310838_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type of Visit:()Compliance Inspection 0 Operation Review Q Structure Evaluation p Te ical Assistance
Reason for Visit: O Routine O Complaint 0 Follow-up O Referral O Emergency Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: '7&
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
C►urrent
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Dair Cow
Wean to Feeder
B5Laer
er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultrr
C*_a seit
PLO
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
El Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P-iQo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Z '�o ❑ NA ❑ NE
Page l of 3 21412015 Continued

hacilit Number: - Date of Inspection: l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑1 o ❑ 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 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 ZfNo ❑ 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 vo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes E No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z "'o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ET NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ZINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
IZI N
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
LLJ E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
Z'ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NANE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Y�N E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
6eN
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Surve
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ No ❑ NArME
E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 . 21412015 Continued

Facili Number: 3 J` jDate of Inspection.
f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
VNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[:]No ❑ NA
NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
9NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ;ZNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air duality concem?
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? ❑ Yes PNo ❑ NA ❑ NE
❑ Yes /P No ❑ NA [] NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA P NE
❑ Yes 9No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question;#)i Explain any YES,answers and/or any. additional recominendations,or Ay other comments.
Use drawines of facility to better explain situations (use additional papies as necessary).
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
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Phone: 6 ?3f d�
Date: ZS
21412015

71
Type of Visit: 0 Co
Hance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5(Y l Arrival Time: Departure Time: OO County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: J O ^ S K Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►apacity Pop. .
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Q —r'yj Poultr. Ca aeit P■o P.
Layers
Non -Layers
Non -Dairy
arrow to Finish
Gilts
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharses 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)
Z. 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 El"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes Dfo
❑ Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page I of 3 21412015 Continued
lI

Facili dumber: 4j - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETI 1 N❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes <o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes D i 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 EErNo ❑ 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 D<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
ET —No
❑ 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
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required
Records & Documents
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
RrNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Oth :
21. Does record keeping need improvement? If yes, check the appropriate box below. rYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
� ❑ 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
r.

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? �es ❑ No
❑ NA
❑ NE
2 - s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
❑ NA
❑ NE
he 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 folk provide documentation of an actively certified operator in charge? Yes 10
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
®' VA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ffNo
❑ 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 ffNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes / No
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FrMo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes % No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.:.,
.
Use drawings of facility to better explain situations (use additional'pages as necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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Phone: q k 7 i (G 73" f
Date: if
21412015

Type of Visit: Q) Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time: ® Departure Time: p 2/(j County: lJ � Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� N Sy Z,L��/ A Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine C*specify Pop.
Wet Poultry
Capacity
Pop.
C►attle
C►►specify Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, l;oultr
C•.a aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
113cef Brood Co —
Turkeys
Other
Turkey Poults
Other
Other
/No
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
[:]Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

4 r'acility Number: - 2 Date of Inspection: I
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:1su/!�
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 La 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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VN ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Zf <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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VN ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
N6�,�o
o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I �J c ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 51- Date of Inspection: to
/L
2t1. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [:]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [Yes [:]No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 10
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
zjX0 ❑ NA ❑ NE
VNo
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facillty to better explain situations (use additional pates as necessary).
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Reviewer/Inspector Name: 41 � �A—
Reviewer/Inspector Signature:
Page 3 of 3
Phon 0*P19-L
Date: IO
2/4 014

Type of Visit: Compliance inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit. Routine Q Complaint Q Fallow -up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: : t County: Region:
Farm Name ; 5j4 j '2pxvyo Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _Solk� `ie [� M\ Y--A1b" ryn Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
La er Dairy Cow
Current
Pop.
Wean to Feeder
Nan -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Design Current
Dr, P,oultr, Ca a_eit P,o ,
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ;?(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:)No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r_ a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q V
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
5. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
JZ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
EZNo
❑ 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
0 No
❑ NA
D NE
maintenance or improvement?
Waste Aylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;2No
❑ NA
❑ NE
maintenance or improvement?
j
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et }
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ONo ❑ NA ❑ NE
acres determination
17. Does the facility lack adequate acreage for land application?
[:]Yes
allo
TVTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pf
No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis D Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;2rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EI'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yeslo ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j2fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 4No DNA ❑ NE
❑ Yes z No ❑ NA [] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
14No
❑ NA
❑ NE
Comments (refer=to question #):explain any. YES answers and/or, any. additional recommendations or any other;coinments , v
use drawings of facility_ to''better explain situations (use additional pages as necessary)..
0.
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
21412011
_ . ...� . , .', W., Date:

Type of visit: PCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �J Arrival Time: ® Departure Time: O County:
Farm Name: 51..X_LUUrw Owner Email:
Owner Name: �pl}'y � '3�'(Af.L-$UQ-6Z Phone:
Mailing Address: Q 11 ...),34AI L wl % (f­aAnc GA V\A OL- Ue Nf, a 0 Co S
Physical Address:
Facility Contact:
Onsite Representative: J014Jd SCAt_tt U 141E
Certified Operator: �Oioj �- SL+LI u w
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Q Oi Q
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design
C*attle Capacity
Current
Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layer
Dai Cow
Non -Layer
Dai Calf
Design Current
P.
Layers
Dai Heifer
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turkeys
Turkey Pouets
10ther
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - SC Date of Inspection:
Waste Collection & Treatment
4. Is stbrage'capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [k 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:_ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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? N
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 rNo
o ❑ NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes I I ❑ 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): CO(W �µ(GA'f 513 7-01f
13. Soil Type(s):
LL6
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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP OChecklists [:]Design Q Maps [—]Lease Agreements
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No
Q Waste Application Q Weekly Freeboard Q Waste Analysis [] Soil Analysis ❑ Yste Transfers
Q Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
0 Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
Y�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
XNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ 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).
Ac.t6�7�onl �E aD,3
w-A-
�f
IIIf,7L2
3/0)11
5/w
y`f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L4Ju Jla — N4 p4,AN S To CZE po �X` ``4re R 16 h4T
Phone: q/%04.
. Date: 9l//Q/Q
21412011

Divis--ion of Water Quality
Facility Nunnber y - gag Division of Soil and Water Conservation �r
©.Other Agency
Type of Visit: M Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: bkRoutine 0 Complaint O Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:/�/ Region:
Farm Name: S uZ(_i U A N Y 4 e- m, Owner Email:
Owner Name: �p(.)/V � , 'SLt LLI UAN Phone: �9) - CJS�C — Sq So
oq_1 ,OHJy L F W)g GLA D� �8 � � QUVT UC- 0/ Q�3&5
Mailing Address: __ _ __ � , / 1' � O�U
Physical Address:
Facility Contact:
Title:
Onsite Representative: ,04N SLLI U,4,XJ
Certified Operator: _ d%4,tl S L,, L i L3 4. /
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
GIN
ertification Number:
Certification Number:
Longitude:
urrent
Design
Current
i ME
Design
Currenw
In Pop.
Wet Poultry
Capacity
Pop.
C►attle
Capacity
Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P■ouit .
Ca aeit
P,o
Non -Dairy
Farrow to Finish
d
Layers
Beef Stocker
Gilts
Nan -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turke Poultsher
!0-tt
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
�] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: ( - X3,R Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �_§
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [3Yes No ❑ NA ❑ NE
Structure I 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? ❑ Yes IlNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 1
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1�(� No ❑ NA ❑ NE
fi
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [, No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5No ❑ 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 [3 Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): <�Om W r3C-A-T '39 C-0-77OA/
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �(N
o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
QWUP QChecklists ❑Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
0 Waste Application 0 Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking Q Crop Yield Q 120 Minute Inspections 0 Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &
No
❑NA ❑NE
❑ Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: ] - R Date of Inspection: S J,71 i
y .a
24. Did the facility fail to calibrate waste application equipment as required by the permit? YeskNo
No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes NA [] NE
the appropriate box(es) below.
[] failure to complete annual sludge survey Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No D NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes D No XNA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
No DNA
0
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?
D Yes
No ❑ NA
NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
D Yes]
No 0 NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
p 1�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
No (] NA
D NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
D Yes
No D NA
D NE
34. Does the facility require a follow-up visit by the same agency?
D Yes
No M NA
NE
Comments (refer. to;question ft Explain any YES answers and/or any; additional recommendations or, any other comments ,
Use drawines of facilitv.to better. explain.situations_(use additional paees,as.necessary). `
w.P+
a,btq
��p Tv Cn�-r CP('k �j'on/ 09 V GA(.LgQAT� TR115 r��,a2 W1714 A
N -To 4eLP14i _
I O & &7 A, N �JG 'v�X3R'J` 1 'r C0NT GT rvt +41,t D,a 17-C N L
'�"AI �O�SN 7 LrQQAT�'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1�b�
Date: �5�j 1111
21412011

Type of Visit 'Q� Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit \*Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J Arrival Time: Departure Time: County: utv Region:
Farm Name: `\"C,�u
_C_1 Up k/ �7A CLM Owner Email:
Owner Name: ,�jy "b• SQ_UA-/V Phone: -I19—l2SR—SL/50
Mailing Address: ��Nx/ `-- Wlg QLPD A �Z8 d7T QLr u� , %U�' a. a &o S
Physical Address:
Facility Contact: Title:
Onsite Representative: SoNN S(A j_L1 cU A )V
Certified Operator: 141%1 1:� . SL.._L4 UA1gi
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /
Ope—ra�rtification Number: _(2JU0
Back-up Certification Number:
Latitude: = c [= I [= Longitude: = ° = 6 = 1{
Design Current Design Current
Design
Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean pry Poultry
❑ Da Goµ'
❑ Non -Dairy
❑ Farrow to Feeder
159 ❑ La
Farrow to Finish d
❑Non -La Non -Layers
El Beef Stocker
Gilts
❑ Pullets
❑ Beef Feeder
ElBeef Brood Cow
❑ Boars
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)0 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 38 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ANo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d` 3
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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
[INE
maintenance or improvement?
Iq
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ App(liiccatiio�n, Outside of Area
12. Crop type(s) 1 T -rlt�lil l-a�i�
13. Soil type(s)
V
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
TRfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
54No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Y[No
❑ NA
❑ NE
Comments (refer to question): Explain any YES answers and/or any "recommendations or any other comments'
a R ,
Use drawin s of facility to better ex lain:situations. use'additiopal a es as neccssa , '.
Reviewer/Inspector Nameti
f )S k; + a Phone: ��}GII'O� 3a��
It,;;.'
Reviewer/Inspector Signature:
Date: :5JDVjQ
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )Ivo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA [INE
0 0
the appropriate box. WUP Checklists 0 Designs ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �aste Transfers f ❑xnual Certification
[] Rainfall 0 Stocking El Crop Yield 0 120 Minute Inspections El Monthly and I" Rain inspections [] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility faii to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
❑ No
X NA
❑ NE
❑ Yes
'4 No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
9.No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments` and/orDrarvings' ;.
T6 COVER
� 05resr�Mp� s P
Out 7>1S
109
'bL&C' M
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name: �dN� �� ���LIV�� Phone: ��059~SC/S9_
Mailing Address: o� ���17� Le W� S �--� +2�� ►`6 ' ' blJllii [ „ u if V WE
Physical Address:
Facility Contact: ` Y �� Title: Phone No:
Onsite Representative: Jd�"i/V ��J� LLI k.� 4)V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [=' =" Longitude: = ° =' = „
Design
Current llesign Current Design
Current
Swine Capacity
Population Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Daia Calf
❑ Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Non -La Non -Layers
❑Gilts
❑ Beef Feeder
❑ Boars
❑ Puliets
❑ Beef Brood Cow
❑ Turkeys
Othe
❑ Other
urkey Poults
❑Other
Number of Structures:
I
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 ;KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
P--QNo
❑ NA
❑ NE
❑ Yes
:�kKo
❑ NA
❑ NE
12128104 Continued

acility'Number: TF
Date of Inspection �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes kNo ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ` No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes *o ❑ NA ❑ NE
11,
Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
-I�No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
ennce of Wind Dri`
❑ Outside of Acceptable Crop Window ElEvidenceDrift Application Outside of Area
12.
�❑
Crop type(s) C0q'N �li� G� 1 S La C-0-raw
13.
Soil type(s)
LA-Tq_ A V 1 uy-
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
}No [I NA
_
❑ NE-
15.
Does the receiving crop and/or land application site need improvement? El Yes
i4No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
P- No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
U-No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
!�.No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or, any recommendhtions�6r-lany,othe comr�tientsr F� F
Use drawings of facility to better explain situations. use additional a es;as nevi ssa
g ty. P (. Ply rJ)
) 07 l COP �o F 'oq CAC cQD qp� t,�) �s - cxT)l 1�6 1 f ns 4 CAC Aa,QE
•
3w4)4c Gor w- k oFLk C'�� SAD CjC tl S o f T4 c-
5GLXD e Sc�QUCu�S w) R U;_�'rrC-P— WSel/`lri IP0e(4.sV FXEMPTion/ -fo
(-ram! a o
Reviewer/inspector Name S 0_# Phone: -
r�
Reviewer/inspector Signature: Date: `,� d
12128104 Continued

r
Facility Number: 1 —g' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. EIWUP 3 Checklists Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 1?aste Transfers ❑ /nnual Certification
0 Rainfall 0 Stocking El Crop Yield El 120 Minute Inspections [3 Monthly and 1" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ (No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ix No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
,, \\
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
-J&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
q�fola � G,3C.ta
�� jd�rlog a.(0 LO
.5uq T) -5 ! G G� L �ti3Q-� 101\1- T ��t U� 0 (NTH �
s� T� to I Y TT i�(Z 'C IO LI VA- v dev Fob
Page 3 of 3 12128104

Division of Water Quality
Facility Number M__
M
Division of Soil and Water Conservation
0 Othet••Agency
Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: i f7 Arrival Time: Departure Time: County: UN Region:
Farm Name: Owner Email:
Owner Name: _ _� 614N SULU U
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representati
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Phone:
Title: Phone No:
ve: �0 SLA L-Q V AIV Integrator:
0 t4 AI S ""` L-U U tW Operator Certification Number:
U Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 ' = Longitude: = ° = ` = "
Design : ` ".CurrenUl Design Current
Capacity Population Wet Poultry - Capacity Population
❑ Layer I
II ❑ Non -Layer I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouets
❑ Other kk
Cattle
Design> Current
Capacity., Population <.
❑
Dairy Cow
If
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
i
Number of Structures.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
[(No
❑ NA
❑ NE
12128104 Continued

Facility 1Vhmber: — 8 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 St r ctu� Structure 4 Structure 5 Structure 6
Identifier: I OL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes q No ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground [IHeavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > l0% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4No
❑NA
❑NE
NfNo
❑ NA
❑ NE
IX No
❑ NA
❑ NE
%No
❑ NA
❑ NE
O(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J 'Al 16& 5 LtA� 5u�G�' N�11�G /N /6` - �G T �dL9 SkG2ts C�
(.001G S � Q�� �l
(A 0* TION' b t"G,
r/Inspector Name G S . Phone: I'/6-(0 -r/Inspector
Signature: Date: Q
E
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [11"�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Dd No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
% No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
,Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
Q�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number 8 3 S
Q(Division of Water Quality
0 Division of Soil and Water Conservation ,
Q Other Agency .
Type of Visit 2f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OlRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Z,� O Departure Time: County: X%t1P4Zy%)__ Region: Zall(V
Farm Name uG GZ✓�n1 �/►'1. Owner Email:
Owner Name: - �T liti��/ ��ff/ n� Phone:
Mailing Address:
Physical Address:
Facility Contact: C Title:
Onsite Representative: �Q/�i�% SuLGzcJ�¢,�+1
Certified Operator: :)D_ n
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Phone No:
Integrator• i✓/1zP/-ND4!y�
Operator Certification Number:
Back-up Certification Number:
Design Current . Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I, ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Longitude: = o = ' [=] "
Design .Current,,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ANo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes JtNo
❑ NA
❑ NE
❑ Yes ,'No
❑ NA
❑ NE
12128104 Continued

• 1Facilit Number:
Date of Inspection 94Q _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesXEI
No ❑ NA El NE
a. If yes, is waste level into the structural freeboard? El Ye No ❑ NA ❑ NE
Structure 1 Stru ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 721
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes/�No El NA El 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 /PlNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of c eptwle,Crop,)Yjndow El Evidence of Wind
d Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s) ALI
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElYcs/),f No
❑ 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):
�.� �i✓G�/ � F?GG,a 5 s�vwfo %1if_ fAt�G. ��, � 2 / � O �- �z c S ��de>
�40In 71 � s�D
�. 2
Reviewer/Inspector Name T_ Phonec % 9 -7312
Reviewerlinspector Signature. Date:

H{acility Number: — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists //
❑ Design El Maps ❑Other ,_
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes V,( No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers/ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes PJ No
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes / No
E❑NA
P NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes [2No
/f
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes IX -No
lCC❑
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 21 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes Xj 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 ONo
❑ NA
❑ NE
12128104

Faculty N umber
0Division of Water Qua [it y
0 Division of Soil and Water Conservation
Q Other Agency
Tjpe of Visit 9rCompliance Inspection O Operation ReOieW O Structure EOaluation O Technical Assistance
Reason for Visit Q� Routine O Complaint O Follow up Q Referral O l:mergenq 0 Otlier El Denied Access
Q� Date of Visit: 1 Arrival Time: � Departure Time: !�; County:
Farm Name: �La anz % Owner Email:
Owner Name: �D1F 1 /%2�. �LG21%i�fJ Phone: ._
Mailing Address:
Physical Address:
Facility Contact: Tittle:
Onsite Representative: 1� �1/��/ij!✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: (ALL
Phone No:
Integrator: _1 o� ewwE --
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
0Division of Water Qua [it y
0 Division of Soil and Water Conservation
Q Other Agency
Tjpe of Visit 9rCompliance Inspection O Operation ReOieW O Structure EOaluation O Technical Assistance
Reason for Visit Q� Routine O Complaint O Follow up Q Referral O l:mergenq 0 Otlier El Denied Access
Q� Date of Visit: 1 Arrival Time: � Departure Time: !�; County:
Farm Name: �La anz % Owner Email:
Owner Name: �D1F 1 /%2�. �LG21%i�fJ Phone: ._
Mailing Address:
Physical Address:
Facility Contact: Tittle:
Onsite Representative: 1� �1/��/ij!✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: (ALL
Phone No:
Integrator: _1 o� ewwE --
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ Other
&Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
T]
❑ Dairy Calf
❑ Dairy }ieifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges
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? ([f 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 W1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
[I NA
El NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

i
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
ructure 3 Structure 4
Structure l Structure 2 Structure
Identifier:�l�
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
bserved Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes PNo
[INA ❑ 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 ;ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes VNo
❑ 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 ❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN OPAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ac eptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) S p
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
'1Z
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
PfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7-;rWA✓ �� yes
41
/ !
T
Reviewer/Inspector Name Phon� Z
Reviewer/Inspector Signature: Date:
121281041 Continued

t
Facility Number: — Date of Inspection="
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;dNo ❑ 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 ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard OWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge'?
❑ Yes
[2'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XN A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
/Yes ❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes XN 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 )z No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
7J /lamr!� v
2/A 4&70# ���fr NI�G y<j25p }�`�E59zv.
Ifs
•
���/✓�5 , /vo (N46;r4 I7f✓9 �Ys�s % C`�dfa2 .�i% ��-� 60
6V Z��?
Arlo �%a GG��
�jPPE�� �,v/''F
�,►,� a�� ,gyp ,s���Ga�
/70-u v�J,�/�/�`�
T
/� L/ /" A�� C��d� C..r ,= 12128104

Type of Visit d ;FRRoutine
piiance Inspection O Operation Review O lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: B60
Not Operational Q Below Threshold
Q'Permitted Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ... .._ ... M.
FarmName: _.......................... County:....... .41 1� .».» . _........._._..... .._....__........
OwnerName: ... ...... ......_......... .......... ......................._.........................._...._........_.......... 'Phone No: ... »....... ....»......... .................. _........... ........... ..................
Mailing Address:
FacilityContact: _ . _.. __._ ._.._ ____..._.._. _M » ..».... Title:..__.__. __..__ .. __._ . _.__.__. Phone No: __ ...__._..._ .Ww.. _. ...
Onsite Representative:.„ .»o K*� Sv L L'TJAi __ ..... __ Integrator: ____ ...'�T
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • d 4;4 Longitude • 9 «
Wean to Feeder
❑ Layer
Feeder to Finish
:A
Non -Layer
Farrow to Wean
„; Other
Farrow to Feeder
Farrow to Finish
! 5
0-Al D;
Gilts
Boars'z.�
Discharges & Stream Impaets
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ____ 2,-- .»_.- .._..
Freeboard (inches): L f
12112103
❑ Yes [�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
2f4c,
❑ Yes
GRI<o
❑ Yes
L��O
Structure 6
Continued

Facility Number: A -- 1311 Date of Inspection 4i sv.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes[ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenanceCimprovement? ❑ Yes Q'Ko
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [lio
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ETNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C-&o Q co'Mba3 (S r- 10 0, (. H) 56,6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑Tlo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EWo
b) Does the facility need a wettable acre determination? ❑ Yes QNo
c) This facility is pended for a wettable acre determination? ❑ Yes Qy No
15. Does the receiving crop need improvement? ❑ Yes ❑.Aio
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes EJ&
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ETgo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes CI -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 01410
Air Quality representative immediately.
Field Covv ❑ Final Notes
Tszc ES HAOC G3cnEN k-A Cwoa&-1 C-"' L4A_b(L 2J►n ;-TA C e CC..m R_ C'�
iJEw w vP C):5rJ 6 (-J:ZTtl up V AT c-r> A c_ajd5 Tb -r� F_ ZLi�
a3 0 e e- SurtC -�d 1lA AYE) "5Z6� w-►vat e'� Zr3 7'b Cao al°`t SIa�P
µgas 0Z)T, C�� �rcL�, �e 5t3�E 1 2L.CvrtD E�lC�
Lrz� t,i�,.5�ar.aS, 2 �i✓EN�� (�pPL;Ze-_V TTD SC90 a.�N�r✓ s�v�rj o
d e6tL v,,voA . Mo vvcti APPCZ c' Zori O U e, T , E6t+c-o�C .
`3C 5u -r6 TiR OsF� R-GCaR-bS F"A& OLT 1�01,'/ to Ya6 lf(DlA)
vj=r 14 0--�6 uJ
ReviewerAnspector Name N
ReviiewerA Spector Signature:
Date: it j2 oLf
12112103
Continued

Facility Number: R1 — $Iq Date of Inspection I i+ o�
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [4o
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 j" io
23. Does cord keeping need improvement? If s, check the appropriate box below. �es ❑ No
Doe
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 QNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes U-No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 2No
28. Does facility require a follow-up visit by same agency? ❑ Yes ❑'lqo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0<0
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes dNo
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

1417
Facility Number Date of Visit: Z !3 OZ Time: I I Z :
Not Operational 0 Below Threshold
Permitted [3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .sU 1 �' ✓ a In FA r ""` County: 3) u
Owner Name: �' +'� D,, ; 1 Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: �O1 "� �G `ry 1 ]i V r N
Certified Operator:
Location of Farm:
Phone No:
integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ cattle ❑ Horse Latitude 0• 04 " Longitude ' 04 �u
Design
Current Design Current
Design Current
Swine Ca a
.. .
ouation oulte
Capacitv Population
❑ Wean to Feeder
❑ Layer ❑ iry
❑ Feeder to Finish
I ❑ Non -La er Non -Dairy
❑ Farrow to Wean
..:. ........
❑ Farrow to Feeder
❑ Other
Farrow to Finish 1/5
Total Design Capacity
❑ Gilts
❑Boars
Total SSLW'
Number of,Lagoons
❑Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area Fs
Holding Ponds /eSolid Traps
❑ No Liquid Waste Mana ement System
Discharge) 8& 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: IS4 Sa4cC Zne( sfc,rf 3rel —94.1
Freeboard (inches): 19 � 8 z q
05103101
❑ Yes CYNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes R�No
❑ Yes ZNo
Structure 6
Continued

Facility Number: 3 f — 3 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?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Gar%n1 i"ike61I r.SoI,bCctit^S/ 9err-1V*1 iJ '�Gy
13. Do the receiving crops differ with those designated in the Certified Animal Waste
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?
Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Reguired Reigrds & D c m nt
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
l8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes VfNo
❑ Yes XNo
Oyes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes LZ No
❑ Yes V(No
❑ Yes ONo
❑ Yes [:]No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes .0 No
❑ Yes ZNo
❑ Yes )zNo
❑ Yes ONo
Yes ❑ No
❑ Yes 0 No
❑ Yes ONo
❑Yes ONo
❑ Yes FdrNo
❑ Yes ONo
Yes ❑ No
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Explain any;;YES answers:and/or any recommendations,or.any other comments_
Use drawmgs;of facility to better;explainsittations (use'additional pages as necessary:!V ❑ Field Copy ❑ Final Notes
4v-cc or .5o�-.e -gees an -rake 4�500�•, ! ���� of 4ke 3rds-k c
�j �1lag� j sees geed 4o be rc,-coved b) 3aod e�9;•��e✓'at.. �rAC-�,'eC-C
CC, I4G00L+
I -It 10 5CC mGtr/Cc✓ 11'% Znd�911�C ���oQt.� t�'� is Ove.-e4 W 1'7�
J
eye'sS.
1 4.bZ5 . Yar., G --e Cf 4 ,en ►Aq ...tore 44eea9P oN ber►�-,u�W �,e ld a�., �1Q-��s
41,01, 41tc [„/-,;f VPAM#, I Aj .'^ ;4 j I$. 11,ve $. ZS 1A
I�as 6 ewes. HAve Qi we -Heal rtfcs cuethe W41, mc4ctlt L�4e ]plot" � rAyri,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2 f z
05103101 Continued

FaciNty Number: 31 936 fate of Inspection Z f�3 2� Printed on: 7/21/2000
'Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes -OlNo
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,ZNo
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 XNo
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 permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: ,
�� ��• t'' r) keo® recat-,ols
SAS �^aw GrOrO So�1 SQwtpfvl Se•�-! ��CC�"'I�e� ZD��
res V 1-T3 hod bark ef; he dov Aav/e ZdD 1 k!"Lvd-1 SIi-1 sav'101c
resV1+S Lvk; rtpf1 r';r+�n-�D
e M Oe hle e.e'en �e,,r`%vdo) OS
re t o„ ^ v-1e, h4e4 - K'eer If boa --d re eo.-d S - ✓ 1 A y a a r. S o t t q W eekl >�
I;as;S - Be Svre 4o kSe cd.rre-ei w&.fie a.-L, I AS— 1V^Ive OK
---1[7r{2-'I'f eA VS'e pr-000�r �jgaJi�+✓1r+-+� Y+►-�roGt Y, gifOW4�Le TYa'"1
l�vci-roe pCa h VCed JJ1 D�11 Qn :RA-Z's VTDr wAeq�) plet,►. sitLjs 1p6
�)q �-ie ✓ zi l yreq.-a n re o,r 44, 15 Lv e 11 keP4 .
J
5100

ua i:: .i,,- 'r v�
i1♦�.'D1V15IOn of Water >, � �a
�.' i 'f'� t' i�4 I'�¢k°! S i�34
�r tr{ �E`�
it` +"�`"s r6`'f'i
l�r"y�*�5 =
sQuality , t'' i,
Q Divtston of Soil and Water ConserVatlon
�: £ f' rl'� pia ,"'� ;
i
o5
F � •'
1 4
! t - � ��f..-'-� a ` i 1. T� fil�•t)FiY 1d'it t t'tN � -C t
�
1
�• r
�����, �f ��1. sir t`�'''�`
ry �a— � � ti
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit �dk Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �0 F/ 00 Time: �%• d� Printed on: 7/21/2000
Q Not Operational Q Below Threshold
(Permitted Ed Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ............................................ County:........ ��!.1� ...lV...............................................
.......................................
Owner Name: �� I ,Q �L �GL/Phone No: c�2
.,1...................a.................................................................................... 9.1 ......-................................................
Facility Contact: ...,�,14 ..... ....d.SA.L 4f ..........Fitle:....JCW"a.. .......... ...... hone No:.. ...............................................
P ,,�
Mailing Address: �I �!�✓NI..�... G�w S. l�.� �... ...../vl...•.....®Lll�,lid.... !!.'.................. �'K!�.Sa r.
,I
Onsite Representative: ............. J9 l%LL/ U!..N............................. Integrator: .......... 1A/D;Pt �! ►.1..........................
....................
Certified Operator: ;fO. ,�I i./i/ V� /Y Operator Certification Number: ..........................................
Location of Farm:
T
❑ Swine ❑Poultry ❑Cattle ❑Horse Latitude '�� Longitude ®•� 1114al<<
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
JE1 Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE3 Other
Farrow to Finish
Total Design Capacity
❑ Gilts
Total SSLW
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im act
1. Is any discharge observed from any part of the operation?
❑ Yes
SNo
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, w,is the conveyance than -made`?
❑ Yes
❑ No
h. If discharge is ohcerved, did it reach Water of the State? (If yes, notify DWQ)
❑Yes
❑ No
c. If dischar,_,c is obscrVOLI, what is the estimated Ilow in gal/Irvin`'
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
QfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
W(No
Str1ucttu�/ I Stru1cturc 2 Struc;tUrc ? Structure 4 Structure 5
Structure 6
Identifier:
........... ti...jf................. ..... ........�1.11..
Freeboard (inches):
5100
Continued on back

CAI
Facility Number: — Date ofInspection TT Printed on: 7/21/2000
,5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes allo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes E/No
❑ Yes VNo
[-]Yes {(No
❑ Yes FjNo
❑ Yes V No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes allo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VNo
b) Does the facility need a wettable acre determination? ❑ Yes igNo
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ o
P
15. Does the receiving crop need improvement? ❑ Yes 7No .
16. Is there a lack of adequate waste application equipment? ❑ Yes _VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes dNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes V(No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes VNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes -�6 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,6 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes .VI 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 VNo
�tiQ viglaftgris;or deficiencies 16re h4eif• ilta-riing this.visit.' • Y;o(iwill recgive tjo further ;
icorres oridence. about: 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):
lJi✓G�.o � �>-�� Lt/�nl C�C� SDn� �l � �2 . e�2�.�r�o��
ow 3 � A)U .J P» t
7
Reviewer/Inspector Name e ✓U/ /,fi'gym I
Reviewer/Inspector Signature: Date: 1 ,31 5/00

Facility Number: 41 Date of Inspection D 0 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 bglow
❑ Yes
V'No'
liquid level of lagoon or storage pond with no agitation?
�No
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
29.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
VrNo
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
4No
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.)
El Yes
V,
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
dNo
32.
Do the flush tanks lack a submerged fill pipe or a peimanentltemporary cover?
❑ Yes
10 No
5100

Lagoon Dike Inspection Report
Name of Farm/Facility �h4 Sl
Location of Farm/Facility
Owner's Name, Address —J.,h,e
and Telephone Number
21 t .yj"Lew.r G��Ve-1 c'1t at d1C Zs3Gs'
Date of Inspection Names of Inspectors
_ Gkca �G S
Structural Height, Feet Freeboard, Feet 2
Lagoon Surface Area, Acres Top Width, Feet _
Upstream Slope,xH:IV Downstream Slope, xH:1V
Embankment Sliding? Yes x No
(Check One, Describe if Yes)
Seepage? Yes �_ No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Ve etative Cover
ra s, Trees)
Did Dike Overtop? Yes X No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes_ No
Engineering Study Needed?
Yes X No
Is Darn Jurisdictional to the Daze Safety Law of 1967?
Other Comments
Yes X_ No

Facility Number 3 Date of Inspection ZB
Time of Inspection J 06 24 hr. (hh:mm)
© Permitted © Certified [j Conditionally Certified [3 Registered 113 Not Operational I Date Last Operated .
r,
Farm Name: County: h ✓t 1 County: �1�J1.l�±.......................................................
................................................. �............ J........,...................I.........
Owner Name: �U� i .An ................................................... Phone No:
FacilityContact: ..............................................................................T':tle:................................................................ Phone No:.............. ........
MailingAddress:..........................................................................................................................................................................................................
Onsite Representative:.... 4.. .n.. U.l1t V R_n. ..... Integrator: ......................................................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
1�
................................................................y................................................................................................................................................................................................................................................................. -
Latitude 0•` " Longitude • ° 66
Design Current Design, Current, Design Current
[, Capacity Population' Poultry, : Ca acit ., Po ulahon °, ', Cattle Capacity towl"i
'�
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
1 Non -Layer ❑ Non -Dairy
❑ Other .,
Total Design Capacity
G � 5 ° 'I' 'gyp !,' ... i.,.. _
a Total_SSLW
i
;! t Ntimber of Lagoons . ,'':, ❑ Subsurface Drains Present ❑ Lagoon Area 10SPray Field Area
,Holdirig Ponds / Sofid.Traps , ❑ No Liquid Waste Management System
s.
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'?
h. 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. Dices 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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: t 2. 3
Freeboard (inches): .2S Z 1 i2
................I............................................................................ I ........... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes. ❑ No
seepage, etc,)
Continued on back
3/23/99
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
..................... I......

`A acilityNumber: _71 Date of inspection je
6. A.re the?c 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 maintenarcelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Anplication
10,
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding []PAN
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ 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
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑ No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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
�'Vo yiolat%tjris :off cl$fic�er�... ... ngtea i >rrtng phis visit: Yoe wi1i r, ee�iye 06 futftr
corres' oxide'&alb" this visit: ' ' '
"l. I1' .9 .,lo l -E" E:•} i'.- �i
Comirients (refer ta,"question #):'3Ezplain anyEYES rtnsw'ers an Uor any recommendations or any other comments. °j z E - �
{
Usetdrawings of facility, to better explain situations.(use itionalFpages,as,necessary} 3 I ;;'a€ s,'+,i € l
caddt; yx l sE,
, 3.4
1
s Se s sr✓}Q+? 7- 0 {' Sq�e-� y p.� jaG o a h o�a h�,S.
�
Reviewer/Inspector Name l i4 n' S-�il'►ieltl!l �li; w f,'S ''l �d
Reviewer/Inspector Signature: Date: Z q
3/23/99

I
`a
. Lagoon Dike Inspection Report
Name of Farm/Facility __L ry,l s,� lfr No, F11 7 l — 939
Location of Farm/FaciIity
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:I V
Embankment Sliding?
(Check One, Describe if Yes)
2 / t —4,1N Lewir G�qV,� e-1 _jr7: phat
91 Names of Inspectors /w A/y�
Freeboard, Feet
• -� Top Width, Feet
Yes /K No
Seepage? Yes No
(Check One, Describe if Yes) - -
Erosion? Yes _2� No
(Check One, Describe if Yes)
Condition of
Ve etative Cover
s, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
��ica �c
�iYJ 5
-----�
+ram• -
Downstream Slope, xH:1 V
Yes X No If Yes, Depth of Overtopping, Feet
Yes - _ ,Y No
Yes )( No
Is Darn Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes )( No

{ [3 Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
IWRoutine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number
0 Registered OCertified [3 Applied for Permit 13 Permitted
Farm Name 11 �..... �i
Owner Name:.... 55 ..(. �.......SA\1!&!........................................
Date of Inspection
Time of Inspection 11G 46 24 hr. (hh:mm)
113 Not Operational I Date Last Operated: :........................•
........... County:.-...1.!-.................................
........... Phone No:
............... ..........................................................
FacilityContact: .................................................. Title:................................................................ Phone No:...................................................
- �-. GI
MailingAddress: .....��....J.............. ........................................ ..........�Y....... `......5...... ..........................
Onsite Representative:...w`' e" ............................. ....... Integrator:................�
Certified Operator:............................................................................................................... Operator Certification Number:...................
F,ffatiyq of F
Tr
...... `4rs..4 4....... ............. .. c ...... ....................................:.......................................
...
Gti-�....5R..� ..5�.....:........� Y.�.As...... G�... �....G�, t-..ti`at! ... A.. ........, ...�1��2.-1..
Latitude ' 4 " Longitude ' 6 04t
--,,Design:
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
;• :Design °`Current Design
i r Poultry Capacity Population Cattle 7 Capacity
110 Layer I I Dairy
kNltttrber of Lagoons / Holding P©nds ' ® ❑Subsurface Drains Present]❑ Lagoon Area 10Spray Feld Area
i ❑ No Liquid Waste Management System r
Gene
1. Are there any buffers that need maintenance/improvement? ❑ Yes 5dNo
2. Is any discharge observed from any part of the operation? ❑ Yes O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IfNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑'Yes [A No
c. If discharge is observed, what is the estimated flow in gal/min? NA
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 ( No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (XNo
7/25/97

Facility Number:
J
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons —Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2 Structure 3 Structure 4
Identifier: �Q .aa
......... I..�.................. ...................................
Freeboard(ft):............. ........................... ................ ......3%:�`............. ....................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes Wo
❑ Yes �(No
Structure 5 Structure 6
................................................................
❑ Yes No
AYes ❑ No
,Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 4 No
Waste ADDlication
14. Is there physical evidence of over application? ❑ Yes IN No
(If in excess of WMP or unoff ent rin waters of �h State, notify DWQ)
' jlrj
15. Crop type4.''''�t-..:....�u.............:................. .................... ............................ ..................................... .....................................................
r
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes tE(No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18.
Does the receiving crop need improvement?
❑ Yes
[X No
19.
Is there a lack of available waste application equipment?
❑ Yes
(XNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
%No
22.
Does record keeping need improvement?
(Yes
❑ No
Far
Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(;�No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
[3- No.violkions-or. deficieincies:were,iltited-during this:visit.- You:wvili i&e' iVe' -iio-furtlier-:
corrOOp ndence shout this: visit.- : ,
4-3
Ley--�."h�d
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: