310821_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral O Emer2encv O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: oc7 County: Region: W /
Farm Name: , �.,' 1r_ Owner Email:
Owner Name: 7,,��n.1� �(', Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design. Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Fnp.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Foul[ .
Ca`aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
(Other
Turkey Poults
OtherLjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes, No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
i►J� o-
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:_K�720117
T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: op
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��ll
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 4o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes 0'<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [VKNo
❑ 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 [9 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E l�o
❑ 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
[R'<o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Eg o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[! No
❑ NA
❑ NE
acres determination?.
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E�<o
[] NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[9'*"No
❑ NA
❑ NE
Reuuired
Records & Documents
N
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNo
/ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: S1 - Date of Inspection: Ao
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fig-<o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes B<o ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 03'1 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E.NT
❑ 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
CT<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
to
❑ 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
u a K'o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
too NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[L]' Ih O
0 NA
NE
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q ID 19 C —737 1
Date: 1
. Wto
21412015

type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Tlme: � Departure Time: County: /^ Region:
Farm Name:19?e,,-- 15r1975 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: JJ Title:
Onsite Representative. %l�iq�,�f�„ ar
Certified Operator:
Sack -up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: [ ��
Certification Number:
Longitude:
Design Current
Swine Capacity Pop..
Wet Poultry
Design
Capacity
Current
Pop..
Cattle
Design Curr�e,nt . k
Capacity Pop:
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
,
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr P,ouitry�
Ca acit
Pao .
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Lilts
Non -La ers
Beef Feeder
Boars
Puilets
I
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
4 a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated: volume that reached waters of the State (gallons)? ^
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Page I of 3
❑ Yes JE:rNo ❑ NA ❑ NE
❑ Yes 6 No
❑ Yes 2rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes P'No ❑ NA ❑ NE
❑ Yes e3 o ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Ye �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes F No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
'0
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
"I__l No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑' No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑1No
❑ 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
Lallo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA
[D NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j:] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�jNo
❑ 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 ❑ N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis oil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,E� N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ❑ N
o
❑ NA ❑ NE
.❑ Weather Code
Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3
V.
21412014 Continued

Facility Number: WTI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑'Yes ❑ No ❑ NA ❑ NE
25. fs the•faeility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [D'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes '2[ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
qNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
eNo
❑ 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
;a No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZrNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
! o
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:////
Page 3 of 3 2/4/2014

Date of Visit:Arrival Time: 10eZreparture Time: County: Region:
Farm Name: IL7 /m J/%160-- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ��}} Title:
% !
Onsite Representative: (/. 1 A4, '6'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: / 7
kfD
Certification Number:
Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D.r. lyoultr. Ga aci P.o
Non -Doi
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turka Poults
Other Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes effNo
❑ Yes ZNo
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �]No ❑ NA ❑ NE
❑ Yes ��No [] NA ❑ NE
❑ Yes 9X00", ❑ NA ❑ NE
Page 1 of 21412014 Continued

Facilit Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage Capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'RNo
a. If yes, is waste level into the structural freeboard? ❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes P-No
❑ Yes ;2] No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 I o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T 7Vo ❑ 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 J�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 21'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�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J2'Ro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes -�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Efo'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes1'Ro
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EM
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

I1!,
Facility Number: IW7 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. Is She facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes eNo ❑ 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 2 &o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [21f4o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P'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 J24No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes )2"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 )2 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E�fNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ NA
❑ NE
Comments (refer to.question,#) Explain any YES answers and/or anym additional reconiendations or`any,omm ther coents
Use: drawings of facility, to better: explatn.'situations (use a3dditianal`pages
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rU 'Ike 5 uAz- 4-
<<19
`5 ec
r-�_75 caPCs lQ�L
S
Phone:
Date: 11
A5 /9/
/4/2 4

f Divi`s""ion of Water Quality
MID. Number 31 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine � 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Otheerrj 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County: (/ 4 / Region:
Farm Nam Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: if_ 1 h&4, C_ r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: AI
Certification Number: F /
7,2f,6 G�3
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
La er
I
Cow
Wean to Feeder
I
INon-Layer
I
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C*ur:rent
Dry Cow
Farrow to Feeder
Ur, I;oultr.
Ca aci
P,a ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
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 ONo ❑ NA ❑ NE
❑ Yes,,ONo
❑ Yes ;Er No
❑ Yes EjNo
❑ Yes f"No
❑ Yes RNo
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r;
Page 1 of 3
21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
41s 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats two the integrity of any of the structures observed? ❑ Yes C3No ❑ 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 ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (VNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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 D 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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
W No
❑ NA
❑ NE
[-]Yes
m No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
[-]Yes P�fNo ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
[:]Yes PfNo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
D Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did tho facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ):3No ❑ NA ❑ NE
25•Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E!rNo ❑ 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 J' No
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ;2'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes JC2'No
[DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes j' No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 0 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes J:2,No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J�!rNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �/ o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Aj
,-h-r 1 e ee --ee.5-
Z/-p-ellz �� d
0
Reviewer/Inspector Name: Vol), Phone:
Reviewer/Inspector Signature: 'e4000' Date: 11'
17 Z 73
Page 3 of 3 121412411

Type of Visit GPIC&mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit L>oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /lJ Arrival Time: eparture Time: County: Region4 dl/G
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Ph/one No:
Onsite Representative: i Integrator:
Certified Operator: Operator Certification Number:Zt2Q�3
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° =' = r
,besigm , Current�FCii.i. �a
lie' kjxtx ' ttz'';c: ;.3:s f=Wetl?0111tC. i" ,.:: ? ar# a Cattle �, gAf.xd.r: s'c.3>.a.�, ,•,
zCapcltyPo Mahon yR. Capacity Population. Capactly P�opulat�onf
p 1��-4.,.�.��. '�a t? aI, K�. ���i�-�x.e .,�.rex.. $��.. 4�,�.c�aa: � �5�4?'.�'i �4�? N�� �.ss_ r+.a_t •5 <.
❑ Wean to Finish [] Layer ❑ -Dairy Cow
❑ Wean to Feeder 10 Non -Layer [] Dai Calf
El Feeder to Finish t i� t fti` s i. ❑Dai Heifer
_.
❑ Farrow to Wean D:ryPoultry ?,g ta$ ElD Cow
El Farrow to Feeder ❑ Non -Dairy
iK ❑ El LayersFarrow to Finish � El Beef Stocker
❑
El Gilts Non -La ers ❑ Beef Feeder
r.° ❑ Pullets
¢ ❑ Boars ❑ ❑ Beef Brood Cow
5 yy _xg-
y°.s: Turkeys t� iZ4,�
-ZO�thCi'Ya .:�, .c, .�Y_.��# tea... :� sf; '_,$�',❑Turke Poults x°4 _ - a x
i i��k i ��
❑ Other ❑ Other ,�,'N c ew��
IWMI :;" ".zit.- :. >�x4a .a,,e .7 is Y i n :: a r.. �mn ,:Y rUH f,5
u er of Stru to
iG,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ErNo
❑ NA
❑ NE
❑ Yes KNo
❑ NA.
❑ NE
❑ NA
❑ NE
❑ Yes 16 No
[]Yes 6o
❑ NA
❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page I of 3
12128104 Continued

Facili Number: - Date of -Inspection:
Waste Cbllection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .2TNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ET o ❑ NA ❑ NE
Structure 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 12'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 hlo ❑ 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 ;2-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes _12%io ❑ 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 [] Ycsj2oNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2'<o NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,23''No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E�rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes' No ❑ NA ❑ NE
❑ YesZ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes L;•No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2f'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �>o
❑ 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 ffNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: RVDate inspection:
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 V 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
WH
Reviewer/Inspector Name: A�e bip'l
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ;2"No
❑ Yes �2'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes o"'No ❑ NA ❑ NE
0 Yes '�o ❑ NA ❑ NE
[] Yes 9No ❑ NA ❑ NE
E] Yes ;2fNo ❑ NA ❑ NE
❑ Yes o
❑ Yes n
No
❑ Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r4f6v? d- I _CCvr�j la0 JOCC11'e.
SdV / le.5-k / 4514e,
4?(t '5-CAC'6'jWe "
s6rbwr4. OW
Phone: xu 7fX—'7ya_—
Date: rz laf 2__
/4/20 1
Reviewer/Inspector Name: A�e bip'l
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ;2"No
❑ Yes �2'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes o"'No ❑ NA ❑ NE
0 Yes '�o ❑ NA ❑ NE
[] Yes 9No ❑ NA ❑ NE
E] Yes ;2fNo ❑ NA ❑ NE
❑ Yes o
❑ Yes n
No
❑ Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r4f6v? d- I _CCvr�j la0 JOCC11'e.
SdV / le.5-k / 4514e,
4?(t '5-CAC'6'jWe "
s6rbwr4. OW
Phone: xu 7fX—'7ya_—
Date: rz laf 2__
/4/20 1

Type of VisitCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for M4s�Outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: f? O Departure Time: County: Region: _(L/2 `+D
•
Farm Name: 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: r 6+ Integrator: rn
`� �O
Certified Operator: Operator Certification Number: U_.a/ 1,
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: c = = Longitude: 0 ° = ` =
11
DesignCurrent` 1 ` Swine �g�—CapacityPoPulation t�Wet.Poultr�y-(
i iXax_i, f< �_ F
'El Wean to Finish ❑ Layer
❑
Wean to Feeder
❑ Non -Layer
s,
❑
Feeder to Finish
z
l� Dry Poultry s>i
❑
Farrow to Wean
❑
Farrow to Feeder
F
❑
Farrow to FinishA'
❑ Layers
' ❑ Non -La ers
❑ Pullets
❑
Gilts
❑ Boars
Other '.xae,.t, rt'ri:
❑ Turkeys
❑ Turkey Poults
❑ Other
'J ❑ Other
,iLn't . Currentr il 5s a 3 3 a
12 I tr
tCat tl
.Capa*ty
PopulaEonX&
❑ Dairy Co;
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
15
r
n
i
� nu
yN r4,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
F1
«1
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�fl No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PTNo ❑ 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: l
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [PNo
❑ 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 XNo
❑ 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 El Yes �No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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
�TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
7No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
'0_exe/ -
Reviewer/Inspector Name p Phone: U- % ;G
Reviewer/Inspector Signature: Date:
Page 2 of 3
12/2$/04 " Continued

Facility Number: — Date of Inspection
Required kecords & 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 ZNo ❑ 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. 9yes jro ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Rf.Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �TVo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ko
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9,Go
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PkNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems. noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P(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
W�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:��
w�-
P jwa Ca 116'rVfe oX1s
71AM
0-7/
A 1s ear,
y
a/�
7/v
1. Z
e �i✓� ��Q
oo I t ' Iv Q2v� do 5 o L( 4C S_�s
&S A 0U SO l 4r_5P-s
-6 ( Zc�o t
#ry
w
Page 3 of 3 12128104

III
Type of Visit ,Q•Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I //
Farm Name:
Owner Name: r--
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
IIII! � Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator: / / "
A-3
Operator Certification Number:
Back-up Certification Number:
Region: 44—A
Location of Farm: Latitude: 0 e = ` = Longitude: 0 ° = ' = {t
rrent
Design :6ul,Pon
Swine Ca aci Pa
p ems, ..,�
Design Current: , E "r Design Current '.
wet Poultr . C•a "acit Po 1 hon GattleCa aft Po ulation
y op y : per. f :�UHW, Pu
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Nan -La et
❑ Dairy Calf
❑ Feeder to Finish
'
Dry Poultry
—
❑ Layers
❑ Non -La ers
x`
Alk t ,
r r. R
"'
❑ Dairy Heifer
❑ D Cows
IF rrow to Wean
❑ Farrow to Feeder
❑ Non-Dairy3
❑ Beef Stocker
[] Farrow to Finish
❑ Gilts
❑ Beef Feeder
❑ Pullets
El Turke s
❑ Boars
�
❑Beef Brood Cow
. y,
Other'
F
4Nuniber of Structures:
❑ Turke Poults
❑Other j
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
j2No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
'f�rNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
A:fNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )EI'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c }
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 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 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,�TNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )21No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ',No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? El Yes 0,40 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [:I&o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: ([/r
Reviewer/Inspector Signature: Date: 7 3
12128104 Continuer!

-Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �(N o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [--]Yes oNo ❑ 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �'l�fo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes,, No
El 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/E!fNo
❑ 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 E 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 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes PIN' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ,3 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
,_,%
El Yes lQ No
/940",
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
�C5
12128104

Type of Visit Cqf Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Q, cjU Departure Time: County: Region J_L42
Farm Name: �L(rr�//i�/ ��//� tf� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: ANZ, f1 i7 Zr 5.n _5" t J ✓.
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: LylI
Operator Certification umber:
Back-up Certification Number:
❑ a = f = 6 g = O = 4 = 14
Latitude: Lon itude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
q.7q..2Q
0
El
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
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
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: =I
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 Ri to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
No
❑ Yes
,❑l
El NA
El NE
El��,],Yes
,LNNo
L� No
❑ NA
❑ NE
12128104 Continued

Facility Number:q—A211 Date of Inspection
W� aste.Cdllection & 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
Structure I 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 _Q`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 2rNo ❑ 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 A 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 jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 rift El Application Outside of Area
12. Crop type(s) Sl i'%j?1� � - (CV) i Ahvk- jG / l i
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ 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
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P(No
❑ NA
❑ NE
seFdrawmgs oflfacility to better
Reviewer/inspector Name �;',:� Phone:
Reviewer/Inspector Signature: Date: %
12128/ 4 Continuer/

Facility Number: -- Date of Inspection
ReguiredlRecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes .E] No ❑ NA ❑ NE
❑ Yes,,EfNo ❑ NA ❑ NE
114
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �❑/ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes -ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes yO^No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes J3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [I No
❑ NA
XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YeslE]'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes [l•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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�ErNo
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 E-1-Ne ❑ NA
❑ NE
Additional Comments and/or Drawings:
ern /S /�
12128104

Type of Visit /0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: �WNot
Time:
FFacility Number �
Operational O Below Threshold
Permitted ❑ Certified © Conditionally Certified /© Registered Date Last Opera Above Threshold:.. ..._. »...»..
Farm Name: .�....� %r� „��»..rl t~..�_. .L.. rt . ._ County: t
OwnerName:_.....__._..._.............»»._.............».....».......»»»..».............»»...»..» .._.... ' Phone No:........_......._...... _....._._...... ».__»».»._..............._.
MaltingAddress: .._....... ._..... .................. ..........»._............._...._._.........»......._....._..... .._._.»....»»._._ . _...._......._...... _..».... ».» » ......_.... _........
FerilityContact: ............. ..j�..1. . _.»».....___.... _... Title:... .... ...._._......_.__ .._...._.»....__.. Phone No: ... _ _.__..... »»»...».._ .....
Onsite Representative:...! l 1. f.! � .... S,a.n .................... Integrator. _ C ' Y .....».» .., » ..._....,,... _..
Certified Operator: ------ ....__----------- .».»... _...._.» Operator Certification Number:.—.._....__.,_»»....., .».....
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude a 6 "
Discharges & Stream immpacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ 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 .12NO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J2No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J2-No—
Struc ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _....».. 2 __..... .... , . __ ..w.-_ .........__.»_...... »_ ......._ _ .._._ ....... _..»»».». »» ___ __ __ . _ ._.
Freeboard (inches): 3
12112103 Continued

Facility Number: Date of Inspection U
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes •'d No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ,2314o
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 Er No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 2TNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes J"No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes eNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ) -
13. Do the receiving crops differ with tli se designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes GNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes Z No
b) Does the facility need a wettable acre determination?
❑ Yes El'�No
c) This facility is pended for a wettable acre determination?
❑ Yes -❑'No
15. Does the receiving crop need improvement?
❑ Yes j2mo
16, Is there a lack of adequate waste application equipment?
❑ Yes Pdo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge atlor below
❑ Yes ^EI o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes EfNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes El"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 ;R-No
Air Quality representative immediately.
".:::.iY.i�' T'm:7'.1?i'.. r.R&,ys^:�� '4."�r �°S�'-•C"'�.71:C}nl:°`�- �`t3e,Rr7lt-!'�S:v"�i. ".'^Y-i.+L..�!4fr"'= iei�IIi .u` '9':3%'^:'7C:,F.......� - fix: dj:'.".k.'i�.:7'YEI.`2`N i`,�I Sn�^,�' �i_ !�"i rt-.
'Co
m en#s {refer w gaestrvin # . F. phut any YES a�oswers and/or auny;t a�attoas ar airy other ea eats. r {' ! ,
Hv
Use dlrawuegs of fac�lyata bettCri�eacplat� situat.ous. {gse�ad�tianid�pages as ry)•�_ ❑Field Copy ❑Final Notes � ; „t ,fx
�Eas €C W r % :F=iA t �a E 11 �ii ` �.
ReviewerAnspector Name ' :S�i'
�H r � � F � t
ReviewerAkapector Signature: Date: t?

Facility Number: Date of inspection
.Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes en —No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZMo
23_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo
❑ 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 Ino
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes , -90
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Q'So
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Erlffo
28. Does facility require a follow-up visit by same agency? ❑ Yes J2�Qo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9>0
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) P'Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes JE No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
494010-
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Q'No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Plyes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ,inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no timber correspondence about this visit. I
3 3) P/(-G.sz r7Z�tX S-1 u Oj e,
�rG ",3S�U •- oc� jd
_5,6;e_ C- ACI-,1,1.
r
"A
/" /?,/f C! //e6�'e-v-z/,-/
I'-e 6vyr�_5_
12112103

Type of Visit Acompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time: �
L - Not O erational 0 Below Threshold
E3 Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated o Above Threshold:
Farm Name: 1 u, ri r .l PJ ryde%e ' / it' 12'7 County: jt
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: /
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 cc Longitude ' 1 OK
Design Current Design: .Current Design Current
Swine Capacity, Population ..- Poultry Capacity Population Cattle Capacitv Population
❑ Wean to Feeder 10 La er I 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer I I 1Q Non -Dairy
❑ Farrow to Wean --
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
ElGilts
❑ Boars Total SSLW
Number of Lagoo"ns�'
` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
'' �;
µd -
Halding'1'onds /�SoLd Traps ❑ No Liquid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Sprav Field Cl 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 r
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: X — ;5w 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlieation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? 0 Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
SYes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cnminegts (refer fo quest/' 4.) Explain a y Yk9j"iwers and/ur n!4rec6mmendations�'or any other.; com Hants
,, .,t El Copy ❑
Use drawiogsof facility to better explain situations (use additional pages as;necessary),
Final Notes
.;.
F
`�
+ Vr, vR
�Jep 7 kI.cCrt • 4A : ri
`
e A
Name Reviewer/Ins ector
P
Reviewer/Inspector Signature:
Date:
05103101 c L�_
Continued

Facility lumber: 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
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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Dmwingsc
Ae,
e.(G LP oS % 6le *-It
-awn /L �� LcJ.G /✓ J GOv� /^U/`I dI— i �h �d
lloid ' /„/. AAW&Ajar 4,4,1 �,b ,l/o `T1Aa 4�oa Woe,
Pdh�/h�j �f1✓��Il�m, -
/{{��
05/03/01

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit .6 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not O eratianal Below Threshold
Permitted [3 Certified 0 Conditionally Certif d Re iisstered Date Last Operated or Above Threshold:
O !� County: )Qy,� Z u
Farm Name: /�
Owner Name: 1 10,(-72 % Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: WNWS Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �° CJs� Longitude
Design Current Design Current Design Current
nowpne UapacitV ro ulation
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Poultry Capacity Population Cattle Capacitv Population
❑ Layer ❑ Dairy
❑ Non -Layer I I IEJ Non -Dairy
❑ Other
Total Design Capacity '' I
Total SSLW
Number ofLagoons — ❑Subsurface Drains Present ❑ Lagoon Area 10{Spray Feld Area
Holding Podds /.,Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /�
Freeboard (inches): t!
05103101
❑ Yes fi�fNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A NoYes No
❑ Yes �No
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,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 l . Is there evidence of over app
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
❑ Yes [�INo
❑ Yes No
❑ Yes �No
❑ Yes �'No
El Yes iz
o
El Yeso
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
4zNo
❑ No
❑ No
No
XNO
❑ Yes FfNo
❑ Yes o
❑ Yes o
ElYes No
❑ Yes No
❑ YesAX
No
El Yes No
❑ Yes 7No
o
[I Ye
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments�(refer toy' uestlo'n # Explain any�YE$�enswers and/or any'reco emendations or any o ter comments.Use drawings
better A ddittonal as,
offacilityfto explain situations '(u pagesnecessary)
`' c_
Field Copy ❑ Final Notes
�'.• .p.
� %i nlr,�F v O� Qn/ _5�/t�ZS/�z��
.2�4SS Od�-� ©r✓ �j,�
AAF_ � AAO'1PjD I'llao0A). ��z �y �,��
sA&I- A&4 �*r '�s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: Z
O5103101 f Continued

i acility Number: — Date of Inspection l LGI
Odor Is5Ue5
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes A
No
Yes dNo
s
ElYes CWNO
❑ Yes o
❑ Yes // No
❑ Yes /❑ No
Additions comments,andlorI)rawin s:..,>
D 5 AY?,�f7-
60A &Kly) 4/44- AN
�F—
�g s At-A14 Al AH Aelnea4-
(11,14
Q
deEp
�a2 7ffr= �� r
S�mPL�s f/txFnl
V614 el
40� (2�- A
T
05103101

(Type of Visit �kGompliance Inspection O Operation Review O Lagoon Evaluation I
Resson for Visit ')6 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Hale of Visit: I
�ermitted 0 Certified © Conditionally Certified 0 Registered
Farm Name: ....... WN...\�Q`?-a..............................................
OwnerName: ...................................................
Time:
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: ...... D SLm......................................................
Phone No;
FacilityContact:............................................................................... Title:................................................................ Phone No:
MailingAddress:..................................................................................................................... .............................. .............................................................
OnsiteRepresentative:... --F.......................................................................... Integrator:..... ! . ..................................................
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' it Longitude • d 66
I
CDer..
:DsCurtgo rent g
CCtlePo !Population Poult 3. .CaaciPoulat, a ee
❑ Wean to Feeder
21 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Otheri;;,;.
Total:Msi Caa
p.. .3',:
;Tota1�SSLW,•
i Number of`Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding>Poads`I 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 MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J� No
Waste Collection & Treatment `
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 10 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

M
Facility Number: !j —$'03-� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
XNo
(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 maintenancelimprovement?
❑ Yes
14 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9 No
Waste ApRlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidenceof over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
,� No
j %
/
12. Crop type ) V' -9:1
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
NrYes
❑ 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
J�No
15. Does the receiving crop need improvement?
OYes
❑ No
16. 1s there a lack of adequate waste application equipment?
❑ Yes
P(No
Reauired Records & Documents
I7.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
W 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
KNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard; waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes UNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes , f$ No
24. Does facility require a follow-up visit by same agency? ❑ Yes D(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 21No
1'�it� •yiQla(i¢rts:ot- dgfcjjen�&j -*Vrb looted- O(Wiog thjs:v1s1t; • :Y:oo 3vdj-t•ecoiye 0o �t-thor . .
•Tories• 6dence: a 66f this visit:
Connrients refeir ta' aestioit'#} @E lain an YES answers aad/or' an' recommenclatiaua o_r'an" otiicr`conurieats
(.:i�. � Fa € €� ikiii ...:4e @�' �(>>of ' i Y' ""3y@
,IJse draw!ngs of facility to better expllarn situatians: use additional a
p\ I�.'�4..rp►-ram
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Slpp

Facility Number: —ga 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 at/or below Xyes ❑ 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 XNo
28. Is there any evidence of wind drift during land application? (i.c, residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
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 1 'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanenVtemporary cover? ❑ Yes �Wo
Additional..otnments an or rawin&g:
�r-O<<
J
5/00

DInSIOU of Water Quality
�ns�I
Division of Soil and Water Coervation k
V.
yII * • ` 13 _. '! �f <>.�! : -'l! I . I' 3 } ,. n.O.:OtheF'-A�enCy. 1 r +i.0
Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit (�(_Ftoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit: Tune: I q3G Printed on: 7/21/2000
0 Not O erational 0 Below Threshold
Permitted ©'" Certified © Conditionally Certified Registered ' Date Last Operated or Above Threshold
Farm Name: ..... County:..... i..�O.�..................................................
OwnerName : ................................................... ........................................................................ Phone No:.......................................................................................
Facility Contact:.............................................................................. Title:....................... Phone No
MailingAddress: .............................................................
Onsite Representative:.ke.!..................................,
CertifiedOperator: ................................................... ......................
Location of Farm:
......I .......................... I. ..................... ................................. I ...............
..
.............................. I ... . Integrator: ......Wt.,..
........................... Operator Certification Number:
S +des c�3 s 3 ,_(
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 4 Da Longitude ' ' «
Design Current Design Current Design Current
Swine Caeacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I JCI Dairy
Feeder to Finish X ❑ Non -Layer I I JC3 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity E_
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE3 Subsurface Drains Present J10 Lagnan Area I0 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 XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance than -made?
❑ Yes
❑ No
b. If discharge is observed• did it reach Water of the State'? (If yes, notify I)WQ)
El Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/ntin?
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
b(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
,b'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Idcntificr:........................................................................................................................................................................................................................
Freeboard (inches):
5100
Continued
on back

Facili#y Number: 3 — Date of lnspection printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
&No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
[�qio
(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
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
)YNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
JTNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
t;�No
10
12. Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
15No
b) Does the facility need a wettable acre determination?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
k`No
16. Is there a lack of adequate waste application equipment?
❑ Yes
1KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
,�(No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
�<No
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
C 'No
24. Does facility require a follow-up visit by same agency?
❑ Yes
IRTNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4No
O yiOih i6ns oe d�ficieliciE`S •'er'enoted- dil•Cit;g Phis' Visit} • Y:oiF Will •reeeive iid futthPr: - :
corresporideiace: abvtit 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)AL
T
Reviewer/Inspector Name 9+U-39S-3'70Q %\^e-aC
Reviewer/Inspector Signature: Date: I cc) 5100

Facility Number: — ga.` 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 Wor hplow *es ❑ 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 'EfNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property) !!
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O(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 t�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j "0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANo
Additionall'Cornments:and/or rawtngsc
��S���G�
�S �i4 O�"��n.✓�! ec��--��j hQ�`T SU�Y'�--� A, -op
TJ
�t p—V
bwa
s/00

Lagoon Dike Inspection Report - "-1-- -
Name of Farm/Facility U ,� , Q �r �� r�
Location of Farm/Facility _ � S , e S /� L ' �' -sC ).pc)
Owner's Name, Address
and Telephone Number
c� , je-r -e C_ "a R Q '(, to yy�
Date of Inspection XNames of Inspectors j / J G
Structural Height, Feet �� Freeboard, Feet [�
i
Lagoon Surface Area, Acres Sre 4c, Top Width, Feet b
Upstream S1ope,xH:1 V Downstream Slope, xH:1 V
Embankment Sliding? — -Yes No ,^ V c jk 4 e i ea
(Check One, Describe if Yes) 1
C3� I~.- �r ci VJ� �� L !,✓� �� Gt0S'ts'n.l-1'C'c.
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
� I 1
Yes No
f r
+ IJ C k P,—
Yes No — �'� no 1/ cis
rec
r'G 5 P✓P�� [ �C r C /)U s YZ.a C
Follow -Up Inspection Needed?
Yes No
XYes
If Yes, Depth of Overtopping, Feet
IM
Engineering Study Needed? Yes 1_� No
Is Dam Jurisdictional to the Dam Safety Law of 1967? _
,
Other Comments _ r e- � 1,�fl
k /'�
• c� c f�C' L.� G � �� � Gt U P
Yes
No
rr
S0 ,C��r
UC?,- +���
`o o--(`L' PcaC�
0
G,, 4 0Cq , (:�rvL)

'
N
m
\

Lagoon Dike Inspection Report`"—L-----
Name of Farm/FaciIity
}�
y ,� , /� er ! � �.>•�� � o'er � I " �y�
Location of Farm/Facility
&2jk S ,e_ 0
4 C'U- o c—�
Owner's Name, Address
r 1 4c7.. - _ Q
and Telephone Number
Date of Inspection
Names of Inspectors
Structural Height, Feet
Freeboard, Feet
Lagoon Surface Area, Acres
5ee Top Width, Feet —
�b
Upstream Slope,xH:1V
r t Downstream Slope, xH:I V
Embankment Sliding?
^Yes No � — V ea
(Check One, Describe if Yes)
y. f
Seepage?
! rr
Yes No P �,.� h!-- ^ a1 c
(Check One, Describe if Yes .
)
, ke 7 i
n �. 4 --g r r+
k rr Ir1 9 f 1 I
Erosion?
.Yes No
(Check One, Describe if Yes)
t ,
s�- lo�-n , A
G',rPc rn '� 2 , e
k }
�< �c
S
Condition of
5 P✓Pie /1 U yl a c
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? X Yes No
Engineering Study Needed? Yes X,' No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
_r L
Other Comments _ r k

k ZA
�;�, LA iA

'0.
ID Koutrne 0 (Arnplaint 0 vollow-up of DWII inspection 0 Pollow-up of U!,WC: review 40 Miler• f
Facility Number Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
Permitted p Certified ■ Conditionally Certified p Registered in Not perationa Date Last Operated:
Farin Name: 4uniper..Farpas.#1..&.#2............................................................................. County: Duplin WIRO
Owner Name: 1.Y Utoa.................................... liendparson ................................................ Phone No: 9.10-.285.4.499 ................................................
Facility Contact:...............................................................................Title: .. Phone No:
Mailing Address: 20J2..Light.H:oud..Brjdge.Rd............................................................ W.allace..N.0 ........................................................... 2846f, ..............
Qnsile. RC131'CSenultive:.......................................................................................................... Ilitegi-,itoi-:.Murpliy.Family,,Earm ....................................
Certified Operator: Mifton.R ............................... Hendetrsan....................................... Operator Certification Number: 1:I2.1.(.............................
Location of Farm:
a c. ny. nt..tn as . mrm. m. en.anamte toe .. Qm ...arm.is. Itxl t;S.t)1a.s�aut .sit ...............
Behind.&obt ..shofar.Tatrtn..............................................................................................................................................
�.
R
LatltndC ®• ®` ©i° Longitude ©• ®c ®cc
Design urrent esign urrent Design Current
Swine„ Capacity Population '-Poultry Capacity 'Population Cattle Capacity Population
❑ Wean to Feeder
® Feeder to Finish
❑ arrow to Xkrle7ann
❑ arrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
p Layer I 1 1:, p Dairy
p Non -Layer I 1 1[3 Non -Dairy
❑ ter
Total. Design Capacity 9,792
Total SSLW 1,321,920
Number of Lagoons❑Subsurface Drains Present p Eagoon Xrea ❑ Spray FUTU Area
Hold iiig..Poiids / Solid Traps ❑ No Liquid Ma-s-FeManageinent Syytem
Discharges & Stream Inipacts
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 galh»in?
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? p Spillway 0 Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 StrUCtnre 6
Identifier:
.......................................................................................................................................................................................................................
Freeboard(inehcs):...............3.0..............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on hack

Facility Number: 31 _821 Date .of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
[]Yes
[]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[]No
Wasic Application
10. Are there any buffers that need maintenance/improvement?
p Yes
[]No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
[]Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
El No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
C7 Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Diwuments
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
© Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
C �1ovititatiioilsor.'deficieilcres.were.'n.�u.te.ti.'durin:visit. • Youwill:receive ni further: h.
..c. .......
.--k 66dekc a oirttbis:visit;•........•.•.%-.•.•.•.--.•.-.-------.-
cane Flovd Assessment
vailable freeboard is good. Did observe a few bare areas inside dike and around outer wall. Work on reseeding to establish good
-ass cover.
(Gannon-DSW): Dike wall is in tact with sufficient frceboard. Did observe a few non -vegetative areas of inside dike wall. Lagoon
is lined with bentonite. Dike is not saturated. Some erosion in non -vegetative areas of inside dike wall and top- not significant.
Condition of vegetative cover is fair. Dike wall is in tact with sufficient freeboard. Follow-up to verify if dike walls have been
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

[ Division of Sail and Water Conservation ❑ Other Agency ,]
Division of Water Quality
14) Routine . 0 Complaint 0 Follow-u of DW2 inspection 0 Follow-u of.DSWC review 0 Other
Facility Number
Date of Inspection 30
31
Time of Inspection � 24 hr. (hh:mm)
A Registered 1p Certified © Applied for Permit M Permitted JE3 Not Operational Date Last Operated:.....
Farm Name ................... c�.11nAS,., 1LC`.......r4d.t .=...... `,�J..... Z.............................. County:....... t, i�t`.............. ......................... .......................
Owner Name: .........................i`!�1.1.1...........�3'........I.......... ....... Phone No: '�.�Q 1. -.. .�....
.............. .... .....................................
FacilityContact: ................................................ Title::.................................. ,............................ Phone No:...................................................
MailingAddress:....,...., je........ Je............. ...... .........1N.ralaC..t..r.... W.................................... .!;�H. ..........
Onsite Representative:...............+`kft1 N.......!aR..................................... Integrator: .... 1.Yt"�.....................,......................................
Certified Operator........................................................................................4.................4..... Operator Certification Number.................... ......................
Location of Farm:
..................x..s......o......5k...6:21.,....Q.. ....... tan..f... ........ ...............................................................................
....... ... ........ .
Latitude =' 4 f[ Longitude ' "
Design Current
Design Current
Design'. Current
}
SwmeCapacrly Population
Poultry
Capacity Population Cattle , >
Ca aci Po ulation
P t3' _. p
r ., _
ElWean to Feedery
❑ Layer
...
❑ Dairy
Feeder to Finish 9-7qZ,
ILI Non -Dairy`
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder
0Farrow to Finish
•'`
Total Des�gii Capacity.
`
❑ Gilts
❑Boars`
Total SSLW
Lagoons / Hbldmg Ponds ❑ Subsurface Drains Present ❑Lagoon Area
❑ Spray Field Area
:Number:,
..
.
❑ No Liquid Waste Management SystemMA
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
$ No
2. Is any discharge observed from any part of the operation?
❑ Yes
14 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (11' yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaUmin?
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
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes]
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ep No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
6d No
7/25/97

Facility Number: 3k — gZ
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,llolding Ponds, blush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(fE): ............................ ......... I ................. ................................ ......................................
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RVo
❑ Yes
W No
Structure 5 Structure 6
...............................................................
❑ Yes
1P No
❑ Yes
® No
(] Yes
❑ No
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. Y.Y.N.J.li<,............................. ........ �sCR;i.►a............. .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For ertilied or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0•No.violationior. deficiencies.were-notedducin� this:visit. You;will receive-no,further•:
co&6006deke about lhis:visit:: ;
❑ Yes _
❑ Yes WNo
❑ Yes W No
19 Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
14 Yes ❑ No
❑ Yes [P No
❑ Yes rM No
❑ Yes 0 No
5. 6rm%J viJ-<w•�s l{• s�� �;xlds skoJtei be rr'G,lnt-&I tj 6 p,reue,.X pwj +v ' 6Vavo, aaljctt:':
to 1AG) � Ov v s IL, CoN�Ariut, Va iar.Vmve �40.„t� o_rtt S 0, koyo, WAM,
cack �vli
u t� � �nxryv. �e ccN`dS. � �relUy
1 7/25/97

16 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Thne (in fraction of hours
.Farm Status: Registered ❑ Applied for Permit (ex:.1.25 for I hr .15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ 1Not Operational Date Last Operated: ........ .......................... ..... .».........................................................................................................
Farm Name:........ i.UY11�gr .... t'1dzm...... >�.+....... ..*z............ ........................... County: ....... D—OkM........................................ .......... ............
Land Owner Name: .... .{S.It......... g�->7C`}.k�Ql!h........................................ Phone Na:..(10. I ..........................................
Facility Conctact:...... i!!ti.l-6........ On ....................... Title:VX........................... .. Phone No: ................
Mailing Address:—403.2....1a!5 ..Gs.Gt.... ........... UL .......... ......... _...... ..... C.17Ai. .i... %-................................A4466.......................
OnsiteRepresentative: .......... ........................................... Integrator:............................................................
Certified Operator:......... ka-6........................................................ Operator Certification Number: .....................
Location of Farm:
Ge"ral
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes. No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes IN 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 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes fig No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ( No
5. Does any part of the waste management system (other than lagoons/holding ponds) require M Yes ❑ No
4/30/97 maintenance/improvement?
Continued an back

Facility Number: .3 — .'Ai
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge?
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pands)
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?
❑ Yes P No
❑ Yes ® No
❑ Yes P No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste -Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DW lQ)
15. Crop typed ..IZ�YMsui.. ............................... kll�.u11........................... ......................
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?
IS. 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?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
Ey Yes ❑ No
® Yes ❑ No
❑ Yes ad No
❑ Yes ER No
❑ Yes R—No
❑ Yes RNo
❑ Yes ®. No
❑ Yes M No
91 Yes ❑ No
❑ Yes KNo
❑ Yes R No
❑ Yes RR No
rj
IN Yes ❑ No
Coriiments (refer to q e'stfon lrxplain ariy. YES answers 'and/or any re. commendations oz;any other comments
Use drawmgs,of facility to better ezplam situahans.;(use additional pages as necessary} n
{{ 2 ._ rl y
bxrbt 5WU be byCtT 0.routa Marm� �Oc zb v,.L r 0iLS 4
II.��z, G'rosyOh WKas or. 4%A. znnW Ovitr Wail '� JOL a l SkOJI� 6e �_164 and i W.
luxe. a.YeaS S w [6 be A bean s6uO 6e �y�; �� Cl roVK) �
1\koJ r'. G�,br\ t v, S�frr\ uvy r b vP.. t eq -s W J 6e- �' 16J aid rejea1ej,
7-4- S�roj �e% s6uld �� I �sd-c�] lt� by a►ra+n{� tx,� 44 nun,6,r t h s�" mwk.
a
cc: Division of water vuaury, water muattty 3ectton, ractttty Assessment Unit 4/30/97