670044_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit: C) Co pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: f Arrival Time:—�- Departure Time: � County: �Nr�W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: A Pew d
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 2 ) 593
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design C*urgent
Cattle C►apacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I INon-Layer I
Feeder to Finish p
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ? Poultry
I Layers
Design
Ca ity
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 LJ'� ❑ NA ❑ NE
❑ Yes No C] NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number; - jDate of Inspection:
Waste Collection & Treatment
4. ls;storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U2/No ❑ NA 0 NE
• a. If yes, is waste level into the structural freeboard? D Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �' 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes do ❑ 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 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7yo
threat, notify DWR
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ' ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [:DNA ❑ NE
Page 2 of 3 21412015 Continued
7. Do any of the structures need maintenance or improvement? ❑Yes YNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[;(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
�o
❑ NA
❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑PAN > 10% or 10 ]bs. ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application
Outside of Approved Area
12. Crop Type{s}:
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
�o
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
[�No
❑ NA
❑ NE
Required Records &Documents
ZN
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
VN
❑ NA
❑ NE
the appropriate box.

Facili Number: W. Date of ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [—].NA❑ NE
25. k the facility out of compliance with permit conditions related to sludge? if yes, check ❑ YesVNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rfN0
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
<No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #}: Explain. any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to'better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
U6 &,:,v tJ M >,� f qc -f LL APJ D
Date:
15

(Type of Visit: (9'Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0.I�oli�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergenev 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: o-y= Departure Time: 0110.County: Region:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 3
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Wet Poultry
C
Finish
rrFarTowtoWean
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
(.Q 9
Dai Heifer
Design
Current
D Cow
o Feeder
Or7y7pgultr,.
Ca aci
P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pultets
I lBeefBrond Cow
Turke s
Other
Turke Poults
Other
I
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes 01To ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 F(No ❑ NA ❑ NE
Page I of 3 21412015 Continued

l*arili Number: - V Date of Inspection; 5—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [91�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ 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
�Io
❑ 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
[3"�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0'Nb
❑ 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
DNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
El"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eal�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�r_No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]"'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[],No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []rYes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [jNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Wacilitp Number: - Date of Inspection: z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑44o ❑ 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 [TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []"No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes '❑ No ❑ NA 0 NE
❑ Yes E: No
❑ Yes [J-No
[-]Yes [- No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or-any:ot1fi* comments.; .
e.
Use drawings of facility to better explain situations (use additional pages as necessary):
(.r G�- G roP
Reviewer/Inspector Name: 94Lc s Qn'_e `I
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date:
21412015

F
ype of Visit: Q 7Routine
liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p v Departure Time: ® County: 0\.jSLZ h1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Ao" W W 4ALq_ Integrator:
Certified Operator: Certification Number: 93
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish lD
Farrow to Wean
Farrow to Feeder
Farrow to Finish
W
MnOsian
D . P,oul_ . Ca act. P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Bro-
Other
ey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yeso
Y
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: j
Waste Collection & Treatment
4.-is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1}] Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ 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 n1wo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
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 20 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes "o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes hTo ❑ 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFadlity Number: - Date of inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
.'
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ 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
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
`o
❑1,Vo
T
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ETNo
❑ 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
EfNo
❑ 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
Q<o
❑ 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
[;,Ne
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2'IVo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rN ,
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoneY,"zi
Pi�4
-- 3
Date:
121411011

(Type of Visit: UCogfpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: V Arrival Time: ® Departure Time: O County: dNSl Xr-J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &"t/ 4)14ALr-_ 7 Integrator:
Certification Number: ZZ,Sl
Certified Operator:
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
6
Dairy Heifer
Design Current D Cow
D . P,ouI Ca ac-t7y=P,o Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Points
Other
Beef Brood Cow
Qther
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? []Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 ❑ o ❑ NA ❑ NE
❑ Yes YNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - qL4 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?
Structure I
Identifier: L14
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [] No ❑ 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes NoL1J � ❑ 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 El 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 Ibs. ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
go
❑ 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
� o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El 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
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Oth r:
21. Does record keeping need improvement? If yes, chec 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 El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
g/N
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifity Number: -qq I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes F3�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?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
D/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jz No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
6/jo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #E}: Explain any YES answers :and/or -any additional recomXmendationsor:any othercominents
Use drawings•©f facilifv to better explain situations' use additional ag e's' asneeessa
P ( P g ry}:
ozsscp pm_. tF ANAL_'st.j �7� UWF 2�1z. asE a� r �E t�. ! > U,
dM7J SIZ 1JAC6 Few E CfLU/ ,
��� r� r B�eA MsssE� 20►� , 6b D� S 7' �d�E �e iaer t �� .D O
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: 16b " i300
Date: J1 Z J
2/4)12011

' G
Type of Visit: UCo r,
ante Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: GY Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: ay Arrival Time: E= Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: jw6?j W )4ALf' 7
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: n Q
Certification Number: p` a5 1 ��
Certification Number:
Longitude:
Design Current
Capacity Pop.
an to Finish
Design Current
Wet Poultry C++opacity Pop.
La er
Design
C*attle Capacity
DairyCow
Current
Pop.
an to Feeder
Layer
Da' Calf
eder to Finish
DairyHeifer
TSine
row to Wean
row to Feeder
row to Finish
Design Current
D . P,oult , C_a a_ci P,o ,
La ers
D Cow
Non -Dairy
Beef Stocker
ts
Non -La ers
Beef Feeder
ars
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)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L7 1"o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
❑ Yes l�'i`�0 ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Whste 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
Structures Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2� /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 rest, 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 Ey o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z1"
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the tAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0NNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciliiy Number: - Date of Inspection: t6CF1(-L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N�, NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L*�J 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes No ❑ NA ❑ NE
❑Yes o ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
to
[—]Yes
Yes
WNo
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or: any other comments , I
Use drawings of facility to better explain situations (use additional pages as.necessarv).
)-q,) G LX&tq I J dnj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 S(j ��
Phone(glb
Date: 4` T
21412011

Reason for Visit: Or Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ®U Departure Time: County: dN5U0 j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: A 090 twHxiU J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Cnrrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Finish La er Da' Cow
Feeder
on -Layer
Da' Calf
o Finish
DairyHeifer
o Wean
to Feeder
Design Cnrrent D Cow
Dr P,oul Ca aci P,o Non -Dairy
P,Farrowto
to Finish
Laers
Non -La ers
Beef Stocker
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [:]No ❑ NA ❑ NE
[:]Yes VNo
"N❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
Waste Lollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 52
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
dNo ❑ 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 environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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
ZNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of 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?
❑ YesEyi'o
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [3'/No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes a/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rN ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes rNo
< ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -Liq IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? VYes
s �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo
[:]Yes 2(No
❑ Yes �No
❑ Yes
❑ Yes
❑ Yes
No
0
No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomment& :`.,
Use drawings of facility to better explain situations (use additional pages as necessary).
2�, I uT COPY Of jw w CxT s ►�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 ]V�tl Phone: C �� 6
Date: Ip d
21412011

L(
Type of Visit C�C,00mpliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance t4 Reason for Visit Routine 0 Complaint 0 Follow up ' 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I S I T. Arrival Time: Departure Time: County: aN&(f✓ _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: A Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = Longitude: [� ° [� i [� «
Swine
Design Current
Capacity Population Wet Poultry
Design
Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean DrJ Poultry
❑ Farrow to Feeder
El Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
El Boars El Pullets
❑ Turke s
Other. L0 urkey Poults
❑ Other ❑ Other
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
�❑
NA
❑ NE
ElYes
VNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

J
r
Facility Number: Date of Inspection 2t I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LJq Cro 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2(No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaytheat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yeso
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ZNo
❑ 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
E�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need • ❑ Yes
ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
IQ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
RYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ N
[INA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers.and/or an � Wiim - <s
y r ecommendations or any other comments
w, .�..,.
Use, drawings:of..faciliity to better explain situations (use, addrtional pages.as necessa:
/S,) SGo wigs R-twLovQof (Lec--rt.Ovr..l�1 NE E6 S
U;T,
AL
nE .bop&-_ V_VWoaj-�
0zoo.
3o Vq0
Reviewer/Inspector Name �Jb� i�.f1��L1-!''
Phone:
Reviewer/Inspector Signature:
Date:
S 2-1 l
Page 2 of 3 1 12128104 Continued

`Facility Number: Date of Inspection
&ouired Records & Documents
i
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi gn ❑ Maps ❑ Other
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
/'o
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
RYes
❑ 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
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Er/N.
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
�, /
I� 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
6 N
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
Zo
❑ NA
❑ NE
Atlditi©nal Coidnments and/orDrawi "
Page 3 of 3 12128104

y
Type of Visit &Co piiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q_/Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i `i ! r Arrival Time: ® Departure Time: County: &'VJLhA) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,4 D"d N14I2LEV
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o Longitude:
Design MGurrent�n6gr—reni_DeSwineCapacity
Population
Wet Pou!!210-e—si
tCapan
Cattle Capacity Population
Wan to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
f
❑Non -La er
❑ Dai Calf
Feeder to Finish
174 0
❑ Dai Heifer
❑ Farrow to Wean
Dry Paultty
❑ © Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers
ElBeef Feeder
EBoars
❑ Pullets
El Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
r17 Other
❑ Other I I
Number o€ 5tructures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volurne 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 UNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
❑No
❑Yes
[j o
[I NA
[I NE
El Yes
IJ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

r Facility Number: —gyDate of Inspection 13T1�„jID� I
V Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `rZ�
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
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes EJ4 ❑ 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? LDS No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes 2
9. Does any part of the waste management system other than the waste structures require ❑ Yes u No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
�lo
❑ NA
❑ NE
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
E
❑ NA
❑ NE
;Commients (refer to queshonn#) Explarn any YES answers andLor any recommendations or any other comments..W '
%Use�'drawtngs of faciGty�to better explain situahons (ase additional page`s as necessary) �' ^; • �°°' �- �>� -
-� ° .-:�4: ...,a. ....�+.r, �"`Lm a cf �'4«..^ �.. �«tc"^»`. _'."�- ,r t..:'':5^?".*'...5✓
r
Reviewer[Inspector Name o Phone: 910 7VY
Reviewer/Inspector Signature: Date:
. —15 J

Facility Number: �'� —4y Date of Inspection b`l
�Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
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
i❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and t"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L"No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ENo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CI 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?
El Yes
,�
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
f
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

1
Type of Visit Cordpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Foliow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time. bo Departure Time: County: 0IU5WJ Region:
Farm Name:.,
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ADR.d+J WAALICY Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 1 = Longitude: 0 o = ,
Design Current1IN
esign C►urrent
Design
Current
Swine
Capacity Population
Wet Poultry Capacity IN 'on
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
L
❑ Dairy Calf
Feeder to Finish 0 13011
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ D Cow
El Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
10els any discharge observed from any part of the operation?
❑ Yes
Ul3Vo
ElNA
ElNE
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
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VN
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: & — Date of Inspection o$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
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 [a No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CNo ❑ NA ❑ NE
❑ Yes [ZNo ❑ 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 JNo ❑ NA ❑ NE
8. Do any of the stuctures 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 [(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ld No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes CI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
d ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?o Yes
VN ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
aA�,) Oe6C) To 00 sLUa(C_ Sv-PlE ► QL_Th=0
DA%,'l S9" Qif `; To O
Reviewer/Inspector Name 1 Clo NK) 1 Phone: 710 l9 6 39g
Reviewer/Inspector Signature: Date: Co •
I -Age L uj j aci wivy a, v.a6acu

a
1
Facility Number: (p7 — Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes d No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LI No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ es
,O
L� Flo
El 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
M'1Vo
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElC Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QYt/o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJ"N o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
j!I 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ILI No
❑ NA
❑ NE
tlddltlOnal-Comments-andlor'DraWingS `:=,x ��= • �' ea;
Page 3 of 3 12128104

U Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 7Routine
pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: 6P1y1_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: '',�� ��j�n Title: Phone No:
Onsite Representative: T "Z Ay11-4 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =]e =' = Longitude: =c =]' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes IZNq
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facili Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -06 No Cl 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): A
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA [-INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�D-No
I� 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
E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EFNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
do
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
aL) CALLOW-Z6A1 aC 60L60M�5417_ id- a V trIC %.. l 9oVA)'
ANb c1PV/ sc— t Dw6,) GvC ° , �G�a 5C, rf�'� 6�
7� 7 0 �c fir✓ &�✓SE,
Reviewer/inspector Name Phone: 7 L I—IrtrAPP
Reviewer/inspector Signature: Date: d

Facility Number: 77 — Date of Inspection
1keguired Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Li'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L90<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ld'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
C5Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑, NSA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
EKA
❑ NE
Other issues
�
2$_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El.,
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
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
N
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[I Yes
7No
❑ NA
❑ NE
Comments and/or
12128104

(�(Division of Water Quality
Facility Number G! 0 Division of Soil and Water Conservation
_ — 0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: G 7 Q f/ Arrival Time: S Departure Time: County: 4A)A4 Region:
Farm Name:
Owner Email:
Owner NamePhone:
d�
Mailing Addres3s
Physical Address:
Facility Contact: Title:
Onsite Representative: D�
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = e =1 = Longitude: 0 ° [� f
Design Current Design Current' Design Current'"
Swine Capacity Population Wet Poultry Capacity Population Cattle i"., Capacity^ Population,;
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
6-6
/�llb
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
j
❑ Boars
j
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ DaiEy Calf
❑ DaiEy Heifer
❑ Dry Cow
❑ Non-Dai
❑ 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?
Page l of 3
'•, .
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
❑NE
El NA
❑ NE
❑ Yes
❑ o
ElYes
I No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
12128104 Continued

_Facility Number: D — Date of Inspection G 0
.r
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 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7S�
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 EirNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes LI 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? E:fyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2No ❑ 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 [I/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes [3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E to ❑ 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) 360 e S O
13. Soil type(s) iqAyat pW (a oL0_rd3od /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[[A No ❑ NA ❑ NE
7[INA El NE
o ❑ NA ❑ NE
❑NA ❑NE
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):.
JA LL, Wlt,t. ST£l t IkIEE� ✓No�E 2oY+ i ��y,iT-�A�fJ� W •
u10,0A x>G sro c.k-CA IG Fd c*v-i ,
Reviewer/inspector Name �� Phone: 914 7r
Reviewer/Inspector Signature: Date: 66i
Pate 2 of3 12128104 Continued

Facility Number: (r�'] — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWN IP readily available? If yes, check ❑ Yes 2No ❑ 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.
2�es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ET/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
- 24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
D N' A
❑ NE
*25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑l No
Ej/NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
LT 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
Ek o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[2/No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit SI;Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 f$ 5 Arrival Time: Departure Time: County:4N6W0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facilitv Contact: Title:
Onsite Representative: o�t� I�NALE-Y- - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
j Swine
Wean to Finish
an to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 1 = tl Longitude: ❑ ° = ' ❑
Design Current Design ' Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1' 0 Non-Layet
Other
❑ Other - --- ----
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: . ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife)
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
El NE
❑ Yes
El Yes
No ElNA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: % — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: 6 Oo
Spillway?:
Designed Freeboard (in): Z6
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�I/ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
enviroumpntal
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
VrYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Zj o ElNA [INE
(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
ElYes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z01,; ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
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 [IEvidence of Wind Drrifl ❑ Applicaction Outside of Area
MWindow
12. Crop type(s) Qcmn^ v Oh 1 E G Urs
13. Soil type(s) to 60 LD L
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
��,,��
Id NNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]L
Yes
,'Lf'
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
' ❑ NA El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo❑ NA ❑ NE
7.) l o v"U &a4- t S O tV iDT Kk 1.✓AC LL V (J 1PC,O,
al.) A)eco -ro --XA#JS ,Fern- R.Co4,DS OP 5 0Ew Fat'ukr - S,
CE2-r��� cl �- %T t- � * - �cc I' a3c �•�� eE
�-jc6L1Jf f7.�E L.D "AS ((,::t) ?E V6&)6 tLN KS
Reviewer/Inspector Name j �, A'�jLdl Phone: 5 to 775- 39.o6 k2zyl
Reviewer/Inspector Signature Date: VA&A
12128104 Continued

Yes ❑ No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
Facility Number: —t I Date of Inspection94-1
dS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
-41
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
LINE
❑ Waste Applic ion Weekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers
El Annual
Certification
Rainfall shocking ❑ Crop Yield ❑ 120 Minute Inspections 1 Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
6No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
' No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
No
,❑._.,/NA
L7 NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
EllJ Yes
�❑
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[3 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[J 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
�
ENo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L_ o
❑ NA
❑ NE
Additional Comments -Ii&o Drawings
12128104

Time: O O
Permitted © Certified 0 Cojjndii'�'onally Certified Q Registered Date Last Opera A or Above Threshold: .........................
Farm Name: AMOAJ!.....r._ /_� Fr?Rm -- Count, ------• .... --- -- .----....
Owner Name: ........... _._.A �i .V - Phone No:
Mading Address:
Facility Contact: ..-.......... Title:............._.......... Phone No:
-- ......................................_........,../� I ,gyp
Onsite Representative:... ...................... ���_� . In tor- / (L1d,i4�
... tegra
Certified Operator: ... ............................................... .................................................. . ... Operator Certification Number: ........ ................. ............
Location of Farm:
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• �� �"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;eNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .............................................. .................. - .._.............................
Freeboard (inches):
12112103 Continued

aciliff Number: — Date of inspection ! '
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ 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?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessii
12. Crop type
13. Do the receiving crops differ with those
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?
I6. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes RfNo
❑ Yes ;M No
❑ Yes VrNo
❑ Yes fid No
❑ Yes PfNo
❑ Yes EJ No
❑ Yes O No
❑ Yes No
❑ Yes ZVNo
❑ Yes (EYNo
❑ Yes XNo
❑ Yes joNo
❑ Yes XNo
❑ Yes 7fNo
❑ Yes A No
❑ Yes XNo
❑ Yes 'W(No
nCommeats {refer to question ) Eicplain siny YE5 Ansswe�rs and/or aay rero datrons ar_any ot>xer comet '.
I�� .:
Use drarings of fac�Ltyfto better exglsin satnatidns.-� j� se addrt:anal pages as necessary) ❑ Fteld Copy ❑ Final Note~ s '' a -
e
a
Z!� IJE p Lvc►4r C v C /¢N�0n/A� %�ER�i.
e4u,iAe �i4cREs & APPp�zc.47-Lou GV v
APP2c�� zoo scE F�,s.`7004 Aijo
E z h Pt°c CA-,r zoo - eg**%)AT a
SEj, C)PGtDLJ C©uN-r-q 5 4 AWFS NECk
E) WO cR PIA11 �t o
Reviewer/Inspector Name ,'
Reviewer/Inspector Signature: Date: /$
12112103 Continued

. TaciL y Number: Date of Inspection
Re aired Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 10 Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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? ❑ Yes Qo No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (VNo
28. Does facility require a follow-up visit by same agency? ❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP. ❑ Yes �No
IIPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit: D 3 Time:rO S
Not O erational 0 Below Threshold
O Permitted 0 Certified [3Conditionally Certified Q Registered
Farm Name: Artij^'� ra "
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 4d T`dn �✓ hg �e
Certified Operator:
Location of Farm:
Date Last Operated or Above Threshold:
County: f� h .SI DW
Phone No:
Phone No:
Integrator• ! '1 Vy Jok n -
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' _ " Longitude ' 6
Design Current Design Current Design Current
Ca aci P.o ulationt 1?ot�ltry Ca act ulation C+_attle ' a '+ Ca aci • �P,o ulation
❑ Wean to Feeder ❑ La er ❑ Dairy
❑ Feeder to Finish
❑ Nvn La er ❑ Non -Dairy
❑Other
Total Design Capacity
-
Total SSLW
...
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
&
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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 S
Identifier: r
Freeboard (inches): 3
c
OS/03101
❑ Yes ZNo
❑ Yes ,ZrNo
❑ Yes P10
❑ Yes 'No
ElYes ;62
No
❑ Yes'ONo
❑ Yes No
Structure 6
Continued

' 1 facility Number: 47 — 4
Date of Inspection 3�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(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 'ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 'PMo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,EfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes eNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ZO 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 XNo
15. Does the receiving crop need improvement? ❑ Yes �XNo
16. Is there a lack of adequate waste application equipment?
Rea uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
❑ Yes 'ONO
❑ Yes ,E:fNo
.ZYes ❑ No
❑ Yes ,fNo
❑ Yes ';2'No
❑ Yes Jago
❑ Yes'125No
❑ Yes )2rNo
❑ Yes )2rNo
113 No violations or deficiencies were noted during this visit.. You will receive no further correspondence about this visit
.Gotnmeitts (refetwto "yuesttoit ) Explatn.a`nv YES:answeTs and/or an} recoEuatendattans.or any other comments:
Use drawingitc s of iltty to:bettei explain situattttd! (Use addttloual pages as necessary) '- ❑ Field opv ❑ Final Note", ` -
7,
-..._- air.
Q ve ra l� , +1,e 4a r►ti.� re GQ''d j i a h al G raIps are Gve if M q,'rl1a,'-, e ((
aid ;At,reave^iergr Ore bet,1l nj&4e oe yG., hale� s
j� -}fie �rOGess ��' Ad�f ►'� -�wa herd sera. y �`,��d�. also, t,� mat
refaiee4 *Lie ;•,rre✓ 44e wnllryes,- -#Ike f i 10 :pe. �1,,�,.� was r1a
1 94i-54e, A'40rysi_r -ore"Sa1"e l q4,e 2DOZ CaO,!ti/ 63
!
t
._
Reviewer/Inspector Name V. -
Reviewer/Inspector Signature: Date: 0.3
05103101
Continued

11
Facility Number: — t} Date of Inspection 3 13 3
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan 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 ONo
❑ Yes XNo
❑ Yes ZNo
❑ Yes 'dNo
❑ Yes gNa
❑ Yes ❑ No
Additional Comments and/or Drawings:
��sa,--�')'lerc qr� .S�r�r �l G�v�v�e ei Lt/e� b�i�'e �ir�as ►'-► .��e
..re s e ue li e ld • 1,1e 4'15 C V S S-- W .moo •ne. 0 Aq S �' r 9 e
_H74, for^7 C� -I 'O belp i� a-W,/11se On Al"S T"hk Y04 JO ✓
7 � e��Or�s �a wza����t �"� 41,e
O5103101

sue.. : Almy. .
r�
Type of Visit 6 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit: ,t L _ - Time: t �U
IQ Not O erational 0 Below Threshold
0 Permitted 0 Certiified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
� nry
Farm Name: _- ! 1 Gf `' D''%, �r �,'14 i C'l r �"�- County: Yt s i OW
Owner Name: R �D "1 w hI210'? Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
r
Integrator:g .- /
911
Operator Certification Number:
J21wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' « Longitude 0 4 u
Design Current. Design Current Design Current
Swine Ct'aaci Po ulation Poult Ca aci P,o ulation Cattle .. C
r3 ' a aci P,o ulation
Feeder
❑ Layer
❑ Dairy
r to Finish
❑ Non -La er ❑ Non -Dairy I
ther
Total Desin CapaciTotal SSLW
rto
w to Weanw to Feeder
w to Finish
Number of Lagoons L� ❑ Subsurface Drains Present ❑ [,a oon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ZNo
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) ElYes ❑ No
c. If discharge is observed, what is the estimated flow in gat/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 FeNo
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 ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3A
05103101
Continued

Facility Number: 6 7 — L114
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any 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 Amplication
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Fe —se t�e Nuy j r G v �ds4v✓e, .der 1 vdet J u k � 3e✓^'tu414 pG
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss rcview/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ;3`N0
❑ Yes ,fNo
XYes ❑ No
❑ Yes �No
❑ Yes�No
❑ Yes EJINo
❑ Yes jNo
' Small &z
Yes )ZrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O No
❑ Yes 0—No
❑ Yes �No
❑ Yes �No
,Yes ❑ No
❑ Yes ❑ No
❑ Yes_,VNo
❑ Yes •5I No
❑ Yes 'RI&o
❑ Yes ❑ No
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
' s �. en
Coents {refer to=gaeshon#}. >r aplain any YES answers:and/ora'ny recomme:.nadte'ahonsor snyaothercommts mm; u
;:
Else drawings of facility to better explain situations (use addihonNI pages as necessary) +
a °:, ❑ Field Copv El Notes
, : ,-, x
/
l�. 71le re iS ►'10 W-0 S-r�e Cirielt � r 44ed w�-]LT rh 6a dCy-s of S�.y12
Na re vvt 6 e,r Zo 4 j alof' l,'c� �� c�vQnaJ. G / a�ve lP r1ce4.'S( �O hg vie+ I Ltxt-�I e
ah��YS,f �Gr-��d Wi ll�+1 rp dg s F GlI a�"e�t'Cg1trOn_ e-,ItV 4JPC'dS
use a w ee anal' s�S d id fv;., (D d�Y of �hz
cv eA s -too CA (c v la4e 4 e r1. �� e yG� a� !;\OA am 41re :rglZ - Z aL
�e ca ids
r . .
Reviewer/Inspector Name on eGNeI'
Reviewer/Inspector Signature: Date: 2
05103101 Continued

Facility Number: ? — ( Date of inspection ZBO
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan 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 -eNo
❑ Yes 2 No
❑ Yes ❑ No
❑ Yes I"No
El Yes No
❑ Yes J�No
Additional Giimments_and/or,Draviings.,;`W:.
�, I�'.,►�'�,.�fe -�I�,e SGt�I�.-,SS �,�ar-. 4Ae laydoo walls.
ves�i Jca-/c and de-errvt;rle ��P Gauseno� �ras;o►1 6�
1ri
-f )finer tGtS4 f'1 lNci�% Gldj]BIG��'iq 44 i" /GW f�+p2f i,
I >'
�,r. �iJ1���ey Lt.� q �e-f��✓ �i^4M -���' �.`5�✓'°G� -ConC�rrt�"�j
Whetle7 neews
cans;4eAVe&tves and h,q✓e �� i,��,`qa4foki ►-�s�all�lJ�
on ��P ✓aew f'f'�Ids qhd hAve 4e n4eo lee'ed
.n G�GGofdgnc� W''�lt 1f ,0t q"t; e4 ,pro' 'el C � q� ��Q 1G,A-e rn
Tyrese heed 4a 6e eom f le-,W wI; #ti �n 6o da y.� a.F
9/DZ s�' l�r. (,1}tia] decides no� �� ;r,s�u1 i1ir'/`�`c4110�
6 � 4�t Y1eW iii�l ' Ae` he F7ecdS to elisule `de g v`� eC r?r�✓`o
-Poll his -ri8ld 5
-/lac i�►/'r1'jC ran need s 1}i/
Y�eeDi1 �d deG,a1` Q," e, �1�a1 epffl-Se a c- :a,, and hR✓e
welt Ae ��/rOr^,'ct7�
w► }���, �a da y� aF b1Z6lox - Wken
Pi-od ;.ri gd , ,See h 4,4 e yew,, ,'a vid 4escve vJ; qC,(Ow -
05103101

Type of Visit RCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number lDateorvisit: © Time:
Q Not Operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified [3 Registered Date Last Operated or bove Threshold: .........................
Farm Name:.......1...1`..WSZ............................ .............. County:.... Gam,
....
OwnerName:.......................................................................................................................... Phone No:
.......................................................................................
Facility Contact: ---... ......Title. Phone No
Mailing Address: ...............................
�I..r►•��,.........................................._........................................................................
Onsite Representative:
................................................................................ Integrator: ........_ .............- y ........
Certified Operator:
Location of Farm:
Operator Certification Number: ......:..................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 44 Longitude • 4 64
- Design . ' Current Design Current Design' . Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
FOFarrow
ean to Feeder ❑ Layer [I Dairy
ceder to Finish �r )� [I Non -Layer ❑ Non -Dairy
to Wean
arrow to Feeder ❑ Other
❑ Farrow to Finish Total Desigil :Capacity
❑ Gilts
❑Boars :Total SSLW,.
5 Number of Lagoons ent ❑Subsurface Drains Pres❑ Lagoon Area ❑ Spray Field Area
k
Holdm91 onds 7 Sohd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
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 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes xNo
01/01/01 Continued

Faci Number
Date of Inspection '% d
!Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --.......
Freeboard (inches) . .................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NfNo
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 �2_�t � 1 --,o /
13. Do the receiving crops differ with those designated in the Certified'Animal Waste Management Plan (CAWMP)? ❑ Yes DfNo
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?
KYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J?fNo
17.
Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayf;eld boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site . ❑ Off -site
Required
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
OYes
❑ No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
)6Yes
❑ No
22,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
14No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Z No
(ie/ discharge, freeboard problems, over application)
25.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
NfNo
26.
Does facility require a follow-up visit by same agency?
❑ Yes
N�No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,(No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
N'No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
[:]Yes
NNo
01/01/01
Continued

`l Facility Number: — Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do -the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 5(No
❑ Yes RNo
❑ Yes No
❑ Yes No
❑ Yes MNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ise urawings ob-rac[ury to uetter,expiam situauons fuse auajuonai pages as necessxry)r
❑,Field Copy Final Notes t"�••r
Ort.—
A��Q L.J -4
CA
&-e-tJ
ezL) A
A5�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: ot— r?—Q
,.,
OU01/01

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 6rl -� t
Farm Name: 1-
On-Site Representative:
InspectorlReviewer's Name:
Date of site visit: � ��-�o
Date of most recent WUP:
Annual farm PAN deficit: Wb LqL0 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part If eligibility items) Fl F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s)._ circle #: 1. hard -Dose traveler, 2. center:pivot system; 3. linear -move system;
Ostationary sprinkler system wlpernanent pipe; 5. stationary sprinkler system wlportable pipe;
o. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and DjD3 irrigation operating parameter sheets, including map
1 depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part II1).
PART 11. 75% Rule.Eligibili y Checklist and Documentation of WA Determination
Requirements. WA Determination .required .because. operation .fails one of the .eligibility
requirements listed below:
F9 Lackofzcreage_whichTesultedinvver:applicationmf_-wastewater=(PAN) on:spray_
field(s) :accordinadofarm'slasttwo--years:of-rmgaffon7ecords:
F2 Unclear, -illegible; or lack of informationimap.
F3 Obvious--T-ield-limitabons-(numerousrditches;failure:-io_deductzequired-..._-
bufferlsetback�acreage;�or2b%-oftotal.acreageadentified:.iii-CAWMP,:includes _-_
small '-irregulariy-shaped fields = fields.less-than-5acres:for.:travelers-or.less-than ;
.2 acres -for -stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER',2
IRRIGATION
ACRES
ACRES
%
SYSTEM
r A"&-" IY VIIIIL?"V\ - 1IyuIpI IL, Mull, LU11GI V11 FUIJ Il IIUII111ay L!G UQ +-: III }JIGS.+ U1 IIGIu AAU1111J>r&Q U-ZPGI IU1111!. Ulk % /P%V VIVIF
and type of irrigation system.- If pulls, etc. crossTnorethan ane field, inspectortreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER - must be clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acFeage_exceeeiing75% of its total.acresand having received less than 50%
Of its annual PAN as -documented in the larm'sprevious-two years' (1997 & 1998) of irrigabon-re-cords, cannot serve-as,the
sole basis -for requiring a WA Determination_Back-upfietds-rnust-berioted in the-commentzectionznd must be accessible
by irrigation -system.
Part IV. Pending WA Determinations -
P1 P1an Iacks:following information:.
P2 Plan -revision may.-satisfy-7.5% rule based on adequate overall PAN deficit and by
adjusting -all field :acreage to below 75% use rate
P3 Other (ielin process of installing new irrigation system):_7��ti

a 't
Facility Number Date of Inspection — QQ
Time of Inspection F 24 hr. (hh:mm}
Permitted E3 Certified © Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
vCJI WrL Coun:...G1...................................................
FarmName: .....................................................�............................................... t3 .......................
OwnerName: ................................................... ......................................................................... Phone No:......................................................................................
Facility Contact:.............................................................................. Title:.................... Phone No:
...........................................................................................
Mailing Address:.....................................................
Onsite Representative:... . ......................................... .................................... Integrator:..... cr►'?L�.................................................
Certified Operator:................................................................................................................. Operator Certification Number:..........................................
Location of Farm:
............................................................................................................................................................................................:.....................................................................
................ .............................................................................................................................. ...
Latitude Longitude
_ :Design Current Design Current .
twine T
Ca act _ =Po" ulatron -Poultry _ Capacity_ _Population,Cattle
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [INo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
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
❑ Yes ❑ No
❑ Yes X'No
❑ Yes C�No
❑ Yes 19 No
Structure 6
Identifier: r�
Freeboard (inches ) ........5nJ.. ....................
.....................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes D(No
seepage; etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
�7
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
)dNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes .
NrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
tg(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
WYes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
;No
11. Is there eviden of over ap lic tion? ❑ Excessive Ponding ❑ PAN
❑ Yes
&No
12. Crop type t . SG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
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
MTo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Wo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes
gNo
(ie/ checklists, maps, etc.)
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
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ 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
INO •yiolaticiris:oir di f cWhaes -were hated i 06fig Ois:visit; • Y:oft. wiii tno further : .
corresooridence: abouti this visit ....: ..................::..:..::::: .
F 1 ' ' `ti"","� ►�Q Jam. �iC J'� 0 I'j -� t Y� `cam
�`�,�-c � �z � ass` r�-��-�. ��►•e, `fit-•`�� 30,
1q) PQ40S I-ek
Y �►-e Q� �--� +.� s�--,sk� �'
Reviewer/Inspector Name 3�3
3q
Reviewer/Inspector Signature: Date: fti-(Y�

Facility Number: '� — LJLj Date at Inspection (�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes 4NO
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
N0
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
4&0
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
P(No
to ►'(�,i--- � �'����t. t- -�.
Kees Ly 5CK� L'w'L 6-\-L4 5601 L"I t ,4V-�L., s

Facility Number
Date of Inspection 1 ,3a 9y
Time of Inspection 24 hr. (hh:mm)
® Permitted ® Certified r] Conditionally Certified [3 Registered 113 Not Operationaq Date Last Operated:
Farm Name: ........pi A&Pt4......................................... County:... ............................... x.. Q..
Owner Name ...... A. . 9tA...... 1 fit- ..... z................................................. Phone No. ...qlq--- 3 .. w?4275.................................
Facility Contact: .. .................................................. .......... Title........................... . Phone No:
Mailing Address: ....P .P�Gi'C..... �.� ......................... 1Z,�C-H LA D ...t.. #QC................ . .......
OnsiteRepresentative:................................................................................................... Integrator:,.....................................................................................
Certified Operator: ,....I?..._.µ%.(1M71_. ..- Operator Certification Number:.....�fo Z
Location of Farm:
.............. .:-.. 1FT.....aHro„C,�FoRr a.n- en zm4L65_ rAK ...!e ............
.RoG ....R!�.......YAa!1......!...!K ....Q!1....R..!.MT............................................................. I,
Latitude 34 ' ,�4 ` ®" Longitudes
Design Current _ -,,: ' Design Current - ' .. Design Current
Swine Capacity Population . _Poultry Capacity Population Catle Capacity Population 2T.
❑ Wean to TFeeder
Feeder to Finish
J -7Z)
-7a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
lNeimber of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holclrng=Ponds /Solid Traps ❑ No Liquid Waste Management System
a..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RrNo
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 21:Uo
b. If discharge is observed, did it reach Watcr 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 \,J7(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 6(No
Structure I' Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches); ..........��, .........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'tom
seepage, etc.) �"�
3/23/99 Continued on back

�c:
T=
r�n.
,� �

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?
(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
"Mal
■ - 1�
❑ Yes KNo
❑ Yes h�No
❑ Yes Wo
❑ Yes RNo
❑ Yes �lo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E�LNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes too
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?
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?
yiolatigns;or deficiencies vere noted during #.... s..... will teceiye Rio fuirthtr ;
correspondence. abaut. th" visit. _ .. .
❑ Yes ❑ No
❑ Yes Wo
❑ Yes B�Ro
❑ Yes M1 To
9Yes ❑ No
❑ Yes [�T0
❑ Yes N<No
❑ Yes kNo
❑ Yes �4 No
[]Yes VNo
❑ Yes $;rNo
Comments -(refer to question #).-.EXplain any.YES answers."a(or any --recommendations or any.other comments
Use°drawings of facylEty to better explain situations (use additional pages:as necessary}
�•� C��� - .,zc.�•�-�-¢.� Y-�-�� ys� {�.�t� spa-
Reviewer/Ins ector Name
Reviewer/Inspector Signature. Date. s J/ /to /qq
3/23/99

Facility Number: — LL Date of Inspection
—Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes %�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 KNo
3/23199

tl/
Lagoon Dike Inspection Report
Name of Farm / Facility A. Whaley 67-44 _CCgMlls
Location of Farm / Facility SR 1311
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:IV
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors Patrick Grogan
Janet Paith
7-8' Freeboard, Feet 16"
2.0 Top Width, Feet 10
2 to I Downstream Slope, xH:Iv 3 to 1_�
Yes X No
Yes X - No
Yes X No
xc fl t - gms
Did Dike Overtop? Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X_ No
r
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X_ No
Other Comments Lagoon$QLyp�jbjn 2" of the top but no structural damage
was dons

Lagoon Dike Inspection Report
Name of Farm / Facility A. Whale 67-44 Carrolls
Location of Farm / Facility SR 1311
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
9 / 29/ 99 Names of Inspectors P-at6clLGro=
JaDet P ith
7-8' Freeboard, Feet 16"
2.0 Top Width, Feet 10
2 to 1 Downstream Slope, xH:lv 33t4_1__—
Yes X No
Yes X No
Yes _x No
Excellent - amass
1
Did Dike Overtop? Yes X_ No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No r
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _ X _ No
Other Comments Lagoon aotwithin 2" of the -top -but no Mctur4l damage
was done

i
Q Division of Soil and Water Conservation ❑ Other Agency
SWivision of Water Quality
O Routine O Cam faint O Follow-u gof 1)W ins ection O Follow-up of DSWC review O Other
Date of Inspection d 7
Facility Number
Time of Inspc�tion 24 hr. (hh:mm)
(3 Registered © Certified © Applied for Permit ❑ Permitted 113 Not Operational I Date Last Operated:
Farm Name: ..... .Dt?........ W-H...7�..4..fx��.%......... !`.6� �..... .................... County:.........sr.....t..,SLc�.....
Owner Name: �4DR� � 1�i1�° lb —A.; ', ....................................................... Phone No:.....%�A....�� �..�.��.7b ......................
......................................... .....
Facility Contact: .........�.! Title:...Gul.1�� Phone No: ................................................................................................
Mailing Address:..... 1r..0:... B rd.X...... tJ��a...r�l, ...
Onsite Representative:... j et-'0 /�1 W (i �1 L `� g 'P.,�� ........................
................................................................................ Integrator: !w 4�'r.............
Certified Opera€or;....... 71 f 4/..f#'...... ?...%......:............................... Operator Certification Number,..�b z-...........-...
Location of Farm: Q p
.................................................................................................................... .. ....................................I............
Latitude [_�]• ' ©" Longitude 0 9 "
;Design ; ":Current Design Current
ie -Capacity Population Poultry Capacity Population
❑ Wean to Feeder
Feeder to Finish
<v 0
% % 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
J. 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 lagoonslholding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes N[No
❑ Yes OrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
CRrNo
❑ Yes
't?No
es )'No
❑ Yes
[XNo
❑ Yes
W—No
Continued
on back

.� V
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Eg:;h:o
Structures (I.aeoons.11oldino Ponds,. Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure h
Identifier:................................................................................................................................................................................
...................................
Freeboard(ft):......... 1q.t.'A .............. .................... I ...............
..............................
10. Is seepage observed from any of the structures?
❑ Yes
.U-No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
IcOrYes
❑ No
12. Do any of the structures need maintenance/improvement?
jkYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No'
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ....-. f31! ........ ......`r-SG(a�4.r................................................................................................
..-.... '-...:.-...:.:.....:......:
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
des
❑ No
11. Does the facility have a lack of adequate acreage for land application?
❑ Yes
49No
18. Does the receiving crop need improvement? AR'I�es ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes KNo
20. Does facility require a follow-up visit by same agency? XYes ❑'No
21. Did Reviewer/inspector fail to discuss review/inspection with on-sitt representative? ❑ Yes ❑ No
22. Does record keeping need improvement? ❑ Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? WYes WS�No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes k9jvTo
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes bQNo
0 No.violations or deficiencies were noted during this visit.- Youm'ill receive no further
correspondence about this'visit.
Comments (refer to question #) Explain any lt`ES answers and/or any recbrrtmenclattons or any other coaunents 9 E
Use drawings of fac�lety tobetter`eaiplain situations (vise additibtial pages ds necessary)
U-2-g- # I Ao AA
r
4-0 fWsh4Ah tAJ U P +0
h%CokpS O F P*Ad FOe S pY a r4-#+4 A rSODj.FA
7/25197
Reviewer/Inspector Name "� . a: F
Reviewer/Inspector Signature: Date: p

:,' lg Routine O'Com laint O Follow-up of DWQ inspection O FoIlotir-un of DSWC review O Other
Facility Number
7 Date of InspectionF_ I
Time of Inspection ; 1% Use 24 hr. time
Farm Status:.-2 2a &S z:l
Farm Name: ...
Owner Name: -P,> ►' pA-)
Total Time (in hours) Spent on.Rv iew
or Inspection (includes travel and processing) J!
County:... �k.. -.... _. ._......
Phone No:
Ma -Bing -Address: 922
Onsite Representative: —4i,, C' ._ - — Integrator:.•���--�
Certified Operator Operator Certification Number:—__...
Location of Farm:
Latitude Longitude Lam`
❑ Not Operational Date Last Operated:
T}-pe of Operation and Design Capacity
_.
:� ;Number..- � �Poultry���... �:.
5�vtne=� ww�~ �,.. r i\rnmber;Cattle \
� ,,
. ,..
❑ Wean to Feeder-,
E 2
❑Laver 4
,_�Nu�iier ,
j
`❑ Dairy
Weeder to Finish
= „ ❑ Non -Laver.
❑ Beef
Farrow to Wean
x� ,
Farrow to Feeder
...: .
Farrow to Finish
°: ❑ Other Type of Livestock
Number of Lagoons /hHalduygPoads s ❑ Subsurface Drains Present
'a#''i
❑ Lagoon Area Sprav Field Area..
..:�.^�.:-rx'..:^^�:es"�,�S-Ye.. ..,..'^`. .. ,a•m._ 9r�, .s�.����r'�T-r-aa,a�:::x9. .e,-'z. �'
General
1. Are there any butters that need maintenance/improvement?
2. Is any discharge obsen-ed from any part of the operation?
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)
r . Is there evidence of past discharge from any pan of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
El Yes $] No
❑ Yes OR No
❑ Yes JO No
❑ Yes 10 No
❑ Yes RNo
❑ Yes R No
❑ Yes [XNo
❑ Yes )RNo
I'....r:....na n.. htp,

6. Is facility not in compliance with any applicable setback criteria? +
7. Did the facility fail to have a certified operator in responsible charge (if inspection after l/l/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon I La_oon 2
3
Lazoon3
❑ Yes
O No
-- ❑ Yes
�NO
❑ Yes
A No
❑ Yes
® No
L-,looa 4
10. Is seepage observed from any of the structures?
❑ Yes
RINo
11. Is erosion, or any. other threats to the integrity of any of the structures observed?
❑ Yes
®NO
12. Do any of the structures need maintenancefimprovement?
(z Yes
❑ No
(If any of questions 9-1:2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
11 Do any of the structures lack adquate. markers to identify start and stop pumping levels?
❑ Yes
Or.,\'o
NVasteAgplication
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.- Crop type -
16. Do the active crops differ with those designated in the Animal Waste Management PIan?
❑ Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?.
R1 Yes
❑ No
18. Does the cover crop need improvement?
❑ Yes
® No
19. Is there a lack of available irrigation equipment?
IN Yes
❑ No
For Certified Facilities Only • .
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
21. Does the facility fail to comply with the Animal. Waste Management Plan in any Ray?
❑ Yes
❑ No
22. Does record keeping need improvement? 1
❑ Yes
❑ No
23. Does facility require a follow-up visit by same agency?
❑ Yes
® No
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes
WNo
Cotnineats (refer to quests n,� F.xpiaur any Y1;S aiiswers and/or anv rirseudations of anv oilier chrome.-�s -•=
Use dawmgs oifacity to better explainsitiiatnorns` use a�ddivanal pages as��,necessarv�
v
ReviewerAnspector Name -'- .
Reviwer/Inspector Signature: �-� Date:
cc. Division of (Pater Quality, Water Quality Section, Facility Assessment Chit 11/1.196

•
Site Requires Tmreediate Attention: __'
' Facility No. 6 7- '(-/
DIVISION 0 ENViRONWNTAL MANAGEMENT
A.NEbfAL FEEDLO OPERAT ONS' SITE VISITATION RECORD
ATE: % 1995
Time -
Farm Name/Owner: AO , j //;C 1. r .�
Mailing Address: o? qo iz
County:
Integrator. CA Phone:
On Site Representative: M) n �L Phone: d q - 5,0 75
~Of"' s E4 5o co^`ror &R _) rn3 AQ
Physical AddressA ovation: a 114, rti: KA. a n S ! ! (6 P_-�C x' 1Pv ! -- r
RA1- FC, 01rt rcftf' 1 SY .ndr U ,tba.X/�n u.n
Type of Operadon: Swine
Design Capacity: _ 176, 0
DEM Certification Number: M
Latitude. 3q - 5 (k ' 43: 4�,
Does the Animal Waste Lagoon h;
(approximately 1 Foot + 7 inches)
Was any seepage observed from d
Is adequate land available for spra
Crop(s) being utilized:
Does the facility meet SCS minim
Is the animal waste stockpiled wit
Is animal waste land applied or sp
Is animal waste discharged into w;
similar man -wade devices? Y
Does the facility maintain adequat
spray irrigated on specific acre
Additional Comments: nL-�j
Inspector Name
Poultry — Cattle
Number of Animals on Site:
DEM Certification Number: ACNEW___
Longitude: Elevation: Feet
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
9or No Actual Freeboard: _ 3—Ft. 11- - Inches
lagoon(s)? Yes or oo' Was any erosion observed? Yes o&
s r No Is the cover crop adequate? � e or No
setback criteria? 200 Feet from D%vellings? �s or No
100 Feet from, Wells? ' or No
h 100 Feet of LSGS Blue Line Stream? Yes ofN11%
.y irrigated within 25 Feet of a USGS Map Blue�ine?r Yes or q ers of the state by man-made ditch, flushing system, or other
o Now If Yes,•Pl=e Explain_
waste management records (volt=es of manure, land applied,
ge With cover crop)? Yes
f
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't-' , .L•s-�.;• ate' .
Signature
cc: Facility Assessment Unit
a 1 0 ' 39Ud
Use Attachments if Needed.
�N 3-MIANOSADHr dH 3.. 6l0a 3 26: 7 1 SS I ` JI-IH

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L.�
OPERATION,:, BRANCH - W Fax : [phone] Jul 24 ' 95 to :10 F. 16/18
Site Requires Immediate Attention rG
Facility Number:
SITE VISITATION RECORD
DATE' ' T4c , 1995.'
' r
Owner: _ ra _ % Farm Name:
County:C `d' ���
Agent Visiting Site: / / C _ _ °Fhnnc: lole,4 —, :5
Operator: 4 Phone: ?Z2 Z4z 56 -7 �
On Site Representative: f / Phone: ,Q
Physical Address:. -;r,/f f;,.1 ! a JC E _ � � Cf 3 ,ay4���1l
Mailing Address:
Type of Operation. Swine ✓ poultry ` . Cattle
Design Capacity: _ 1 0 Number of Animals on Site:
Latitude:' Longitude• .o '
Or
Type of Inspection: Ground j,:-' Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +6 inches)�De or No Actual Freeboard: __ z_ Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
cornments section.
Was any seepage observed from the lagoon(s)? Yes o N Was there erosion of the darn?: Yes o
Is adequate land available for land application? e�r No Is the cover crop adequate? ei r No
Additional Comments: tiF_.=rj1 _ Taw .��X 4*0 ,04C•kF; 9' Z vr,reerC.y.. - -
Fax to (9 i9) 715-3559 - Si-nzia(re of A,*cn