0
Design Current
Swine Canneity Pnnulntion
❑ Wean to Feeder
Feeder to Finish
O
DD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current k
Poultry Ca aelty Population, `Cattle Ca achy" Pbviulatiow
❑ La er I Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
fioli in 1ponds] Sohd`Tra s ❑ No Liquid Waste Management Sy stem
i
Y g p
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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A, / djt,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
ZYes ❑ No
Structure 6
Freeboard (inches): W
05103101 Confinued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
{If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notif}, DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste -Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal R'aste Management Plan (CA ANP)? ❑ Yes ❑ No
14_ a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ 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 ❑ No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22, rail to notify regional DWQ of emergency situations as required by General Permit? ,�I
(ie/ discharge, freeboard problems. over application) ElyJ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
I© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
better explaiji sitn ttons (nse_ads tconat pages'as ne ry) ❑ Field Copy ❑ Final Notes
So�0- & Arm IJ� s� �� �0n/h SPm,E L',e,� s -�.� ONs �� � �� s
CJ��Z� �LrJO �VuSES'� !�/�5i � ��f5 �.�7rf2i✓�'!J ��.�
Reviewer/Inspector Name -
Reviewer/Inspector Signature:
Date:
05103101 Continued

FaciHty ,lumber: l —W Date of Inspection r O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to dischargc at/or bclow
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there anv evidence of A-ind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property) V
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the flush tanks lack a submersed fill pipe or a permanendtemporary cover?
Additional
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑1'es El No
❑Yes ❑No
7- �� �� %�!1612Rr� �
U rn��F��e /ram. �9� E J�y�4C ld �,� 7 �vEy/h F_�✓�.�7��i
�2�� y�✓rn � �Ip �",rD, ��l-�re� �O /��� .�9 /�rI'��I'16�,JE/�
% PC_4J-/',Jr/OC�O
05103101

Facility Number Date of Visit: E-� -ime.
Not Operational 0 Below Threshold
O Permitted O Cerrtiified ©Conditionally Certified [3Registered Date Last Operated or Bove hresbold:
Farm Name: _ !/ �__T 4�� _ 2 __ — __ — County: ,/�
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: e:Ui g/-
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: C���✓'f s
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude o �� �" Longitude 0 G Du
Swine
Design
Ca acity
Current Design Current Design Current
.P,a ulation Poultry = Ca achy P,o ulation Cattle OUR P,o ulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Layer
Dairy I
Non -Layer ❑Non -Dairy
❑ Other
Total. Design Capacity
Total SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
ElBoars
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area
Holding Ponds 1 Solid Traps ❑ No Li uid Waste Management System
10 Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ LaRoon ®,Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
Yes ❑ No
U Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
05103101 Continued

Facility Number: T/ —lig I Date of Inspection zz4t'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 5ff Yes ❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? RYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? I&Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Auolication
10. Are there any buffers that need maintenance/improvement? R1 Yes ❑ No
11. Is there evidence of over application? &Excessive Ponding ❑ PAN RHydratilic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? 93 Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
® Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Ayes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Gbmuients (refer tarquesrioit #) Explaut any 1'E5answers and/or any rommendatioas or,any'ather cotuxnettts.
_
Use drawiiigs of futility fo flatter cxplain situations: (ose aildt4onal pages:as ©ecesssry) ❑ Field Conv � ❑ Final Notes V _
1 Ar-ynt`- `/
�! erBj J✓L0e & A iY Lv4 s d ASS'! ✓w[ ArIC- i°OA 0.---
"Wa :: G'� i��'✓��
%r,/i`�6>�66'�t �-c s7ti'�u?," !/l4i�tQ`r' �/Q p:— ,`/Y1` t�i7n �' s��.�zs' k✓4r ,�v7'�;'ri. ,`�i
sf/�7`�rr+
A✓`- AA O� S: i✓ �t GJfr.LP/s �i�r�t p �i f►-
d � mdhv . ,�Jmbtcfe Wes, s e,�e e -t ,�� � v,te ��— &,-
f
Reviewer/Inspector Name ., - " : .9 263
Reviewer/Inspector Signature: Date: e z ll3
O5103101
V
Continued

Facility Dumber: 3/ Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or, Drawings:._.
�1� v� d 17 , Ort �Gi"C Cd dDh
�I
X Z 7 Y2561
eed J
kja�"
t /--"-0 xo/'
�lr�G<a 4, qv /✓Zi40/ 74,
a 4qe-.
As sp"044 / 4'�- dW�4 W06t
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit QrRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: 8 G Time: / 7-• S
Not O erational 0 Below Threshold
0 Permitted ❑ Certified © Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: I?J-12 F-4 - -,%. S __T _ County: �Jjf
Owner Name: 's 7--Z Pj I P4y f Phone No:
Mailing Address:
Faeiiity Contact: Title: Phone No: 1
Onsite Representative: �•ZZ�Ptf �y' S Integrator: Ved c"K?
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 0 u Longitude ' 0 0
Design Current DesignCerre©t p xDestga Corrcnt
_.
Swine:: Ca achy: Po uiatmti .P.'Potiitr _ Ca- scsty ., pb ulstian ,._=Cattle. s _ :Ca acity� Po uEation
❑ Wean to Feeder ❑ La er t w ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 3 ❑ Non -Dairy
❑ Farrow to Wean
[] Farrow to Feeder f ❑ Other
❑ Farrow to Finish Total Uestgn Capacity
❑ Gilts
❑ Boars Total SSLW = =
W-
y.
%Number of Lagoons Z ❑Subsurface Drains Present ❑ La oon Area ❑ S rav Field Area
= �•�
Holding l?onds l 5altdl Traps" =. ' ; w ❑ No LiQuid Waste Management System -=
DischarLyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes � No
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] yes ❑ No
c_ If discharge is observed, what is the estimated flow in gal/min?
d. hoes discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes 'ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ ! 2-
Freeboard (inches): 45 2 to
05103101 Continued

Facility Number: 31
Date of Inspection 4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings)
❑ Yes -WrNo
❑ Yes rErNo
❑ Yes -I No
❑ Yes gN0
❑ Yes [3'No
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes ,ErNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type Vescye Con'+ro)a —ice AneK..rg).lnj;&%4e.-Arimv4)1 A.--'AVda Cont"d) 6•�ze;t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? LRryes ❑ No
14. a) Does the facility lack adequate acreage for land application? '♦� SOwtadt Gear. a %,4 --$eG4 ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? J21es ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes ONO
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZrNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W13P, 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 _ ErNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes _;3'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ETNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes E No
24,
Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comtnents`(referto;,questioit #)-mExplaEnany l'ES answers atid/or_any iecomuuendations oranv:other comments.
_ _.
Use drawings of-faciltty-to better,explam situahans. (ose addttronal pages as neeessarvj _ . -
m M �� 0 Field Conv ❑ Frnai Nates
m
13• pol r7A it i-Ac.Ivde,4 i-i -fke Wct,sie eas pAi or r.eleel 9. ffowcver,
lTvll 7A appcats 4P.aa- S�Xokld be iw"-C1 Udtd ck-C patf of F-ie(d +,,)4eti
loek;^j A4 Ike 41-A4 sllaws tie Pv]ls.'Plerse A'AVC
full 7A i ttlUded e ks p i--4 Ar F7;s1d 4 4L,q� if deS;y••tic�}od r/'o� (,erritvdq
rrA4ke✓ Oka, LlRvjj pull 74 v ►4 eq.-1 vP 5r;eld 9 4"1
iS narjeA >eli� _ •sGSG�e
Reviewer/Inspector Name - Sorttt✓q%i
-Date:
Reviewer/Inspector Signature: Q O
05103101 Continued

11
Facility Number- 31 — r]
Date of Inspection ? O�
P,ve- 3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
M 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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes �\o
❑ Yes �yo
❑ Yes JC2"No
❑ Yes �'�io
❑ Yes 2rNo
❑ Yes ❑ No
Additional Comments-land/or Drayvings:.. =` = _ J
15, F'��1d'.ik 'is d►es�yn�,�d �e�' 6cr•�►v��; 41�e>ra ►S. a s,"y�+t'f'+'�Qn
tRr**gaie4t f a-f 4l e P;aJd 4-114 ' 101GjLi G S4a1GI of 4e,--,kP4q.
woek 10 bcVc� e--s4abRA 6ev-mvAa, 4jie_ Grop i�4ke >C;,eld
needr4o 6e. rati4a;r-end i.I 0e000d4PL a tv 44 44e Color-des+V�j [
;.141,e wns4e, flan. l:o, �l�gsc t„io��(c Jo esAabl;sk Zescve
be >h Sov.4r Afitmg
'-Glr�a� a,P 'rield aL . A Iso, / ; nee®Ls
4ev 6 Ayf 1, ed -/a 44C be,^MVd4 k4';a!d n q Ccofda��e t,�=u+
4Ae .4p✓"i) ZO'DZ sell -lest eesvl...
`Tqce Pi 4'e-eeboQrd c`eco�'oCs � q v'gt')4
©G�c66r1 /lJG✓Q" bar'! a hd Decen1be� q) so
1g_ `�'lcAsc 9cl A Mato WG .,CL, Slows c I ¢q rI� -rl lie pulls akd
a^c a [QS ) [ens
544) w;d4U, ele -ro-- 4QeL Pull • T]�;S CA✓1 .
p r+a 6! 6 p -'od vee d -Fromm LL-d??__k--qqe •;& 4 raS m -jp -/-t%q 4 17ess
. he d r� to, C,14) Oh f MA r'tk ¢d T)-- Q 4 S IZ ew M
Cd e e •S�B,I'd4
Veer 1s to 1sa' S411 loh � 42le .Y"lep and8s.°9Solt.
99 -b SG �kq� is �a �a�r -�I-Q4 --i+ -� awe n�
ele4�'ty rvta^Aed owe 4c,e `4-f. Peel',Vt A liege ago w;11
cicvp.
25. -Tile 6eemvdcq r,,e Id ;s be I rlZawed vi le :r am do;2C.Owr
APx
'T� G V4-wia4Qe I
K 1Pe toll ; am . �e¢d S fo G� ba 1 • Tk
hcrvc rto�- kef� up t4./;-4441iq grew4-4 xr l,4e 9�ass. The ys
rgs
needs �& be s�ew�et.tel 6 44�;;n W h e� 1hs Gal.�/s de rlo4 kPe
VP z ;4&% -4�"e 9 eeL,144 - All C-'o s � kzv+ rece;vee woCle A eed la bLw
f
T'V1°E' l Used AV4 re,,,,Q,ied�,.,p.�., ke r; 1
O5103101 y �66,0 )J-I vQd�

A
Facility Number: 3 % — g
P-OLJ C T
Date of Inspection
Odor -Issues
26. Does the dischg ge pipe
from the confinement building to the storage pond or lagoon fail to discha at/or below ❑ Yes ❑ No
liquid level of laor storage pond with no agitation?
27. Are there any dead ant s not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind i during land application? (i.e. residue on neig ring vegetation, asphalt. ❑ Yes ❑ No
roads, building structure, and/or pub t operty)
29. Is the land application spray system intake no ated near the surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ve n fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc ❑ Yes ❑ No
-31. Do the animals feed storage bins fail t ve appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary ver? ❑ Yes ❑ No
Additional Comments and/or Drawings. _
f »co n Si s rI c It s a q,e0h4l 6e4u eer,
41, e -Pe ac t e a nd drop of Y,i4 4he a mockpq o f Io v.•z10 .-19 .
on Mk 22.E 2.0oz f-),e 4.,eebo4v'ed Iler-eeAs 4rkow
fagaeti 1 ',R4 ZD--v�ckes A la jooll. 2 k4 M'%1
'Zq� zoo. Z fH t re'ce rd S SLtow ! a y �a9, I a4 Z `� 11 a I
a Jao•\ 2- A `73 Th s S.cewt s: -fa b2 we C ,'.,k e xCas s a/
nn a e-,-; 11 > d" A lI dAls W, W'R S4 . 7'L, v � i ,ec o #^d s sh oW
et bow} l8ZP. co0gallo pc•��oed dvri•1� -�1,:s ��n•.e . /y1� •', Y,s
Sq%cd 4a t 4kr °�apyoa/+�n-� '!n carts %s�e� y "y 6e dve :41
fev-4 4o J �F el-eA4 Ael ks /`BGer�i;,.tq -lilP /l �h levels a.S We)(
Vts 4�11 �> t q� o ee-TAI anA
e��y q�qKa-l�,e�. /✓!�. �s has sns•�1)cd .-�cw l �.9>�'an
9ax,�,j�i61)s '� 6o-14 ta�ymo�s zt4A-<-t s Ae ��t:,� s �I;s w))1 Rrlaw
�o DG"`�lee r"o✓�d keV i"y Do' IX. _.
Ne4t M--. E6LV--S 170tS in1�Q11ed SW; ny Lva 4eee, rs qnd
preS[V)r'Q C0j,14rra1l dev-cps 4o k- reduce LV44Q✓'
r✓t 4 o C al. j oOs Cl eg oled a b o t4 4 go aee l 01<' %4✓>1G(J
a..id dp{an.s - o �v-1 ; vnd��' i,��'icq-�iat f 410�9 wqtj-'ke
c,v✓�re�-� �f��q yet afds 14c l7a-F Q1 so ��,�c�4sed ire /'eels
-�47e loaf. c.�plc 6¢' yeq•'f.
05103101

Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O'houtine O Complaint O Foilow up O Emergency Notification O Other ❑ 1?enied Access
Facility Number b Date of Visit:
© Permitted © Certified 0 Conditionally Certified 13 Registered
FarmName: .........S �D .....................................................................................................................
Owner Name: Q i L26 +I D.At v�S
...................................................................................................................
TD Ol Time: �
0 Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: D .. 1' /)
I................ _............. ... _.
PhoneNo: ............................. ....... .......... ............. .......... ...._� .
FacilityContact: ........................................................-•---................. Title:................................................................ Phone No:...................................................
MailingAddress: ............... . ....... . ...........................................
Onsite Reprewntative:.& Z..�¢.....�A..`.�.:.�................................................... Integrator:.. �.` i�.^..j....�?.f .t:.�2 �.. ...............
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..................... ..... ._....... ......
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° 44 Longitude • t 46
Design Current.
Capacity Pnnulatinn
❑ Wean to Feeder
Feeder to Finish
-
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry _. _C ii0aiitY, Population , Cattle_
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non-Dair
❑ Other -
ToW Design Capacity
Total SSLW
Nukd er:of Lagoons -2- ❑ Subsurface Drains Present jF0Lag..
Holdug Ponds / SoUd Traps . ❑ No Liquid Waste Management System
0
❑ Spray 1
J
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,f No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ZNo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 12rNo
c. If discharge is observed, what is the estimated flow in gailmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P'No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes jta-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Struc ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................................... ...................................................................................................................................................................
Freeboard (inches): 33 2
5100 Confinued on back

Facility Number: J —T% Date of Inspection, !D a
`5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IdNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 21No
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes )!fNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ONo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload jj +, ❑ Yes j3N o
12. Croptype reSGve r,,rr►­ev %gnn,vn11 G,l:4er �ranuaf, 8e� �dgLdvMirol UY�Z°/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes ❑ No _
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ 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 f3'No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes J2rNo
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 E!rNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Zves ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes , TNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes 0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes —O No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes Z1No
24. Does facility require a follow-up visit by same agency?
❑ Yes PNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes O/ No
4 Yi41a K}t�s:er defc�enct vt re nQte� dt;�h thjs.vjsjt;- Yost w 1-teoi*o 40i rutt
corres deuce: about this :visit:
[Cominents (refer to -question #) Eaplaun any YE5 answers andlor any recommendations or any oti�cr commend.
)3. Fv!( JA ;.r fertue i�'N kjFCLS4e pkq,bu4 ;,r yme4n4 46 ire ram{
6-*/e,,,vu4A �'�eld `Gh� ►^�v e ;� [ten,
,�1 f f� `� �-k; s � � ►� -�� der' d , � - J
6. �f^ reetS or 4� tz bgrrhvdc, A-ei11d ►teed le bite bev, Q%Ot �'r0P ►^1Pl'vilGu',
rl o-owev 5q.4S IN, V ►.ci tv"'Pt j TO yvt e 4 he Id I►6�,�/ G✓apS• TF i � �-#ti.� t
►�u�a, IJ-fZ.e�, er7llf V-1mdd be
r�
Reviewer/Inspector Name :.� B?t C."
Reviewer/Inspector Signature: Date: 10 5/00

Facility Number: 3 — Date of .Inspection11611101-1
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? ❑ Yes J[ "No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZ'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,P�'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �?No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j2'No
32. Do the flush tanks lack a submerged fill pipe or a permanenYtemporary cover? ❑ Yes ❑ No
Additional Comments: an or rawi
Neetf 4o -'.gvre et44 h/hiG11
P01
i5 g13.
6,r"dwc,, heq <eme )PLd(S
A.
Ao/' g0 onle, v4ts
1 a4ho-S �`°r
hcur�s► PV11 8 S )s
�54aWh ekS IeSS 4kq q I oLCr2
j Q�et i�t-ti
. �� 41 kc, /WIts h,J'e
Weti v%,xr e oh 4;k r )4ken
11
1s 4JA--^,v1;'6 ev&o`a ff 1i ca-},'a�,
LPG
0�9eM 4a c eJr,, -,ine wh c�,
pull
S S�
� whp=ch ; s4
keep ieGor�S�c�.cGareL�'Yy��.
5/00

� Divisidn' of Water 'QaaUty
Q Division of Soil and Water Conservation -
Q Other Agency
'Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation )
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3l Date of visit:
ja:Permitted [3 Certified 13 Conditionally Certified 0 Registered
Farm Name: ......1� SD �rs �
............................:............. `f..................................I........................
Owner Name: 9^j� jT a v
........................................................................................................................
Facility Contact: .............................................................................. Title:.......
MailingAddress: ..................................................................................................
Onsite Representative: L.....!........................................................
Certified Operator:
Location of Farm:
6 Tune: �S Printed on: 10/26/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County-..i l�%� .ft.'! ............................... ...... ....... .........
PhoneNo:......... ................................
Phone No: ........................................
Integrator: j6!:;Q64_TQ!'i.h:ri........
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 6; Longitude �� �1 64
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
&tj61jQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other 7-71
Total Design Capacity
Total SSL W
Number of Lagoons 2, Subsurface Drains Present agoon Area Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. li' discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...............L.......................................
Freeboard (inches): Z 9 26
5100
❑ Yes yNo
❑ Yes $No
❑ Yes EffNo
" Ia
❑ Yes jffNo
❑ Yes No
❑ Yes No
❑ Yes A No
Structure 6
Continued on back

Facility Num er: g i _9In0 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 Q'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 g No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes iffNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JKNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes tffNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes] No
12. Crop type t&S6y4. Go.'drd &Mze,5-UVnrnc�r Aonyg �f*e Mnnvexi &-rrotiC>arFrp' &eze'
13. Do the receiving crops differ w wit th�se designated in the Certified Animal Waste Management Plan (CAWMP)? Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes V No
b) Does the facility need a wettable acre determination? ❑ Yes IffNo
c) This facility is pended for a wettable acre determination? ❑ Yes JS No
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?
�4.6-Aofaf iQris;or dgi'iciencies were noted- during fhis'visit: • Von wiil-teeeiye tio; further "
correspondei i ' e. about this visit.
eK Yes ❑ No
❑ Yes 5No
❑ Yes 0 No
❑ Yes ONo
XYes [TNo
❑ Yes No
❑ Yes No
❑ Yes OtNo
❑ Yes Ig No
❑ Yes 16No
❑ Yes ONo
Comments (refer:to question #): Explain any. YES answers and/or recommendations or any other comments
Use 'dravvings of facility in.better explain -situations. (uwaddin narpages as nec essary)
1 3 • �-iyaj+an� 7#9 i.l' 1h wajqG Plkh M-� -'C5G1Ae f Vl 1r be"IVO(OL I'VI a -let, A.
t� 1 a �. �► e tot p "C� i ce shot, tot a j rec .
15. L'jer•k 40 )"AffCvc. low C►reaS ;h SVV'Q114kseue rc(A. 6-c-14W-A be,,mOai
�
ivv AreeLf 41,vc4—hsk-1 0�/'G1iraCie hers r-L-601101 Geer iv"f!ove-4 gin. Apraj
l ire 4cr.c�rv(i 4. Sc;r 4,,s' resol-k
/1' Need McweP-t L-a&'_ C' gnai�s�s ;), records-. Hye(-A,%4 1a J�as qh-111?e-Z.
For 4, sup► %ee' q+\h va 1 and a►.t TCK-Z Aor -resc,ue.
Nam_
Reviewer/Inspector Name .SiO ale L.Vi? "
Reviewer/Inspector Signature: Date: 6 1005/00

Facility Nu'lnber: Date of I nspection 1 .3o Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge $tIor below ❑ Yes .KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes M No
Additional Comments and/orDrawings:
G� s -}+� N��.�oig .showsll �cr►^.vo(a �;�etd qJ q3 acres, -7-4;•s drcs
P7 64 CO Y'reS(26 ,,V( , 1 a i 0-1 Ak.S i J
" .
J
5/00

Division of Solt and WaterColtservaaon Operation Revlew �;
h D I�IVLs1on of Soil anit Water ConservahoQ ';Compliance Inspection �� e
p
m " �° IVIs10Q Of�WaterQuality ;Compliance nmoecuon< - f emu'
sup r
Other=Agency Operat,o'n.Revlew
m _ = _ r
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review IKOther
Facility Number Date of Inspection
Time of Inspection GGO 2A hr. (hh:mm}
*ermitted Q Certified [3 Conditionally Certified E3 Registered Not Operational Date Last Operated:
Farm Name V�...7— County: ........... ................................................
Owner Name:
Facility Contact:
Title:
PhoneNo :..................................................... ..............................
Phone No:.....
Mailing Address: .. ..•...............
Onsite Representative: ................................... Integrator: ...... �tJ,�..................................................................
w Certified Operator:
Location of Farm:
............................................ Operator Certification Number:
Latitude 0 • 4 " Longitude • 4 "
Design_:; Current
Swine. Canaeity Ponulatitin
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design, . Current _` =_ ... ` Design:- Current
Poultry Capacity:. Po ulation_.: Cattle,.,--_ :. Ca achy'>Po` ulatioil
�.]❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other -
Total Design`Capacify
Total �SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holiiing PondsJ�Solid Traps- "' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier: jq c�
Freeboard(inches): .............1....1...... ..\...J................. ................................... .................................... ....... I ............................ ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7- Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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?
t5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired 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)
21 Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24- Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ,
0: o yiolatiQris:oi &fidendbg were noted• during 4his:visit.' "ik :will•i-eeeive rio; further
. . .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments°(refer.tsi:question #)._-Explain any_YES answers and/or any recommendatEons:vr any other coiEnyments
Use drawings of facility to-betteFexpiain situations (use additional pages as,necessary)
. ry_
�j,��p��' � 54�1 �r�vSS U�—'-l�",� ��V�►�� �- S� �Q%� � �I In•2_ l�+••3�
cam..
Reviewer/Inspector Name L A`%Pn4
Reviewer/Inspector Signature:
Date:
3/23/99

Divisiop'of Soil antl Water Coa'serva#ton =. Operation Review m
w M
s-
...'i _
4k,: ©Divesidn of $ot and Water Ctidse�vatton =Coin Nance ecttoih
_ p
Diviision of Water Quality - Compliance Inspechtu
Insp x�
G
.[3 Other
[Q Routine�0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Z
Time of Inspection r i .7Ka 24 hr. (hh:mm)
13 Permitted © Certified Q Conditionally Certified © Registered [3 Not O erational Date Last Operated:
Farm Name: County....Pf1r...1. _ l................
Cz' �"� hr r,. s
........................111-............-.................................-..............
Owner Name:��z�I) -Dgv11 Phone No:
............. ..........................'.....'...-,..,........... .. -..-......-...----•..-...........-......................................---............
Facility Contact: ..............
Mailing Address: ..............
Onsite Representative:.. -
Certified Operator :...........
Location of Farm:
.......................... Title-
.... Phone No: --.
.............................................................................................I......................................................--...........--.-.-............. .........................
61 Z� C 11 T)a V i 3 Integrator: "�11 +� U� C ✓ G t�'�A
......................................................................................... g.......... .............................-....�.........i........ C ..
•• Operator Certification Number: ..........................................
............... ............� -
Latitude Longitude
Swine
Design Current,
Canacity Pooulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
- -Number`of Lagoaas - -
`Holding;P,onds I Solid Traps
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?
K 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 ttZ
Freeboard(inches): .....-.....'5...............11. ............1 ................... .................................... ................................... ................................... ......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
Continued on back
3/23/99
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
I

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ 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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Aanlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type FeSGVe rn m S o 1 { rh v o(A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ 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 ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations -as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
violaiiQns :oir• deficiencies were ito(64 0'&' ing'this:visit: ;Yoit V' i' f <eceiye iio: fu'i-ther • ;
correspondeitce. a'b if this visit_
rnnaents'(refer toquestion #): -Explain airy YES answersWatnd/orany reeoinmendahons'or any_other comments
drawings of facility.. to�better explain situations (use additional pages as..necessary) ,=
OIL Se� -FQ r r►�te r �o �Sheep lou pir rtj -ro ✓ ncpw , 1<u v r�l� p t/�+hr nI A.
�1G��(S pCGorhe afrjp AJp+r-/y I`yQ W Cohn C ipi s'4vei�id
5 n
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3123/99

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Fann/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection %- 21� Names of Inspectors
Acts —
r
Structural Height, Feet _ Freeboard, Feet 6 �71 _
Lagoon Surface Area, Acres e__ Top Width, Feet /o " _
Upstream Slope,xH:1 V 3 ' Downstream Slope, xH:1 V �1:
Embankment Sliding? Yes >C No
(Check One, Describe if Yes)
Seepage? Yes K No
(Check One, Describe if Yes) - -
Erosion? Yes !� No
(Check One, Describe if Yes)
Condition of _
Vegetative Cover /
its, Trees)c�/�N
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes 14 No
Engineering Study Needed?
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

Lagoon Dike Inspection Report
Name of Farm/FaciIity 2Z f-,�,�� 31 7Gi — —_
Location of Farm/Facility 512, 11�62 S'2/1,5,/ _
Owner's Name, Address ��aO_ �rri r�� �� (�u1 AIC -2 9a
and Telephone Number
Date of Inspection 9- ? 5 - 5 Names of Inspectors 6611
/iAa /:�ac;!
Structural Height, Feet Freeboard, Feet ;74 o
/r1S�CC �
Lagoon Surface Area, Acres A6 G e__ Top Width, Feet / Q
Upstream SIope,xH:IV 3= 1 Downstream Slope, xH:IV=^�
Embankment Sliding? Yes V No
(Check One, Describe if Yes)
Seepage? Yes K No
(Check One, Describe if Yes) - -
Erosion? Yes �� No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
ems, Trees}
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed?
Yes �_ No
Is Dam Jurisdictional to the Dam Safety'Law of 1967?
Other Comments
Yes /1( No

Facility Number '](og Date of Inspection
Time of Inspection ! 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified [3 Registered 10 Not O erational Date Last Operated: ....................
Farm Name: ......-•---..h...............................
County:........:R............................................ ..................
OwnerName: bi-zae— ................ 5..........................................._.. Phone No:................--...........................................---.......................
Facility Contact: r [ ... Title: ...................................... Phone No: .. ....................................... ..........
Mailing Address: .....
p ........ ........ .......I. ............. ............................. $3 4 .........
pp `
Onsite Representative: ......L�]�2C.1.......... 5......................................................... Integrator:.....kZY3...............................................................
Certified Operator: ...................................................
Location of Farm:
.. Operator Certification Number:. .........................................
r.................................................................................................................................................................................................................................................................� . .
Latitude �° 1 Longitude ' 1 44
'Design
Swine ti Ca acit
r< ❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
(Number of.Lagoons
Holding HPonds / Solid _Traps
Current •.r - ' Design Current_ .. Design Current..,
opulation "Poultry •Capacity Po ulatiori ._ Cattle- Capacity Population
❑ Layer ❑ Dairy
(o ❑ Non -Layer ❑ Non -Dairy
❑ Other e
Tdtal D6sigrr`Capacity
:Total"SSLW
�_ ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area .,�
�
No Liquid Waste'Management ement System
.: ❑ 9 g y . ,
Discharges & Stream facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 7—
Freeboard(inches):................................................................................................................... ......
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
i7lYes ❑ No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23199 Continued on back

facililf}, Number: 3 I = r(�� Date of Inspection j( �
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [-]Yes [:]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E. .... deficiencies mere noted iii}r4rig his.vis. t. • . ii'wiil-reeeiye iio further
rorresporidence: abauti this visit. ........................ ... . ... .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gomments (refer toquestion #) Explain any .YES answers afld/orany recommendations oi",any other comments _
Use;drawmzs of faciilJty.to:better explarii situations (use additional! pages as necessary) T r
C-1V_•k co, be. `I kr �' i rt3 i fo I Af6v\ � [ �xw,�(r�
$ � y,�is 0.� h,t^s C&C,,j �.
Reviewer/Inspector Name [ : ! = . y-
Reviewer/Inspector Signature. tllllel�11_`- ,.0 , Date: xi3q
3/23/99

Facility Number 3j Date of Inspection -at
Time of Inspection 24 hr. (hh:mm)
JZ Permitted certified (3 Conditionally Certified [3 Registered 0 Not Operational 1 Date Last Operated. p .................
Farm Name: `� D ......... ....�w"�i .. County:........P...!ff��'..r.�.........................
Owner Name: .................... Phone No: ...................................
FacilityContact: .............................................................................. Title:......................................................... Phone No:....--------------.................................
MailingAddress: ................................................................................................................ ..........................
Onsite Representative: ... Qs:L.`�.. L �. L r.....D! t l s........ . Integrator: 1Q �.k 3.1.]..� ... �...5- Ra <.3 N 4-
...........................
Certified Operator ............. Operator Certification Number:
Location of Farm:
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
►
Latitude ' ' •' Longitude ` 4 4.
_ Swine
[]We
Design Current-
Design— Current Design . Current
Capacity Population Poultry --Capacity . Population Cattle -Capacity Population
'
an to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons 7/ ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdtn Ponds /Solid Tra s g p ❑ Na Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2fNo
Discharge originated at: ElLagoon ❑ Spray Field ElOther
a. If discharge is observed, was die conveyance man-made? ❑ Yes ] No
h. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes Z(No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ......... /19................. ........0.................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes VfNo
❑ Yes �No
❑ Yes j(No
i
es ❑ No
5tr 'lure 6
❑ Yes ZNo
Continued on back
3/23/99

Facility Number: I - '7,/0 $j Date of Inspe•etion
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or -
closure plan? ❑ Yes EJINO
(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 Rj No
8. Does any part of the waste management system other than waste structures require maintenatice/improvement? ❑ Yes /ErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )�fNo
Waste Al2plication
10. Are there any buffers that need maintenance/improvement? ❑ Yes IETNo
1 1 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes (�No
12. Crop typed C:.(3ce_ k V ,p b, / SM _C a_A ' .J f-CSC
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW -MP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes o
c) This facility is pended for a wettable acre determination? ❑ Yes J�No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Oyes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
J'Yes
❑ No
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�3 To
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,fNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes EfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes J!fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �ErNo
0: �io•yio A66ris:or• &hdencies were ngted during fhis:visit; • Yoil will-C&OW iio fuirthgr
corres oritien e,about:thisvisit.......':-:•:':•:-:':•:•:-:-:-:-:-:':-:-:-:•:.:.:.:.:.:.:•:-:-:-:-:•:-:':
Comments (refer.to:que46ii #) Explain any YES answers and/or any recommendations or'any other comments.=
Y
IUse..d-rawif%&- of facility to -better explain situations {use add.itionaupages as -necessary) �. J
t 4 ect M,- 7rt, o t� c s L`� is s R fie-f.� ta' /�tAri�Frl�r`n/ P �`7r� o 7 L t'r4 •
1 g� Ccr�►P���� aoarcl I�1s�c� R�nq(,; lY cH ctGt_,; ST.
L.t O a r� 4 fH nl►'M v M e[ z c�C><l��$
-•�---t d►n,�s � `��rM � rr+t►"v D � A r ty `f'a i-a -.✓z L ss V-- L
bf��
l 5? Ajo: O u 1Eri- Aim- 5 L.s �
rites PA`i t�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
yr"sS c=fEA4C,:F_
c�JT�°rJv F_ '71) 1" U-0
'�S? ►z _ � as
Date:
3/23/99

i
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? ❑ Yes o
2$. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [ 40
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 INO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes INO
31. Do the animals feed storage bins fail to have appropriate cover? /Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? ❑ Yes No
3 r ) ode 9;;j c AP �-Efi7- afEd — T-b 7 T- o%M---ssC-jc>
3/23/99

L
Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
lip Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other 1
Date of Inspection q q
Facility Number i (08 Time of Inspection �24 hr.(hh:mm)
0 Registered Certified 0 tApplied for Permit ;9 Permitted JE3 Not Operational Date Last Operated:
FarmName: .................. 5......11k.................7................................................................ County:....... ��ih..............................................................
OwnerName: ................. 2.gi.................. UkrvE/................................................. Phone No:.... ?..........................................
FacilityContact: ............................................../..``................................ Title:................................................................ Phone No....................................................
MailingAddress: ......... ..�6......,n4h.�t4t...._................................................. .......... .iaxSSW...ft,.......................................3. ..........
Onsite Representative:................gS.1.ZC.��........bA%J.k.............................................. Integrator:.....4' ...... &.O?r�3.......................................
Certified Operator;............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude 0•0'=" Longitude 0•=°=11
Design Current",
sign, ..,Current ,
Design " . Current
"` Capicityzti _Populaon PoulEry '.
Somme,
Capacity Population Cattle
Capacity Popub4on„
❑ Wean to Feeder
`" ❑ Layer
' ❑ Dairy
Feeder to Finish
❑ Non -Layer; ❑Non -Dairy
»k� Farrow to Wean
El Farrow to Feeder
r ❑Other
4 [I Farrow to Finish
Total Design Capacitj'
as ❑ Gilts
❑ Boars
`
b..:
Total SSEW
,
Number of Lagoons 1 Holdmg Ponds"
Subsurface Drains Present ❑Lagoon Area Spray Field Area
> a
_ ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
0No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gallmin?
iJ
1/t
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Ii9 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
09 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
ER No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

r
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 2.............................................................................
..............
Freeboard (ft):............2.-1...............................�..............
10. Is seepage observed from any of the structures?,
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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 4�, Iication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes iQ No
❑ Yes
MNo
Structure 5 Structure 6
................................................................
❑ Yes
$9 No
❑ Yes
29 No
M Yes
❑ No
15. Crop type ................ I?,_Sf.Yn fl fig ..............:( rAcw................. � Ff `G� �.S...... �yZ���Y...................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
D No.violations°or. Wiciencies were- noted- during this.'visit'. You 'Mill ieceive-no-fiirfher
:�:•corres'pQnde�ceatioutthis:visit:-"•.::::-, :: ::�: .:..�......�• . .:...... .: ;,_-..•.
S WbC-15
Ciejr 4-1 '&6vU
6
ttiv.WClJ. 1'Ge-3O11 sktQ b�
12 •
M rest;uL %r. 'rc(r]
I kid
644, t &youn S S 6-
Ix rt t�
z2. wez�c(� &50
s
(,c�c�� f
plc►,. .
Woried.
2sgw. Vctc,�e)1 ,0" in k0
4Z, oY, "Ut, L zgl61r.C.
❑ Yes CgNo
❑ Yes W No
❑ Yes RNo
❑ Yes 1A No
P.Yes ❑ No
❑ Yes ,® No
❑ Yes ;N No
❑ Yes P9 No
j9 Yes ❑ No
❑ Yes 1� No
Yes ❑ No
IP Yes ❑ No
VP`,
7/25/97
Reviewer/Inspector Name
Iieviewer/Inspector Signature: Date:
1

£; [j DSWC Animal Feedlot Operation Review
3 DWQ Animal Feedlot Operation Site Inspection �3
mom. h.
„.
Routine Q Complaint O Follow-up of DIVO inspection O
Facility Number 7 b
13 Registered 0 Certified 2 Applied for Permit M Permitted
Farm Name:... i A--•---�o.,�r.:,<.•.�.�.... ....................
Owner Name:...X 1................... ..... Dal+a..1.1............................
Fallow-utt of DS1' C review O Other
FacilityContact: .............................................................................. Title:.............
Mailing Address:.... 1.1$..0 ..............
Onsite Representative.. �.t..�.� �..�.1............ ��+-�+l-i.C�......................
CertifiedOperator:...................................................................................................
Location of Farm.
Date of Inspection
Time of tnspection ULi= 24 hr. (hh:mm)
10 Not Operational I Date Last Operated...........
..................................... .1....
Phone No:...� 9.. j 4�. .. ..9... ...... `J..3..I`..,�.............
.....'................................ Phone No:.q........ �. . r....4tQ . ...`..Z Z Z f}
....... .... tAO.a.M.s..4..1--tJ..C. .............................
....... Integrator:---Z.- ......................... .........................
Operator Certification Nttmber:...---•-1.00 g,,,,,,,,,.
1`x.i.s...... x..#-......,5.
................................. :................................. :.......... ..........................................................-----.................................-.............-................-........................................y
Latitude r_�• ` _' Longitude • G .4
Design Current Design Current Design:-... Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity, Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
❑ Feeder to Finish JEI Non -Layer I I joNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds ' __ Z� Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
❑ ,No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?'
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water" (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
' k
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes M No
❑ Yes 91 No
❑ Yes No
❑ Yes No
❑ Yes R No
❑ Yes R No
❑ Yes I'No
❑ Yes 19 No
❑ Yes 19 No
❑ Yes W No
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Iiolding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(ft):....................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12, Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste 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 ....Q t.,.a..sx.r...........................................i. +' ^:.V....................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement''
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes ,I No
❑ Yes 91 No
Structure 6
.................................................
❑ Yes
® No
❑ Yes
EY No
9 Yes
❑ No
❑ Yes
® No
❑ Yes
& No
............... ............. I ...... I .........
......
❑ Yes 5d No
❑ Yes 91 No
® No.violations or. deiaciencies.were`noted during this" visit. - :You.will receive Ito further'
correspondencegi out this;visit:
C9 Yes ❑ No
❑ Yes &No
❑ Yes ® No
❑ Yes KNo
Ed Yes ❑ No
❑ Yes l9 No
❑ Yes ld No
❑ Yes KNo
7/25/97

•
Site Requires Immediate Attention: ' AJO
Facility No_ NGW
DIVISION OF ENVIRONMENTAL MANAGEMENT -
ANEVAL FEEDLOT OPERATZM.1995
TE VISITATION RECORD
DATE:
�l
/J Time:
Farm Name/Owner: / u
Mailing Address:
County:-1
Integrator.
On Site Representadve:
Physical Address/Location:
Type of Operation: JJ,,Swine �_ Poultry Cattle
Design Capacity: T<Y2)4V r&/o 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 inches) &r
No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoons}? Yes No as any erosion observed? es r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes �or o
Crop(s) being, utilized: _ -7�1/ % ' 1Z l /Y�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es o No
100 Feet from Wells? Yes No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes —or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the faciliry maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
• Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.