310059_INSPECTIONS_20171231 (2)

NUH I H UAHULINA
Department of Environmental Qual

s ,� , ; - .: •�'� � �J.Dtvtsron of�Water Resources`. s� � �;
ity Number 6 O D�vts�o ow
Fakin of Soil and Water Conser anon �{ T
Agency
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �j / /j Arrival Time: Departure Time: �(� /J 1 County: Region:
Farm Name: T� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: (Kr G �C&e
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: 1 ,(—.j 9�k
Certification Number:
Longitude:
Des n CurrentDesn
n�Current
MZ:g
Swore Capacity
p ty
�Cnr�rent
Ca aci Po
Pap Wet Poultry Capacip ty p
Wean
to Finish
Discharges 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 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 NA ❑ NE
Page I of 3 2/4/201 S Continued

FacilityNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ 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: Of- °�^ ! ��A Ls+ 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EjNo ❑ 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
M No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E:j"'No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[al 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
[]"No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EjNo ❑ NA
[] NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑'No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
IGl ivu ❑ NA
❑ NE
acres determination?
Co
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
V
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
To Q NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E2<o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o ❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
No ❑ NA
❑ NE
Page 2 of.3
21412015 Continued

[Facility Number: --5 TI Date of lns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes P' - ❑ 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 El 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 fait provide documentation of an actively certified operator in charge? ❑ Yes fflNo ❑ 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
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
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?
_251�v C_� rof C-V/- J-5 '__e� C_ e --A I /C �
Reviewer/Inspector Name: ✓/ d tJ �
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes g4o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No ❑ NA
N ❑ NA
❑ NA
V❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Phone: 2 /O 7 f
Date: 572—
Y l
21412015

Division of Water Quality
Facility,Number - 0 Division of Soil and Water Conservation
I 0 ,Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: ` ounty: Region:& /�
Farm Name:_ Owner Email:
4,
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Imoacts
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Canacitv
Poo.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ff�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes eN o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes �rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of -Inspection:
Waste Collection & Treatment
4. Is, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
jo—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
,E:fNo
❑ 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 l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,fNo ❑ 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 C No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes U(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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [/No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [po
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr nsfers
❑ 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 PA No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3 0
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

[facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes ONo
❑ 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 ZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes allo
❑ 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 ;a -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
❑ YesrJ2'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 [� o
❑ NA
❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAW T?
❑ Yes J;3"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes J�no
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J 'No
❑ NA
❑ NE
Comments (refer to question #)• Explain any YES answers and/or any additional recommendations or any other_ comments.
a
Use.drarviri>Ys of facility to better exolain situations (use additional Daces as necessarv).
Reviewer/Inspector Name:
Phone: Z'
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Facility Number
3e of Visit:
tson for Visit:
Date of Visit:
Farm Name:
�IVision of Water. Quality
0 Division of Soil acid Water Conservatiqu. �' p
0 Other Agency ;
0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: feparture Time: County• Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
to Finish
t
Other
Other
Design Current
Wet Poultry Capacity Pop. ,
La er
Non -La er I T_ A'
Design Current
Dry Ponitry I `a Canaciti' 1= Pop.
La ers
—.Non-Layers
Pullets
Turkeys
-Turkey Poults
Other
Design Current~ -
Cattle Capacity Pop.;
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2-<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes J2'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
❑'No
❑ NA
❑ NE
❑ Yes
fn*No
❑ NA
❑ NE
❑ Yes
;I No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

IFacHity Number: 51- Date of Inspection: jO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZfNo ❑ NA ❑ NE
Struc e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j2 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;3^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 JoNo ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes '2 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
❑ No
❑ NA ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA eo'14E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA �NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NAiE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NAZ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑ NA �1E
❑ Weather Code
El Sludge Survey
❑ NA eNE
❑ NA ET�NE
Page 2 of 3 21412011 Continued

[FacilityNumber:01 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pe it?
❑ Yes
❑ No
❑ NA XNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[] No
❑ NA ErNE
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 �TE
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"'ZNE
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
❑ NAE
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 91E
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 _ZNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA� E
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA ONE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EAKo
❑ NA 20�E
Comments (refer to question ft Explain any YES answers and/or, any additional recommendations orany other: comments: -
Use drawings,of facility to better explain situations (use additional pages as necessary).
C'(11fl lio�xv- 6�1""'L re�r4,--
k.
It.,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t,
r
wc' 3
�a Z2e
a
V
Phone:
Date:le"CG 1 Z
214120 l

rQ'Division of Water.Quality %
Facility Number 3 tJ O Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit.' toutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3d Arrival Time: eparture Time: County: Region:(,�-cJ
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phones No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= 6 Longitude: = o= 1
Design Current Design Current -Design Current _:;;
Swine. Capacity Population Wet Poultry., Capacity Population :Cattle- Cap,
pulatioo
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ❑Non -La er
`• ❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry',
❑ -Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars i
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
-
Number of Structures, "'a7�
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 JdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�Mo
❑ Yes
;ZNo
❑ NA
❑ NE
❑ Yes
?No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of InspectionM12i54
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strucki
�/re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R�No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Cl Yes XNo ❑ 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V5 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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tO No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
qNo
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� a
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Xo
❑ NA
❑ NE
Comments refer to uestion,# Ea lain an YES answers and/or an recommendations or_'an other comments r '
( Q ) p Y Y y x
UWdrawings of facility to better explain situations. (use additional`pages asmecessary): -
Reviewer/Inspector Name -
Phone:
Reviewer/Inspector Signature:
Date: Cr
Page 2 of 3 e IfI28/04 I Continued

Flcility Number: Date of Inspection 3 Qa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jXNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 PTNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1qo ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes '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 �io ❑ NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El [/�No ❑ NA El NE
Other Issues f
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes VNo ❑ 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 Vf 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 V No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo ❑ NA ❑ NE
Page 3 of 3 12128104

GAvision of Water Quality
FCiiityiltiibCr. Q Division ofSoil and Water Conservation
Q Other Agency
Type of Visit � Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Id Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: ZA //c- I
s
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: %% Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
,Other-
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c ❑ 6 ❑ « Longitude: ❑ o = d ❑
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
-Dry Poultry .:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharp_es & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pogulationj
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number�o€ Structures
�y
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 ONo ❑ NA ❑ NE
❑ Yes L-jNo
❑ NA
❑ NE
El Yes ❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes ; "No
❑ Yes ZrNo
❑ NA
❑ NE
❑ Yes ;?O�o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy -rainfall) less than adequate?
❑ Yes
2fNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
[I NA
El NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
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
;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
ONo
El NA
[I 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 VNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apmlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Vlo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
J21 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
VNo
❑ NA
❑ NE
Comments Irefer to question #): Explain any, YES answers and/or any,recommendations or any o_tbtr,eomtrients
Use drawings of facility to better explain situations. (use additional pages as necessary):
ao `
AL
w
ReviewerlInspector Name
a;° Phone:
Reviewer/inspector Signature:
Date: Q
7
Page 2 of 3 121AI04 Continued

Facility Number: Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5YNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
/A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)6 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
[�40
❑ 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?
ElYes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E/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
[;VNo
❑ NA
❑ NE
33.
Does facility require afollow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or=Drawings.
Page 3 of 3 12128104

Q Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
ZE Q Other Agency VZ
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
��/�
O Re Date of Visit: Arrival Time: �2 , parture Time: �� CounRegion: wr'�fJ
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=, Longitude: = a 0 6 = H
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La ei
Dry Poultry
❑ Layers
❑ 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts io the Waters of the State
other than from a discharge?
❑ Yes _'No ❑ NA [J NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
;]'1Go
❑ Yes
�o❑
NA
ElNE
ElYes
U?igo�❑ 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? El Yes ;[ o El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 6 No ❑ NA ❑ NE
Stl Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ructure
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
VfNo ❑ 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
JZI No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
E 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
dNo ❑ 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?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
dNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
VNo
❑ NA
El NE
Of
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 acre determination?❑ Yes
/ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[(No
❑ NA
❑ NE
71
Comments�(refer to�questton,#} Egplam any YES:answers and/gravy ecommendahori�sYor any other comments:
� V.'�V'+`�+�tE""� fi r� ar � -to+.-..5, :� r- .
6Use drSAngs=of facility�to better egplam s�tuati6 i`s` (use addthonaE:pages as necessary}
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: O G
01
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ;7No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
t
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
❑ Yes E No
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes PrNo
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes Rl"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CYNo ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
('No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

r
)D'bivision of Water Quality
Facility Number r Q Division of Soil and Water Conservation
_ _ . _ _...... Q Other Agency
Type of Visit Q.6bmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: parture Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _4: ZZym
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Soars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = ' ❑ Longitude: = ° = ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�_� ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
Turke
❑❑
TurkeouIts
ft
❑ Other
Discharces & 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: Eli
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 2<o ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes P-no
❑ NA
❑ NE
❑ Yes _,UIqo
❑ NA
❑ NE
12128104 Continued

Facility Number: �7 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Struc re 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
0No
❑ 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? XYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ONo
❑ 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
gfNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
oNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Flo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 7(% 7
Reviewer/Inspector Signature: Date: 6
12128104 Continued

Facility Number: �� —��1� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z,�N"o El NA El 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,_No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;2-No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�]-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PkNo
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
, rNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to no the regional office of emergency situations as required by
El Yes
,D—No
El NA
El 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
LQ No
/
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
to
❑ NA
❑ NE
Additional Comments and/or Drawings:
P S.cr
s l lUG
4 / ✓ __//JJ
•
o'`j i2 5�C G 7`�9-r1
X a r /'e�e,"7L irc.c
T
Page 3 of 3 12/28/04

1 :2140Division of Water Quality
Facility Number Q Division of Soil and Water Conservation Loo��
0 Other Agency
Type of Visit j2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QeAoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I(p/ Arrival Time Q d Departure Time: C] County: Region: C✓l
Farm Name: _rIIG� 1i�1 Tc C/�/Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification �Number:
Back-up Certification Number:
Latitude: = u = 1 Longitude: = o = g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T.❑ Layer _ I I I,
` - ❑ Non -Layer I_. _—
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
El Beef Brood Co
I
Number of Structures: EIE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ 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 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5-4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]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
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/lnspector Name jPi/i!�[ Phone: 7�G —
Reviewer/Inspector Signature: Date: 4
Pave 2 of 3 121ftIO4 Continued

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

b..
1
Type o€ Visit (> brnpliance 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: 141
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: f"DRegion OS
S
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator: k"
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 6 ❑ Longitude: ❑ o ❑ A ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
k ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ 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
❑ Dai Cow
❑ DairyCalf
❑ Dai Heifer
DDry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[--]Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes allo
❑ Yes
;2'No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3— Date of Inspection
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yeso El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: % 2-
-Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes` ZNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [)lo ❑ 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 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 91
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [YNo ❑ 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
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P, No
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Reviewer/Inspector Name ?� Phone:
v-,
Reviewer/Inspector Signature: Date:
12/28/04 Continued

t___
Facility Number: 3 — Date of inspection c
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �& ❑ 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 Q 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 [JIB o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FKo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �' o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes J:�'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes DNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �o
El NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
, '/
❑ Yes 1,—a-tvo
❑ 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
f
❑ Yes Vo
❑ 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 �io
❑ NA
❑ NE
12128104

Di
Water
•Y K
"Divt�� af5oil a r,Conservatian : � � '--
Type of Visit Q Compliance Inspection Q Operation Review to Lagoon Evaluation
Reason for Visit O Routine Q Complaint Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: c? O Time: %d>
Q Not Operational Q Below Threshold
Permitted PCerdfied © Conditionally Certified 13 Registered Date Last Opera or Above Threshold: -------
Farm Name: ... OIrY. 4au kl. .... Q, _-1! _"7�.---_------_-.-._._-- _--__--_---------•--- County:... ,(�YJ.................. ........... .........
OwnerName: .............................................................. Phone No:.......................................................................................
MailingAddress:.._ _ ........ _........_......... _ _... _ ._._.. __ _ .__. ___ _. _ .. __ .. .. ...
Facility Contact: .................... ...... ......... - ...... ...... ........ ...... ........ --Title: --,-_ -- _--•- Phone No:
Onsite Representative:._ . - � L -.. ................. Integrator: _ +-..., !!FA. .........
..........
Certified Operator : . ................... ....... �.... - - .. _ . ._ ..... Operator Certification Number: ._.... .........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 �1.6 Longitude • 1 64
—, a wit Design Nr Current' a` Design -Curren[ Design :� Current
Swine , . ;Ca aci . Po illation `PonitrY Ca Pn alafiori Cattle Ca—aci ?Po elation
❑ Dairy1 lam
4 ❑ Non -Dairy
ti �a s b
Capac><ty
�= x
otal SSiW r
'� � Number of Lagoons ^` _
Y. 1 n _, x
❑Non -Layer
Discharges & Stream Impacts
I_ Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._...... ............. ..........�..............-_ ........................... .......................................
Freeboard (inches): 70
12112103 Continued

Facility Number: ,3/ — S Date of Inspection < O
5. >Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
-s : r ' _ :� _ _ -
Cnmreeients (refer to question #) sEzplauuEt any YFS answers aaiid/or amy r�v►mmendations'ar any ot%r cnYnirigents.
- m „
:_Use drawtings of faalxty to better explain situatrons (use addrtaonal pages as necessary) ❑ Fteld Copy Final Notes
.. �.. .c•^ .mac _ �'
r
'&j0 /�lrr°c' 'ga-1 SICle
1,5
�Gasec .P iK o� cla ��rc�ies
�� :o�, . � y
7`Xe eaw C7`LGr! 7L� 5 /; /0/PO.fG�el°
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

Type of Visit 91Compliance Inspection O Operation Review p Lagoon Evaluation
Reason for Visit f eRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 0 Time:
1�0 Nat O rational 0 Below Threshold
,,_ePerxfflff d� erti#ied [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ..... ......._...._....................._ ..__._ ...... w __..__........ County:
Owner Name: --� .........»...�....»��.. W »� _ .... _ ... Phone No: ... .......
Mailing Address:..._ . ... .......... .... .. _ . .W.........----
Facility Contact : .......................Title:Phone No:
Onsite Representative:....Q ` 6._.� ....____ .. .� .__.� _ ......_.... Integrator: ...... ..................... ............. ............. ..
Certified Operator:. Operator Certification Nuumber....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` at, Longitude �• �4 44
rA.r-,:h- is„ _ F.i- t t.w "�"_ ', q _ -«:
Design Current z Design C _ M Current
_ _ EP'
Swine J a act Po i9_ Poultry � Ca- APO t10A Cattle C act niation
Wean to Feeder
. ,_Po
er to Finish
0Lj
Farrow to Wean
r ,
Farrow to Feeder
Other
Other
- :. .-.vaa
_ Farrow to Finish
d:F -�wx.-i-- --�- i i'[,T
= je '; rTOt81=Desi& Capa©ty
Gilts
�m s E _ v _,� ,� c.
Boars
r Total SSLW �;'
Number of Lagoons
µ
❑ Layer
Dairy
❑ Non -Layer
=
❑Non -Dairy
DiscbREres & 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 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .....----- I-------------....
Freeboard (inches): N 0 3
12112103
❑ Yes
INO
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes Fo
❑ Yes o
Structure b
Continued

Facility Number: 3j — <C7 I Date of Inspection
T�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Y/Ncseepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) f
7. Do any of the structures need maintenancetimprovement? ❑ Y s d No
8. Does any art of the waste management system other than waste structures require maintenance./improvement? Yes ❑ N�To
P
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes rZo
❑ Excessive Pondding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type & iC pn Jfl A (G) S C'o U clS tJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (PNo/
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E14/
b) Does the facility need a wettable acre determination? ❑ Yes CrNo
c) This facility is pended for a wettable acre determination? ❑ Yes L.d'No
15. Does the receiving crop need improvement? ❑ Yes io
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes To
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes;XNo
Air Quality representative immediately.
-co(refer to3quest�on) FF�cplarn any YFS answers and/or any recoendabons ar any otizerrcomrtients y
rtUse drawingsof fatty tojbette�r'e�cplarn sduatsna4 (ase add�honal P �3')❑ Field CaPY ❑ Fufal Notes : s
MA.t.1t'EN NO Ce N E(D D ZkJ coL-j P P_G A o f rX eC O k4 v�2
ic_Ar-fi IS" ?-1
i )UP N(cos r> BE Cf-/ANGEo Sj4C t._/Xjjt, /3FRm✓19A A5 Naq/ a+0
GR.o P SQ0&gC_c oa_D (-j9 0�j
Reviewer/Inspector Name Y "� [
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: • 1 — Date of Inspection
Re uired Records & Document,;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes OIN
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ 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
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?;w
(ie/ discharge, freeboard problems, over application) ❑ Yes N
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? /YesN
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
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
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12/I2103

Type of Visit 1& Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time: + 04rt
Not Operational 0 Below Threshold
M Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ✓ County: —. _ Aids., _
Owner Name: Phone No:
Mailing Address:
Facility Contact: �/j�} �% Title: /Phhjone No: �[
Onsite Representative: //l'd a e l ,14661. S _ Integrator: ,///6.CAxiiF of
/�✓/�✓h
Certified Operator: Operator Certification Number:
Location of Farm:
Swine [:]Poultry ❑ Gattle ❑ Horse Latitude 0 ` " Longitude C�• 4
Design Current
awlize "Pact"Paciry ro utanon
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other I I
Total Design Capacity
Total SSLW
Discharges & Stream Impacts �,(
1. Is any discharge observed from any part of the operation? ❑ Yes �I No
Discharge originated at: ❑ Lagoon El Spray Field El Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. floes 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 olle lion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Struc 3 Struc r
Identifier:
Freeboard (inches):
05103101
Structure 5
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
P�,/No
El Yes
LQ No
❑ Yes
XNo
Structure 6
Continued

Facility Number: — Date of Inspection ! '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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? l�Yes jw o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes W('No
11. is there evidence of over application? El Excessive Ponding ❑ PAN El Hydraulic Overload El Yes XNo
12. Crop type z
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ko
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 o
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XVNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,I,L�J(No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes l�(J No
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 X/o
No
24. Does facility require a follow-up visit by same agency? ElYes N
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes VNo
P No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-- 2'°:'-�Sz;-.r "e�= fte#L`,,:
n #). Explain anyYES answers andlor any recommendahons or any other�camments
Comments (refer to questro : � .
Use•drawings of facility to better explain sittiatians '{use additional pages�as�neCessary):;�� Field Couv ❑Final Notes
77o
,e-P.Fsf 5 ecee7,� A-44 6?A�CaAl eOM46 A/07 �SP
eel r
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: Q
05103101 K ~ v Continued

Facility Number: — Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 1� No
❑ Yes XNo
❑ Yes XNO
❑ Yes X')
o
El Yes No
❑ Yes ❑ No
Additionaf C6&ments.and1k win
.. ,.D...."ra& -C�&_..,..�
�C �1�n�f✓,p �° �� �4Ps. yoe��✓ s
Lam- /vfl� . �i✓ l�� G4C.}i�o�✓ /� S S�D�,✓ ��✓ �F
Z41M
Y
a �cd ���-apl,J 5 iTFtJ�.
�-Y
6'5-d
05103101

el—
` . WDivi ii&i of Water,Qualtty
6Division of.Sotl sin ter ConservationJi
� �� ' . . �..4., r.•--f.� ,� � ' Other -Agency � � r - > � - - �` c �; �5" J ,,�Y ,�:��..z-� ..��f
Type of Visit }D.Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3 Cate of Visit:
�Upermitted D Certified ❑ Conditionally Certified [3 Registered
Farm Name: wn p rr,
Owner Name: _ , L C't.4c � M .rr�
1...................................................................
Facility Contact:
Mailing Address:
Title:....
11 Time: I I f C Printed on: 7/21/2000
Not Ouerational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County: .....!�..�� �J�.i....................................................
PhoneNo: .......................................................................................
...................................... Phone No:................................ ...................
Onsite Representative: VD Yt �' ? t t Integrator: [."" ✓ "'�
'i...................................................... ............................... g........p.-.......�i........................................
Certified Operator: ................................................................. Operator Certification Number:........................
Location of Farm:
dj Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° Longitude �• �' �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I RNRon
DairyFeeder to Finish ❑ Non -Layer -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
tEl
Number of Lagoons 4 ❑ Subsurface Drains Present J10 Lague n Area JE3 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNO
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) El Yes /RNo
c. If dischai- e is observed. what is the CS61nalCd flow in gal/min?
d. Does discharge bypass a lagoon system'' (If yes, notify DWQ) ❑ Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes P�No
Structure I Structure 2 Structrre ; tructure Structure 5 Structure 6
ldcntificr: ....re ' 'r T �....................T�a .a. ............R. �.............. a:,�---- ---- d..".......-...............................................................
Freeboard (inches)- 2_q 3,9
5/00 Continued on back

Facility:Number: 7) — Date of Inspection d d Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes -11?fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )FfNo
(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 (XIo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes A No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑PAN ❑ 11Hydraulic Overload El Yes �No
r w
12. Crop type Fe-► Ld`i - Cecti.2-P, 5—A40,11 4 res,; �, t eo r rtI t Jhm . ,Sal, 6P.S yt f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
14. a) Does thcfacility 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?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
(CAWMP)? ❑ Yes'XNo
❑ Yes Z No
❑ Yes gNo
❑ Yes No
❑ Yes /�No
ElYes r No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
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?
0: yiQlatitins;o dfeiencies wire noted ling #tis:visit; Yoh with I�eeeiyeouf tfttr .
:. ctil-iresnoricience: a'b6 ' this :visit. ....................................
3inenti (refer to question #) Explain any•YF. answers andlnr any:recommendstlons or'agy of
drawiings -facili to better�e- lain situatians . ty _p _' (use additional pages as trerpsstiry).
YcG0 rCl s Gy ✓ Lu ill
❑ Yes XNo
❑ Yes X No
❑ Yes 'VNo
❑ Yes XNo
❑ Yes �0No
❑ Yes ONo
❑ Yes 'VfNo
❑ Yes 'oNo
❑ Yes 'd No
dL
Reviewer/Inspector Namea e
xx
Reviewer/Inspector Signature: Date: 41h 0 1sip

Facilitx Number: 31 — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge ;IL/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes fi3�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )j�r&o
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 J!�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 ZJ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional otnments and/orDrawings:
AL
w
5/00

IWDivision of Water.Quality
w Dwision of Soi! and Water.Conservahon
-m
" 0, Other Agency,
Type of Visit g(Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit JK Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 SCi Date of Visit: / 1 Z 00 Time: / 2: / S Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
a Permitted E3 Certified Q Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ...............
Farm Name: ............. 8-y--Q-W; ...........r^, ... ..... County' _ �.► n......................................................
Owner Name:........�?S..V. '' TGr..... 0.... -S............................................ Phone No:....................................
...................................................
Facility Contact:
Mailing Address:
.. Title:
Phone No:
Onsite Representative:.
........ .....
!,' G � E ..... N o r;,.l r
Integrator.
!•YJ- r'"`Zr
t1.V.....`t...........
Certified Operator:................................................................................................................
Operator Certification Number:..........................................
Location'of Farm:
r
Swine ❑ Poultry
❑ Cattle ❑ Horse Latitude �• ��
«
Longitude •
Design_ Current " Design.
Current
Derrlid Current ..
, _....
f_
capacity.. -Po Population Poultry Capacity
Population
.
Cattle Capacity=°Popiilatioiiii: .
Feeder
Finish
QQ
Wean
Feeder
Li(t
Finish
r, _ Nptiuber:of Lagoons 4❑ Subsurface Drains Present 110 Lag wn Area
Hoildmg Poiu& /.Solid 4mlpls..
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. II'discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Spray Field Area .
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 J Structure 2 Structure 3 Str ure 4 Structure 5
Identifier. frown D�U LagOQtn 13a7i0v"s a %� rler �'�d ............................................................... ...................... .
Frechoard (inches): 3� 43 3 3 I
5100
❑ Yes ;M No
❑ Yes KNo
❑ Yes No
Nr�
❑ Yes No
❑ Yes No
❑ Yes ff No
❑ Yes M No
Structure 6
Continued on back

Facility Number: Date of Inspection lui 'Z• 013 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, El Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I 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 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
H. Is there evidence of over application? ❑ Excessive Ponding $[PAN f3Hydrau11lic Overload Yes [-]No
12. Crop type 4�? e.► r-w d ct G+-. Ze t SmaJ 1 G ra ; n 1 r � t in1 C RT a it n s
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? EJ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes $No
16. Is there a lack of adequate waste application equipment? ❑ Yes Ej No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ]9.No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes �?No
i9. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) lKYes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 19No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes J"nj No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problerns, over application) ❑ Yes ;� No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes iX No
24. Does facility require a follow-up visit by same agency? ❑ Yes J�j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
�ici yiolatiotis ©r delici ndic s were itgted- dit-ritid Ais:visit: - Yop :will-tee6*46 iio fuether ;
comes oridenke' abouk this 'visit. ::::::::::::::::: :::::::::::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
11. ?,�N lbslacre pn 2000 fie,-"1vdot 61►10(
3tO& 3rt1/Inu`'re oh
1�91Z%o even t,
Cjt^► t c-1ld Z NyA-aw l 9,
!�. �c►'� t'-� rena(cd- �o-r Lve•���j(L gtres �e�crr�t�n�-}ion.
lS. ��r-,.eV'� b L��GLd I Q o,�s -Grp f� (,Gr�"►Vci�►�: eld5 �,�"+G� q p�'�J 1 i +"...� Gtc[ordi.�A
pe Soil '�GS f J'E�dt^Lm�Y1G�G7iOYr-io 1
a-v, 4, n Le
Reviewer/Inspector Name
&-N,- U.q 11 f'v1a.-�L s
Reviewer/Inspector Signature: _ _ _ `ram .✓ _ _ _ _ Date: / f / ,�VVV _ 5/gyp

Facility Number: YI Date of Inspection Z CG Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JO'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes A No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
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 permanendtemporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
i.. fie sure
Jo
*Ak2 So�I
sG,��P]es �ar or11 �;�'�df iH �letP1 ano(
deY;,?nG4e
pra�ver crop on soe , Re
,SU re "t"a usee
4 eY nG
/ r
I'eAofe 5 'Oki
gGTES
!
Lge
,
J svr-c 4o VSG ] ropQY Lvat.S-fe
I
5100

© Division of Soil and-Watetr Conservarzon Operation -Review
,
C
.Division of Soil andMater Conservatzfln Coirngliance Insgectroh
Division of Water Quality Compliance Ins: _
Other Agency - Operatcoii Revrew.
C
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number f Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified [] Conditionally Certified © Registered 0 Not O erational Date Last Operated:
FarmName: ..... 13X[L�[ L�!I.......... jr41.`!101.................................................................... County.......... ........... ................. .......................
Owner Name: ..................... Phone No:
FacilityContact: .............................................................................. Title:...................
Phone No:
Mailing Address: ......................
t -
Onsite Representative:Aike.joriN Sy............,lnte ratorg ....MF.f.....................
Certified Operator: ................................................... .......................................................... Operator Certification Number:,1'ra4�(... /1 1..>[G4
Location of Farm: f_�5
J
Latitude Longitude �• 0` �`= -- —
Design Current Design _ Current Design Current
Swine .. Capacity Population Poultry Capacity PopulationT Cattle Capacity Population
❑ Wean to Feeder
RrFeeder to Finish
% d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Number:of:Lagoons, : Z ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Eield Area
HoltLngPonds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�
Freeboard(inches): 3.............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes 9 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(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 main ten arce/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
13. Do the receiving croTs 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
H. 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?
vio�atigris;ot- ileficie;ncies -were ho ed• 04ting thisy. sit'. - Y:ou wiiil.reeeive t7o further • ; - ;
comes orideizce: about_ this :visit: ::
Yes Nd
❑ Yes W No
❑ Yes LK No
❑ Yes DQ No
❑ Yes [,'No
❑ Yes E$ No
❑ Yes P(No
❑ Yes I$No
❑ Yes Q'No
❑ Yes PjrNo
❑ Yes KNo
❑ Yes ;X No
❑ Yes X No
❑ Yes XNo
❑ Yes M No
❑ Yes ;Q No
❑ Yes f Q No
[-]Yes JR No
❑ Yes No
❑ Yes f No
❑ Yes JgNo
Comments�(refer to -question #) Exp[axn_ any YES answers a ld6l. any recoEnmendahnns of any other tom_ments
il,drawtn of facility Eo bet#er explain sttuattons {use additional - a es as necessa Y st}
4
'7• 1�ecejoI-Wkses ke er�ss r :t
gihp / i7' M f 4a6� r 1 c-l/as4 bxc -. Wll nee_ `- G/DSAre recorWs /'4
-�j"l•� a�u e Y '" fey c� - � � /� � is G�a� ' � C1D.S� ae�-�:
Uly la Do a�rl- I,{! / hi eksl �
r
Reviewerllnspector Name
_ ._..,�d'
Reviewer/Inspector Signature Date: %! Q
3/23/99

Facility Number: —
Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
NYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
$(No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
j 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
ANo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
;SNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
WO
3/23199

P Division of Soil and Water Conservation ❑ Other Agency M M.
. _Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection - 0 O 24 hr. (hh:mfn)
E3 Registered © Certified [3 Applied for Permit U Permitted 113 Not Operational Date Last Operated:..
Farm Name:.... Count
..L�C`C ...................... y .'- \\, .. ........
j�
Owner Name:.... ............` 1...'.:... ' `�.................................................... Phone No. X�31\79
Facility Contact: .-. (� ...... Title: .......�....... n .. Phone No:
Mailing Address: i C 1 CMG ..�.L�...�Cg.-vo„
?S .......----.... ..........................
....... '�( .. .
Onsite Representative:..... ��! ......I' `. `,-' ................... Integrator:..... ............... .................--.........
Certified Operator;............................................................................................................... Operator Certification Number,.............................
Location of Farm:
bV
..............................................1.............................................................
.............
........................................................... ......................................... --.............................
Latitude •0° 46 Longitude 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes t No
2. Is any discharge observed from any part of the operation? ❑ Yes MNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes . No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes JgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes OR,* No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 1ANo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes r.No
7/25/97

FacMty Number:,3 —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
Yes
❑ No
Structures (LaQoonsAolding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: t
�. ..................... ...................../0.....&....... ...................3............ ....[........0.q. ----- ................3--.------
.... ....
Freeboard(ft): ..............r�'....................�------...............................I..................: i .................a.2..............................................
10.
Is seepage observed from any of the structures?
❑ Yes
(N No
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 maintenancelimprovement?
OYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
%No
Waste Application.
14.
Is there physical evidence of over application?
❑ Yes
I%No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
`..1
15.
Crop" ..��...'. .............. 5�...........L'.4 ,.............-----------------------.---.--.....------......---------•--..-----..........................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
17,
Does the facility have a lack of adequate acreage for land application?
OrYes
O(No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
O No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
b�No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Onl
23.
Does the facility fail to have a copy of the Animal. Waste Management Plan readily available?
❑ Yes
M No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
VkNo
[]•No.violations,or. deficiencies.we're-nated-duritig this, visit.-.Y.ou.will reeeive-'no', ftiriher
cti&OPOddehO A out -this: visit:: ; - :: .
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ZZ
k
Gam•_ � ��,� i� o,�iwe �, 7/25/97
Reviewer/Inspector Name
ReviewerAnspectorSignature: -�_.(-1-V Date:

Q Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 1
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: .Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:.. rakI mi- s .... x .... _ —.... _ r......... County:
Land Owner Name:.Q? 1t� M�.....s.7..l.s�� ............... Phone No:
Facility Conctact:... - s S_r.....� .S _ .......... _ Title: _ ._- Phone No:
Mailing Address: _...... _............. ........ __.... ......... ._......... _............... ....._................. ............... _..... . .... _......._..... _....... _ ....__ ...._- .... .......
.....__......
Onsite Representative:.. ^1 Integrator: �.st. r �.. ....._....._........ .... _.
Certified Operator......�l.�n.�a . ... L:..._......�^^� ......__..... ..... .. Operator Certification Number:
Location of Farm:
O_._k, ar... _ #.... s.i.d..z ... - - ..� ..i..Gl ��....... a.... :-a...rx....!� _.�_ ... __.w► �...........__....... 4
Latitude •' Longitude �•��
Type of Operation and Design Capacity
to s.'V r
a Design Current Desigu, Current nQN
� D`esign Current
Sw�ie 4 C aci , . po ulatian� _: Poultry Ca aci �Po ` ulahon battle g
.<„ Ca aci P.o ulahon
n ❑ Wean to Feeder ❑ Laor ❑ D k`
Feeder to Finish 5 d ❑Non -Layer ❑Non Dairy
Farrow to Wean `
Farrow to Feeder Tatal Design Capacrty�
Farrow to Finish �� �y
�.
other Ta a
❑ SLW x
se
—Mar
r'NumberafLagoons`I Holding fonds M ❑ Subsurface Drains Present
❑ Lagoon Area I0 Spray Field Area
Qx
:
-General.
I. 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?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes R] No
❑ Yes R No
❑ Yes E� No
❑ Yes R No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
7 No
Continued
on back

Facility Number .... �.., _—..,?..�..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 0 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ,a oon an Holding. Ponds
9• Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft). Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Appligation
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes KNo
9-Yes ❑ No
❑ Yes E.No.
Structure 5 Structure 6
15. Crop type .......... _................... _.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
FQr Certified Fgciljtie5
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes allo
($ Yes ❑ No
® Yes ❑ No
❑ Yes [RNo
❑ Yes UNo
❑ Yes P,No
❑ Yes 0 No
®,Yes ❑ No
❑ Yes ® No
❑ Yes KNo
❑ Yes Ea No
❑ Yes 0 No
❑ Yes J@ No
iaYes ❑ No
8, 0 opt i i c e m LL�c L i 0 a �► ii 1 S l^ . v La I�.e. c (,c �d $ v t 0 r
V
18 • C I i °� I�t�R�+�vV 1 :-2_ C"—a f
t-
rj. Ce� t.a+ rr��✓► { SQ C i s r S i� ���^ V
Reviewer/Inspector Name m w
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
�. Time:
Farm Name/Owner: Y �_ ?�&) �� q
Mailing Address: �D�P �21 *4 -bG 1'j W S9("j
County: 0V 0 )1 4
Integrator. AA urt')hPhone:
On Site Representative: / G le- Phone: r0— ZN�5-4 (P70
Physical Address/Location: kja i 0 U S '' N m► on S R/ 70
I n trz Z-7 �' �-► o t
Type of Operation: Swine Poultry Cattle Cn 56
Design Capacity: S(0 0 Number of Animals on Site:
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' - ' ~ it Elevation: Feet
Circle Yes or No (�1�f�
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: Ft Inches
Was any seepage observed from the lag
40. Is adequate land available for spray;-�o
Crops) being utilized: �>2�
•
)? Yes of To Was any erosion observed? Yes or No
No Is the cover crop adequate? es or No
.esaa_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orb
Is animal waste discharged into waters of the state by man-made ditph, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain. `
.:
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (9" r No / 1.
Additional Comments: _-- 0 . sf2. � c0n / S7 Sf z!
- L L ew►'s
Inspector Name
cc: Facility Assessment Unit
0�1
Signature
Use Attachments if Needed.