820458_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: (tMonudiance Inspection U operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: b0 Departure Time: rl, County: 9d Region: r—J7_0
Farm Name: r � .(tom L r}tdr •ry Aw&-c tit!'- Owner Email:
Owner Name: cK Env Phone: �
Mailing Address:
Physical Address:
Facility Contact: C u4F 13 atnbO c(� Title: Phone:
Onsite Representative: i� Integrator: 'M 13LS
Certified Operator: V't� �lc✓` Vc.#-, Certification Number: .D 0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine = '-
C•apaci Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
ILayer
Non -La er
I
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
2NO
ok
Farrow to Wean
Dry Cow
Farrow to Feeder
D P,oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Non -La ers
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Uther Fz
Turkey Poults
other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Q Yes [ass ❑ NA ❑ NE
[—]Yes
[:]No
❑-N-A
❑ NE
❑ Yes
[] No
[g-NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [] No [T3�1A ❑ NE
❑ Yes [D.Akr ❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
21412015 Continued

Facilislumber: b7lZ - q S, K Date of Inspection:
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[]-N-6 ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NofI"❑ 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
[0.AK_ ❑ 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
ONE
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
.Er o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
F.Wc� ❑ 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
©-151—o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
I O. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
©-iQo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes t.-l"' ❑ 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): C 8 - P S6 -0
13. Soil Type(s): G el- a a
14. Do the receiving crops differ from those designated in the CA W MP? ❑ Yes ❑-M ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑-Nv- ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � 1�. ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 Yes EE-NV-_`D NA ❑ NE
❑ Yes [a-Nv- ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes D-567 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [2'N-o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [; Go
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes LJ -0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: 2 - S' r Date of Inspection: Za
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �], ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ED❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: 3[ I l
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes LG-Ko ❑ NA ❑ NE
❑ Yes [t]-iQp _ ❑ NA ❑ NE
❑ Yes ED- o ^ ❑ NA ❑ N E
❑ YesY❑ NA ❑ NE
[:]Yes [�'1C�o ❑ NA ONE
❑ Yes
E ZD
❑ NA
❑ NE
❑ Yes
I rJ "'o
[] NA
❑ NE
❑ Yes
B Imo
❑ NA
❑ NE
I (-7 .-I 7
Phone: q j 0 433-33W
Date: qaV0
214/20l

313 Q
-
Facility Number - CO�Dt�vis`to�n of Soil�and�Wafer"�Consenahon ��.""'�� .�
Type of Visit: (bTompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: t�/Routine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �^
Farm Name: Owner Email:
Owner Name: �t� Phone:
Mailing Address:
Physical Address:
Facility Contact:r�t.%'�t
Onsite Representative:
t�
Certified Operator: �►7UX t' L 'Lt4" �
of
Back-up Operator:
Location of Farm:
Title:
Latitude:
Region: fav
Phone:
Integrator: It 13 r5 r
Certification Number: 1,7[ L
Certification Number:
Longitude:
Design Current
- DesignCurrent
esign Current
Swine - _
Capacity Pop.
Wet,Pault. ` Capacity -Fop.
Cattle
Capacity Pop.
Wean to Finish
La er
Layer
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
airy Heifer
Farrow to Wean
Dry Cow
Design Current
Farrow to Feeder
D Pou tr�N Ca aeit
-=P,o ,
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults,,�
_.
OtherA
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 convevance man-made?
❑Yes No ❑NA ❑NE
❑ Yes ❑ No E!r—NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
U "A
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does the discharge bypass the waste management system`? (If yes. notify DWR)
❑ Yes
❑ No
Ca NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
[�f'No
0 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 21412015 Continued

Facility Number: - Date of Inspection:
Wgiste Collection & Treatment
4 GIs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F4-N-o- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No E 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[:]Yes [�-i'do'
❑ Yes [:]No
❑ NA [] NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�^ o ❑ NA ❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes V:r-No ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes []r* o ❑ NA ❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n 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):, a tt`tO� J( o
13. Soil Type(s): d JJE
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes g3*No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes [alo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[] Yes
EfNo
❑ NA
❑ NE
❑ Yes
[ffNo
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [!rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [+fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!I No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412015 Continued

FaciliNumber: fiate of Inspection:
24;Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�Vb ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [!r170 ❑ 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 CtrNo ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3-lqo ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[y No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the lime of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�rNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[:fNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[J% `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
dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CE No
❑ NA
❑ NE
Comments (refer to question #): Explain any YlE5 answers and/or any additional recommendafions or any other comments.
Use drawings oflfacility to better explain situations,/{u-se additional pages as ©ecessary,}.
C.4
ad L' 10- 6%-5f
Reviewer/Inspector Name: 6 t 1 f 0
Reviewer/Inspector Signature:
Page 3 of 3
Phonert-0 - `
—ELL
Date: a v l
Z/4 Ol s

i ype of visit: 4,ycom trance inspection t_j uperanon mevtew u btructure tvamatton V i ecnmcat a►sststance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time County:
Farm Name: � ,y?(. { i ""'y N oLst_ik Owner Email:
Owner Name: 4, L,114- Phone:
Mailing Address:
Physical Address:
Facility Contact: t,�(it,1MA_
Onsite Representative: I
Certified Operator: gr7j�
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
0( integrator:
Certification Number:
Certification Number:
Longitude:
Region: �-
Design Current Design Current
Swine Capacity. Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Nym%
-
D , Ponitr Ca aci P,_o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gifts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otber
Other
___ ,_ �-
Turkeys
Turkey Poults
Other
Discharges and Stream Imipacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or ,potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Vo �❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E�T o
❑ Yes eNo
❑ NE
❑ NE
D'rA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Faci ' Number: Date of ]Ins ection•
LAste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA--❑ 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 U3110 ' [] 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 ❑ NA ❑ NE No
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
[;Pftr-'r] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
'-- 41 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
P—]To ❑ 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?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. (] Yes [2-Ko­ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0%or I0 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): W(L /V6 . DI kw""
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:JNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
_Required Records & Documents
19. Did facility fail have Certificate Coverage & Permit
Yes
NA
NE.
the to the of readily available?
❑
[lT!No
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[)No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes EyNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of'3 21412014 Continued

�Facilify Number: 6;4, - q/JIL Date of Inspection:(��� q
?4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes two ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0�1Vo ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [_;❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2 No
❑ Yes ' No
❑ Yes dXo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
[:]Yes Ro ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments refer to 'question Ex lain an YES answers=and/or any additional recommendations or any other comments
Use drawinCs_offac lty,to better explain situa. ons (use ad'. Mohal;pages as necessary). f4._ ,
s- V1 4� 701
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

s �---) —�s _ ab
Type of Visit: U Compliance Inspection U Operation Review iJ Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: r,�}d Departure Timer County:
Farm Name:✓� `Kef,.tj-/ Owner Email:
Owner Name: Phone:
Mailing Address:
Region
Physical Address: �`
Facility Contact: ` C44, � I e�V° Title: Phone:
Onsite Representative: C Integrator: V-!
Certified Operator:Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 NA ❑ NE
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 QUA ❑ NE
❑ Yes ❑ No [IA ❑ NE
❑ Yes [:]No [1IA ❑ NE
❑ Yes CTc ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
Page l of 3 21412011 Continued

Facility Number: . - '' Date of Inspectionr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No rj-7TN- ❑ 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
[0_Ne—
[] 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
ET7T
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-Ne-
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E?,No-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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 1bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr p Window // ❑ Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): 4,5 to V
13. Soil Type(s): Wpm No \ )
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[G]'1CT'o
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El-<
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eg Nu
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1-1 °1V
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a-N-o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_
[:]Yes
F; "o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:)Yes
[g No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

F
[Facility Number: - rrmDate of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LEJ_bla, 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J11a— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ONE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C3-lo [DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes Cf rl o Q 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 ffo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Q Yes [ �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes dNo 0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes allo ❑ NA ❑ NE
Comments (refer to; gnestion #): Explain any YES answers and/or,agy additional recommendations or_.any other comments
Use drawings of facility to better explain situations`{useYadd►bonal }ages as necessary}.
r
` to
St
Reviewer/Inspector Name: ��� Phone: 3�
Reviewer/Inspector Signature: }r A Dater
Page 3 of 3 21412014

Type of Visit: CjKo pliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: U Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Timer County: Region:
t IL
Farm Name:'-�1i1Q99AJ�"t Owner Email:
Owner Name: 1—[ qi Phone:
Mailing Address:
Physical Address:
Facility Contact: cyn � &4440.lk Title: '{"`C/`� Phone:
Onsite Representative: ` Integrator: &(
Certified Operator: t-4AJO Certification Number: L x 1} 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
r
Design
Current
Design Current
Swine
.Capacity Pop.
WetTPoultry
Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
t}a
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Il �P,oul _
C•.a aci
1?a
Non-Daft
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[Tlo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[f NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑11i
❑ 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
ENo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[jNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[r N
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facie Number: - Date of Inspection: MW
Waste`Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ b 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 E3<o ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ET<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 at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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?
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) _ 11i, '- f`�`t`ir -PCVk"'--
I3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0>T ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®,Po [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [&>e- ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [rNO
❑ Yes F3<
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
io
❑ NA
❑ NE
❑ Yes
❑Xon
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design [3 Maps ❑ Lease Agreements [:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Nv ❑ 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 d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciEi Number: XX - Date of Inspection.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No [?�K<❑ 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 ISJ1O 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ~❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ElIZ ❑ 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 CTNc, ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [Dolqo ❑ NA ❑ NE
❑ Yes CPq_o ❑ NA [] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ['NO ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [' No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments;
Use drawines'of facility to better explain situations (use additional poses as necessary). ' . � Mgt. .
C4 it volf CA__
,5,r P.,, _C,,t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4
ft
Plikf 9. �3 3
Date: fTV -Cu Id
2/4 011

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Q Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: 0 2 Z Arrival Time: Departure Time: Q County: s,q JV?P5j�)� Region: Faq-0r
c
Farm Name: �t'Ai1il�1 _1 1—Z Owner Email:
Owner Name: kill,Sri, Phone:
Mailing Address:
Physical Address:
Facility Contact: r i'z1Y1 lLim �IIr SQ,�,g Title: Phone: p
Onsite Representative: Integrator: / "'L�? ]4�J�J UT i� t.� 911
Certified Operator: Certification Number: 190�6
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design Current
Design Current
Swine Capacity
Pop.
Wet. Poultry<sCapacity Pop. Cattle
Capacity Pop.
Wean tjFh
Flon-Layer
a er Da Cow
DairyCalf
Wean t
Feeder
1
ZO [�
Dai Heifer
Farrow
- Design Current Cow
Farrow
D . P.oultr Caaci i;o Non-DairyFarrow
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Gilts
Boars
Other
Turkey Poults
Other
Other
DischaLrges 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 1�1No ❑ NA ❑ 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
3 No
[—]Yes
jl�q No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facitit = Number: 2 - Date of Inspection: /O Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? 0 Yes [-]No
Structure I Structure 2 Structure 3
Identifier: I �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
73
3 _ZIt
❑ NA ❑ NE
Vq NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes K] No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes F' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA [_]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rp No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diner from those designated in the CAWMP?
U Yes
C�g No
U NA
Lj NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
® No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P 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 T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

y
Facility Number: - Ds ection: ID Z-
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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 M No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ® Other: Ce-►lr c� r�Xf
32. Were any additional problems noted which cause non-compliance e p it or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
T] No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /DR Z
21412011

Type of Visit: • Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: :' County: Region:
i
Farm Name: t%1 rtwM C. I �z Owner Email:
Owner Name: f^(.lo , L,�, i�,IJ Phone:
Mailing Address:
Physical Address:
Facility Contact: j�x L�JSCJj Title: Phone:
Onsite Representative: `I Integrator: r , W W �• '
A&
Certified Operator: U Certification Number: I geA6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current Design Current
Swine
Cap city Pop.
Wet Poultry Ca�pactty Pop. Cattle : Capacity Pop.
Wean to Finish
La er Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish°*
DairyHeifer
Farrow to Wean
#DesignCurrent D Cow
.
Farrow to Feeder
I) P,oul ,"Ca aci `. l'o P. Non-DaiEx
La ers Beef Stocker
Non -La ers Beef Feeder
Farrow to Finish
Gilts
Pullets
w
Boars
Turkeys
ar
4
Other -_
Turkey Poults
jiiM
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [�LNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DI ❑ Yes [] No T NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No �fl NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [. No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciliNumber: p, - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
6 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: 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
(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
Wo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
H. 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 ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cjrro Window ❑ Evidence of Wind Drift,�� Application Outside of Approved Area
12. Crop TypeW:
Soil Type(s): ft
13.
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
EP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Renuired 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 CA WMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
T
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFatility Ntimber: -qSB jDate of Inspection: �(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropriate box(es) below. Lr
❑ 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 ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
PR Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
It No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
t No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question ft Explain any _YES answers and/or any additional recommendations or any, otherico"rhi-ents.
Use drawings of facility to better explain situahons=(use additional pages as necessary)
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33"33en
Date: f r�
214/ 011
i'I

I4
Type of Visit 491t ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 4 -� Arrival Time: : as Departure Time: ;ate County:( Region:
Farm Name: Eno- rL � I L . � � �A2 Tiu_ 1 �- Owner Email: �f
Owner Name: _� 4L A k � � vt � _ �-- ►^� 5 Phone:
Mailing Address:
Physical Address: e -
Facility Contact: Fa�4 .� fC i : w Title: r Phone No:
Onsite Representative:
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: latitude: = 0 = f = Longitude: 0 ° = I 0 u
Design5cU—;&—en—tD
gnd.Current
Design t►urrent
ac ulation
Wet Poultry .LCapacity Population
Fattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
eeder [o Finish
t3
ru
❑ DairyHeifer
❑ Farrow t0 Wean
Dry Poultry > �. ram, -
❑ D Cow
❑ Farrow to Feederfr.
❑ Layers
❑Non-Dai
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Turke Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
❑ Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
tR No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ?, — Date of inspection 3�51
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: cir 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P9 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 KNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R 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 D Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [Z Yes ❑ No ❑ NA ❑ NI-
0 Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes ^
®No ❑NA ONE
0. Does the receiving crop and/or land application site need improvement?
[]Yes [3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment? E Yes
❑ No
❑ NA
❑ NE
/ v : 3 ref 8�-�- �S�aD /% r�-!`i; v�i G •-r' e`er
oto . C�iot t Cuck s adsf>/s� !yl i j7r% �vrm� lc��y, i F. /V
Bl'l /¢/`ri�"O�iGr.l Sir"'' Crime c� 1.rre� d-D�`�1c9d� i'7 gf ,��G % C�rT`tea�i S hZorcf i
��au�>✓ SPr� Gam-,.. u�� �7u� : -, ��.- �.s>7`�� �
Reviewer/Inspector Name y. Phone:
Rcviewer/lnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: o� Date of Inspection
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? if yes, check ❑ Yes ,g No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA CKNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
0 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ElNE
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
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
19 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
tRNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9No
❑ NA
❑ NE
Addiiiona"1-6"mments andfor DraKings ''--"° :'>'-::
�r�- s�<'� a�rdF �o--`� �;rd �c�rs�cr /yl/`• L ;..�5�, h c .,�'.������ �.��
a-�to� ��aG � a� %Vd l-o� 8� � � * �` Tv p<� v�.✓�`�a >� /�`ra,r�,_ �-a�� �i.
5 err lcAV%i a �F l � � ��Gua 7�r OL", s/ of �
i �r�rn w t I "ec"Ve__ a-
6- 17 DF t-r G-e'0_" JQ. -P""nF}' 111Lr /poaa£,
Page 3 of 3 122128104

�l
Type of Visit Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit; io Arrival Time: Departure Time: County: L�?56t j Region: a�
a"��` /-Z
Farm Name: t, Uo Owner Email:
Owner Name: +'mow I(-- Phone:
Mailing Address:
Physical Address: r f a r
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Cl
Phone No:
Integrator: �L w�
Operator Certification Number: 1Qagk
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f = « Longitude: 1:1 0 0 I = «
Design
Current
NDesign Current
Design C•nrrent
Swine Capacity
Population
Wet Poultry Capacity Population
❑ Laver
❑ Non -Laver
Dry Poultry
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers ers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars I
I
❑ Pullets
❑ Turkeys
❑ Beef Brood Cow
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
9 NA
❑ NE
0 Yes
❑ No
J�bNA
❑ NE
PRINA
❑ NE
❑ Yes
❑ No
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
1ja No
❑ NA
❑ NE
Page 1 of 3 12/2&104 Continued

Facility ;number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ;8 NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t♦
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.) l
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes QIPNo ❑ 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 10 No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No Cl NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) 1
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill Application Outside of Area
12. Crop type(s) �lr'f , D
13. Soil type(s) 0,244 M_ -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EpNo
❑ 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
[)FNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[§No
❑ NA
❑ NE
Rcviewer/inspector Name MR A ;� Phone: U -- L 3 3 ` 3
Reviewer/Inspector Signature: Date: allky
Page 2 of 3 1212 104 Continued

• Facility Number: — $ Date of Inspection L�L�1LJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W M P readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El other 10
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Y) No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Vj No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�j No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
��y�
lr' ! @@ No
❑ NA
❑ NE
Additional Co ehK-Andler Dra gs_ �'� , r
Page 3 of 3 12128104

I •
Don of Water Quality
BID-.
==acflitymber g2 ` Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G u Arrival Time: �p •',,,,•rr am Departure Time: County: Region: tW
Farm Name: Owner Email:
Owner Name:L,Phone:
Mailing Address:
Physical Address:
II �
Facility Contact: v'[J4 r" U^ / . Title: Phone No:
cr .��,p
Onsite Representative: Integrator: '" "' " C_
Certified Operator: Operator Certification Number: deg
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: 0 0 =1 a Longitude: = o 0 u
F�
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Paaltr�y Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer
❑ Dai Calf
fPFeeder to Finish �l�
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ farrow to Feeder
❑ Non-Daity
El Farrow
Farrow to Finish
Layers
El Beef Stocker
ElNon-Layers
ElBeef Feeder
EGilts
Boars
❑ Pullets
❑ Beef Brood Cowl
ElTurke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[]Yes
QgNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

c
• 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 PNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 11,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oZv u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�] No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�3 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
[INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes bNo ❑ NA ElNE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind /Drift ❑ Application Outside
of Area
1 Z_ Crop type(s) eoaCj4, c Ll SS 4 ' "SY�,P 7� ` C713,-
13. Soil type(s) F-4 Lj'2 rWab
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes (jNo ❑ NA ❑ NE
❑ Yes E?'No ❑ NA ❑ NE
Comments (fifer to question.#) : Eitplatjn any l ES answers and/or anv r_ecomtn ations - any other commetEts.
'Use draivings'6f facility to-better.expliim situations (use -additional pages as necessary):
:.
Reviewer/Inspector Name
� -
{r f `'�k Phone:
..
Reviewer/inspector Signature:
Date; 1
12,128104 Continued

l
Facility Number: 2 Date of Inspection of L
Required Records & Documents r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ yes No ❑ NA ❑ NE
El the appropriate box. WUp ❑ Checklists ❑ Designs ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ((❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J�j No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�)No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P_INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
ElNA
ElNE
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
ONo
❑ 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
ER 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
qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
12128104

}
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine t) Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County: Region: iimoQ
r �
Farm Name: t rL_IL�I tf /1 _Z + r1`C(SjrplVxr � � , - Owner Email:
Owner Nance: r� D+1� t �ht�,(�.Phone:
Mailing Address:
Physical Address:
l
Facility Contact: Title: Phone No:
Onsite Representative: t Integrator: ' t/►Tlwt'�
Certified Operator: u Operator Certification Number: I f1040161'
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 I = u Longitude: = o = ` 0 -
�'Destgn
C t
,� Destgn-.,� Current
Design Current
Swine Capacity
Pop h
K ultry.
CapityPoliulation
C•atile
Capacity Population
❑ Wean to Finish
❑Laver
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish a� % O
` '_-�
❑ Dairy Heifer
El Farrow to Wean
EI_Dry Cow
❑ Farrow to Feeder
-
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
El Stocker
❑ Gilts
❑Non -La Non -Layers
El
❑ Becf Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
`.
❑ Turke s
❑ Turkey Poults
❑ Other I. _
❑ Other
Number of�Structures:
Discharges R: Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [] Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes PONo ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
(�NA
❑ NE
❑ Yes
[:]No
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
EpNo
❑ NA
❑ NF
12128104 Continued
J

4 v
Facility Number: —
Date of inspection G! Z
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
0 No
PIA ❑ 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
ONo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EkNo
❑ 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
M No
El NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
4No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:1 Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s) Fa ev j
14. Do the receiving crops differ frotn those designated in the CAWMP?
❑ Yes
YI-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA
❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
FNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
[P No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Reviewer/Inspector Name ` ... Phone: lfi
Reviewer/Inspector Signature: Date: q
Page 2 of 3 12/2"4 Continued

Facility Number:znm Date of Inspection 2?
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Cl Yes
YiNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EpNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
FNo
❑ 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
Eallo
❑ NA
❑ NE
2T
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
G�:No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R.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
EPNo
❑ 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
IpNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tDNo
❑ NA
❑ NE
Additional Comments and/or Drawings: ` `
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
El O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint C) Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i %,— Arrival Time: Departure Time: r CQUCounty: S P12Y r- S Od Region:
Farm Name: t t� �+� i� Owner Email:
Owner Name: , Fr'av%k 1, ,t t-+ nd' Phone:
Mailing Address:
Physical Address:
. ff
Facility Contact: f�T i�1 DtiSd..r "Title:
Onsite Representative: l(
Certified Operator:
Back-up Operator:
Location of Farm:
U
Phone No:
Integrator: u�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0'= Longitude: = o 0'= u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
al —ceder to Finish a
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
y
❑ La er
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current:
Capacity Poprilatiioc
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
11
El
Beef Feeder
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State {gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �PNo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
/oNA
El NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑Yes
lyNo
El NA
El NE
12128104 Continued

Facility Number: —
Date of Inspection D D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
a. 1f yes, is waste level into the structural freeboard?
Structure 1 Structur�ef 2 Structure 3 Structure 4
Identifier: i 4 4 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26_ 3 3 1
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
;DNA ❑ NE
Structure 5
Structure 6
❑ NA [:1 NE
❑ Yes No
❑ Yes I?PNo ❑ 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 ONo ❑ NA ❑ NE
S_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes FNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes CR'No ❑ NA ❑ NE
maintenance or improvement?
Waste Ao nlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes i?] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1f yes, check the appropriate box below. ❑ Yes 9 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 Accepta�bleJ Crop Window ('❑�,,E,vidence o�f(Wind
1Drift ❑ Application Outside of Area
12. Crop type(s) Ccas4 .I &rm ja tom` `.-i &5 �QS 1 ,sM , �+I\ (Jj/Qysea !
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [J] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Y No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Ep No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [19 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® 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):
Reviewer/Inspector Name Phone: /f1 3ov
Reviewer/Inspector Signature: Date: Cri
12128104 Continued

1
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (19 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
q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[b No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
m 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
19 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
f0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

FA
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 49 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
I It
Date of Visit: to O ff Arrival Time: a , SPDeparture Time: d1.2O M County: S0 N Region: M
Farm Name: rtYl�ll�'l L' IMC� I �� Owner Email:
Owner Name: Em11 F-a l� Ui Phone:ftTJ sbq'y0 1
Mailing Address: asW \VIC ". j W,-kM AG 90 a*
Physical Address: �~ _, J
Facility Contact: ^r �n k t x Q42444 Title: Phone No:
Onsite Representative: i' ��'11t_�+t'i Y t""`sa-t Integrator.,I.LrIP' 7
Certified Operator: Ft``tttn Un"` Operator Certification Number: IgORA
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude:
Design Current
Swine Capacity Population
Design Current
Wet Poultry, Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder 1110
Feeder to Finish J 1Dip
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
JEI Layer
Non -La er t
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dai Cow
❑ DairyCalf
❑ Dai Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
El Beef Feeder
El Beef Brood Cowi
pf Structures:
❑ Other 10 Other
Iplumber
Discharges & Stream lmoacts
1. is any discharge observed from any part of the operation?
❑ Yes
[KNo
❑ NA
[I NE
Discharge originated at: [] Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[)aNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C$PNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
K,No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1
Facility Number:
Date of Inspection 1 4
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 I Structure 2 Structure 3 Structure 4
Identifier: I s g
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 P No ❑ NA ❑ NE
❑ Yes ❑ No Pd NA ❑ NE
Structure 5 Structure 6
❑ Yes "No ❑ NA ❑ NE
❑Yes P5No El NA ONE
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 tR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F3 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window (Pq4t4-e_
❑ Evidence of Wind Drrift ❑ Applli/catioon ,Outside of A�reeaa�, f12. Crop �(s) Q0.5� &-MLJQ 4qj , Sr'v�"` C+42 — 0�7CBI
QQ r
13. Soil type(s) Q V 1- FQA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 29 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 12 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes JR No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
'Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comiiiii s 7
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspec.ter Name I �Qy�l Phone: '90 fV 330
Reviewer/Inspector Signature: Date; /o 1.7104
Pane 2 of 3 12I.NVU (bntinued

I
Facility Number: Date of Inspection I y/y/poJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Nl No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriatebox below. dqp Yes GJ'No ❑ NA ❑ NE
El Waste Application El Weekly Freeboard Waste Analysis ,Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C ,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(N No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
05 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [ANo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No`❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
[I NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
V] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�3 No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
F] No
❑ NA
❑ NE
Additional Comments and/or D I. w. ' gs: . .
` � m cL C.kctM Vs i q..S re Col�,w v�
pt� i a K S 513i r rS�2c�,br► . )
Prna�ses rreJi e� reo� b jj P00 tmr sonr►e.1
Page 3 of 3 12128104

Type of visit 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �i •ZO•o� Arrival Time: 8 i Departure Time: County:-_5f_)esv7 Region: FeC
Farm Name: L.":Is . �a�'iry i _r e" Owner Email:
Owner Name: Fr' „lel: 4,'.,;&� Phone:
Mailing Address: -2560 F've Qr,a/aP Roe C/nTon AIC ;?93_'2A7
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: Frew/!/,� Lnc✓sa,.
Certified Operator. Fran%' L;� rdr
Phone No:
Integrator:
Operator Certification Number: /912A&
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11 Longitude: = o a
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
Eafeeder to Finish
1tio
00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
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?
Design
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 62' o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
,�[�,,'Fo
❑NA
❑NE
❑ Yes
E? o
❑ NA
❑ NE
12128104 Continued

t
Facility Number: -
Date of Inspection ?o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9 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:
Spillway?:
Designed Freeboard (in): /01
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EKo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 21qo ❑ 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 [3No ❑ 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 [21 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EXo ❑ 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
POutside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
2�G p type(s)
-,13.­1 "e-efs}
14. Do the receiving crops differ from those designated in the CAWMP? 9"Yes
El No
ElNA
I --]NE
15. Does the receiving crop and/or land application site need improvement? ElE Yes
o
❑ NA
N
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes
ElNo
[INA
[3*<E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
[Q NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes LBNo ❑ NA ❑ NE
10le&se
See r1cof4e
a., /a,e
Pletw
privot'Wr uottl
5pr-AL7
Reviewer/Inspector Name - ,. „. Phone.
Reviewer/Inspector Signature: Date: 475`-
12/2"4 Continued

Facility Number: ,�l - y5 Date of Inspection S• TT6—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9'11-o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CArr--WMMP readily available? If yes, check
Bles
❑ No
❑ NA
[I NE
the appropirate box. ❑ � ❑ Che sts 901 esign [:]M�Oqtker
21.
Does record keeping need improvement? If yes, check the appropriate box below.
4•Ir lads 1. G 3, y- { +-fn -! t.tr "�
Yeses
[. �•l.�
El No
❑ NA
❑ NE
❑ weftrApoi,& t ❑ ❑ "Waste-Amalysis ❑ Srni-ftiriftp515 ❑ YAMFTERMfers
❑
❑4tsia" ❑ Vo&eking 0, rop Yield ❑
❑
Wr&ftM-05-_de`
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ja<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0'i-o
❑ NA
❑ NE
24.
a,? r
Did the facility fail to calibrate waste applic n equipment as required by the permit?
❑ Yes
O<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D-Go
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
9WE
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
C3 No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,ter
U 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
0'No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
eNo
❑ NA ❑ NE
A+iditioreal Cotnmeots"itnd!©r:dr Drawings:
-2O PI,eAse G11 mof s *7pSa„ nIRcS a On�rh ci Lodi O� yd of la3 pail
9n an.,l lolegae glare {1idAn f'n F4�� reGo�d
t
t Ri2v� e►H,eol C-ra'd i :Gld fdrm-5
has p , 4_ all rl,& ldj r`n C.oaa o� /% Bel fife a, cae Ca•7P%
az
oa^ Qq+'e�e / 3 Soo II /
Ces h ass . �als" �a �..,.0 G Gq e y alit w us
I'0 �:Ir, !.•��sar spt;9�,[ �'.'el� ra< 7 lGs� Fu,J/ �d� rpps /ml
C9verSerJ >v f� / f/ I
nP, r' e`I'J w Ff Goavl' ( -Galt 1
12128104

Type of Visit c7. Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit O Routine +O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Facility Number 82 458 Date of Visit: 11129/2tiO4 'Time: L30
0 Not Operational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: FtrnJkiitx.l. Wdsay..F',arm..,.Inc...1.:.2........................................................ County: Smmpsoa........ ................................... FRO .............
Owner Name: I!.e•attllc a ................................ Undray.................................. ....... Phone No: 9d.Q.5.64.409.I.................................. .............. .........................
Mailing Address: .................... ClixtWil c..........---.......................................... ��5.............. 5 �.GQ.Firx..�ridgti.road................................................. ..... 2
Facility Contact: ..........Title: ................................... Phone No: ..................................
--- -
Onsite Representative: Fralaklittl ixtfty..................... ............................................................ . Integrator: C�►rxtRtl'.s.EagidS� ��...-----•---•--
Certified Operator: FlrAljItluq...-...-............ -........ Wdsa.}C............................................ Operator Certification Numberj9Q5(.........................
Location of Farm:
Farm is located 4 miles West of Clinton on SR 1311 on the right side of the road.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 ' � 45 Longitude 78 ' 23 L 25
_ Design Current
Swine Canacity Ponulation
❑ wean to Feeder
® Feeder to Finish
2140
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Nuniltier of Lagoons 2
'Desigq_ Current. .Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
'Total Design Capacity 2,140
Total SSLW 2881900
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If ves, notify D WQ)
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?
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Identifier: ...................................
Freeboard (inches):
12112103
Continued

Facility Number: 82-458 Date of Inspection 11/29/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes ❑ No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc > 3000
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
C] Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Gommenis {refer to quest�op Exp[atn any YES answers and/ar;any' recommeindahi3ns orally other_comments
Use drawEngs of facility to better eapt_atn sttuat�ans "(use additional pages'as necessary) r ❑ Field Copy ❑ Final Notes
� received a complaint about Mr. Lindsay spraying on bare ground. I met Mr. Lindsay and viewed the field and irrigation event in
tion. He immediately had the pump shut down, letting the reel continue to wind the traveling gun on in. Apparently, the hired
cer set the reel for Pull #7 (com, wheat, soybean) instead of Pull #6 (bermuda, overseed). I estimate that the pull was about 2/5
plete. As long as Mr. Lindsay plants his wheat within the next 30 days, he is within compliance of his WUP. Mr. Linsday, howeve
considering holding off planting the wheat in anticipation for switching Pull 47 to a bermuda/overseed rotation. I told him I would
stigate the possibilities with my supervisor and contact him over the next few days with what I found out. I recommended that he
act his technical specialist early in making any changes to his sprayfields. Mr. Lindsay was very cooperative with the whole visit.
T
Reviewer/Inspector Name Todd A Bennett =_
ReviewerAnspector Signature: Date:
12112103 Continued

(Type of Visit 0 Compliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason for Visit O Routine Complaint O Follow up O Emergency Notification 0 Other 0 Denied Access
Facility Number 8 Date of visit: l l Z o Tune: /= 3 0
O Not Opeational O Below Threshold
®.Permitted PI Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..
Farm Name: _ _. _ ._ . ... __ County:. S V...
Owner Name: �Fr�� K L i c _ 'Phone No: ,-
.MadmgAddress: _7J,� 100..--- i�rP_ �r�e���4 ROM. ..... 1!6�� sa
Facility Contact: _ r� U Title: Phone No:
Onsite Representative- „- r� j_ __' �-+� ,- -- .. Integrator.
Certified Operator: _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ���
Dischmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
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 Stricture 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: &Z — YS$ Date of Inspection EUyR
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ Nc
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 maintenanceJimprovement?
❑ Yes
[--]No
9. Do any stuct res lack adequate, gauged markers with required maximum and minimum liquid level
[] Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenaneerunprovement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
[] Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
FE0 LLreee:v*A m Mr. L;AJ1 sP,-a,.{:,,,� ou ia��e �r,C„J.
YN.t.T utl '{ ""� ��. 4 a �aq,�{{,/ (( SM� l� C�.�J�-d` l "t i�I �CJLLtlL qA,w� �V�� S r� i Q G���� CJ�'` uO1.If.��►"�' �`�.
olvr'5;r�CTn . �� i v.4w, �e�: w `�i1A/ �Q /� `�i"Q P�J+�f �p cS, LJ'r D►pW*� ' �L% 17—+ `1 •� �T �.�`
t o-'(4 rive -10 w;.,,.� -h�e-}�a,,�t g,"1\ `�'` �" Q t f , t►"Q c.• �Se wGi�+�C
Se+ it e- r,rx l *,ac- Vv tl (>, d / (o
CiDerv�ucQw ON�rSEC� J • e5 wra{-c `�'�a"� '�' fly We's aLL01.) "
Cc(ee . s (cr--e [l s Mr-. L:•5 �"1 p�.4..-E s 1.�; s u1%¢ cx-� u�+ '�4 �..� `F-�
h�,c'f 30 �Qo�s , �tt �S wr(�i••� crr�..-p (l �o�..1 �e O� k.s W4iP AAr-. L- s .
Reviewer/Inspector Name -
Reviewer/Inspector Signature:
Date: t
l iliF/VJ

Facility Number: . 0 Date of Inspection {{ p
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other hermit readily available?
❑ Yes
[] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ waste Analysis ❑ soil sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewedlnspw= fail to discuss reviewImspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32, Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33, Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form 0 Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were toted during this visit. You will receive no farther correspondence about this visit.
li � r Q Baer •-•1 l ova
c Di L ciT►. X -6lt� M��""� k]p�)�of 1KVGS��ia�-tL T'�¢. ��3Ssl�. G+i eS
eA,4 CCI +,L-c--+ ice• .N. �over- At*- ,n e-rcf -Ca--,r oJOLys
Val S 4#_ ic_" i c_M f Scfer_. b\ 1 eM.� • Y t rl v4'�044ti arth.t e �"Cl' 3 t?
5fy4 a [JS �r. �:,... Co w aS vEc Y cnca aT� vE .,i�'F ►a �
V,Si+.
12112M3

I
of Visit i Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit a Routine Q Complaint Q Fallow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit.: (, / D Tune:
Q Not Operational Q Below Threshold
0 Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ---•--- —.-_..
r�+nK%,'n L,`nA....r .f...:.�?.�'s�'_f ............. County:
Farm Name: ................ ............----............. ....��.....
Owner Name: C .0 �r_e2l41r !1.............. , n 4i ................. .............. ..... Phone No: 9/D... ...... � y=...410 9L .........................
Mailing Address:.._.SG
Facility Contact: r........le .......... L : �h �!�&L� ....Title: Phone No:
Onsite ve: Re resentati'
p FC�n.���r..a...._._.....__. L_. �Aa�....... -................. ---- Integrator:•--1�.V..r�.�.i.�s....._....:QI.AI�,E�...__............_.........
Certified Operator:........, Fl ,2ft-L:rx 206071 Operator Certification Number:
Location of Farm:
• I�
E14wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �` ���
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes B'fqo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 01 o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑-ice
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes GNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes G No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........�.................. —. ........
Freeboard (inches): %
12112103 Continued

1 Facility Number: Q 2— Date of Inspection l i
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 maintenancelimprovement?
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 maintenancerimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop hype ,(Se/'n*vol, <.,..r,// Gru,'.
13. Do the receiving crops differ with those designated in the Cerd
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?
❑ Yes B—NO
❑ Yes M lido
❑ Yes Leo
❑ Yes MW6
❑ Yes QNo
❑ Yes 9 No
❑ Yes O No
Animal Waste Management Plan (CAWMP)? ❑ Yes
&Ko
❑ Yes
[ o
❑ Yes
aNO
❑ Yes
E No
15. Does the receiving crop need improvement? ❑ Yes [i WO
16. Is there a lack of adequate waste application equipment? ❑ Yes [Nb
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 3 Flo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes BNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [No
Air Quality representative immediately.
Comments (referrto ghota �) Explarru� aay�YFS at�swets and/or apy ns or nay other comments. -=- --
,
,Use drawings of fatty to�better'explam srtuataons.�(useadd�t�ana! pages as necessary} �.. geld Copy ❑Final Notes € �- ='
Reviewer/Inspector Name
Reviewer/Inspector Signature: ate: / / S -O y
12112103 Con>weued

Facility Number: gZ _ ysff Date of Inspection /
Rcauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
g-Mo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel W�;�h k3ists, rleSigTT, Traps; etc-)
El Yes
o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[jNo
OWasteAOUca6on ❑ Flfebeard ❑ W_� 0-55eil-3ampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
O-No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9Vo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[-No
NTPDES Permitted Facilities
KM/3
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
51-Ko
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M4410
32, Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑c No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Leo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
[-No
35. Does 5ecord keeping for NPDES required forms need improvement? If yes, check the appropriate box below. El Yes Q No
0or Ck /15
❑ tocking Form ❑ Crop Yield Form ❑ cif ff_ ❑ " Rain
❑ 120 Minute Inspections ❑
13 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
PF35-- Rev:,eweLrclo Y'C!!� �cJr`wr5 GnC/' IVf] j:��'�v�C rnsPrcf.Ohs
Ald-1 r
rot Was[ Re✓;ecvtanarrS•s 5a�+� �`yg , (60 c/a;,s 4eIrotc
Alasle aPP 11'ca/.';,-i even l ;. 1
14t L"'),;D7 405 plans 10 Mv4V a/'ovnd r(10)0011 6uh�1 s Gv�ir.
Ass ��s4 4-og 's %e,Oc.,[%«(
Air.
L,'acicaX
tiu5
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9 t7uS rs
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12112103

(Type of Visit (compliance Inspection O Operation ReviewO Lagoon Evaluation
as Reon far Visit O Routine O Complaint O i=ollow up a 'Emergency Notification Oder ❑ Denied Access
Datt of Visit:
Faclliiy Number
© Permitted 13 Certified p Conditionally Certified 0 Registered
Farm Name: _. Frtt,,Ki n^ J'-'-�s��� ,.. _ �anMS_ ........ _ _. _ _.
Owner Name:
Kading Address: ° � o _ �; � ^ _ . lea_
Facility Contact:
Onsite Representative:_.��`''
Certified Operator:
Location of Farm:
!g o Tune: !I: as
O Not Operational O Below Threshold
M
Date Last Operated or Above ThreslyQId: .._..-
County:.....C_°
g
Phone No: ».».».._ f19�
Phone No:
Integrator: „ �.. )9 ib " ..t
Operator Certification
dwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C�4 " Longitude a 4 C4
Discharses & Stream Im cts
1. Is any discharge observed from any part of the operation? 9fes ❑ No
Discharge originated at: El Lagoon ❑ Spray Field &&er M-6c
a. if discharge is observed, was the conveyance man-made? C3 ;s ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) EKes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? / ±V ".
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) des ❑ No
2. Is then: evidence of past discharge from any part of the operation? ❑ Yes &<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ala
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ej_N_o
Structure l Structure 2
Identifier- .............r........... .....
Structure 3 Structure 4 Structure 5
Structure 6
............_.....................
Continued ,
Frecboard (inches):
12112103

Facility Number: 8 2 — `1'4;8l
Date of Inspection =% a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
b. 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" IA/ i r
8. Does any part of the waste management system other than waste structures require maintenancefmprovement?
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 maintenancelimprovement?
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
k 14)41�,c' IL opt 4
okr-
❑ Yes GKO
❑ Yes [R'Ko
es ❑ No
Er'fis ❑ No
❑ Yes [ KO'_
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Field Copy ❑ Final Notes
�+1� ✓R%� "�[ RIL t�crZ pow- trUl`iti r �� K �s � !�L , � t".�. SCry KC Mr-.. � � �
4
LD
t::j
�II ��-i-•l1�1 �1�r,a'�+, t+t�y"t� -tom t�+c1` L'n('h�`� ��'�C'ti-K . S�+o►1
Gu�O(a 1t�tt✓dwr, (5 w, . a S..�/�^^� kHJ Nr. f r1
i tlN CJ.n-ice —,. 4 , h "f 1 1 ,� 'to ow"K—,t+vC- A4`1 y,� �:wwf f 4n0 Hw
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: — Date of Inspection C=
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
28. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
S,t" &xcp, , Ow`
lj+'1iL4 , M4) 1�aw. 1q°+r�G..`�i, ,`vt� trtPt O•1 S a1r j t.%v,/� wAivtxl `�,f
a •�.Ito„J � ..�,�.��-bti '� i t��". �� s`fu�a `�„'� `itK., i„td �� �S .�rr..h Z„�,t�'Ir �'s.,
as �.-..� -rz. �.�k of "Ptr, � 74
eg�`� �i _ f - _ f , r1 n
'_4 Y�cci 74 Ultil VA -Kt �LVisu.S � Ac_ b� +-n 6i rj � t U+�1 /�� � &.4vt 1,40C
o�► t lly . �� .µk t a _&or 5.5._ee 'j Selo �b It� +� ►r�.�+i,
CL_ ®,�-r-I a. ptt5t:r}ti� 4,4"+j a(z ),
�e
iL4�
12112103

Site Requires Immediate Aff=tion: _. t4cs
Facility No.
DIVISION OF ENVIRONMENTAL MA.NAGEMF.NT
AN 4AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: As , 1995
Time: to '• 3&
Farm NamdOwner: Flu oskXi, v% L , n
Mailing Address:_ �- 1 Lao X R%,a +yc yam;
County: So r, fw-.0c) -- -
Integrator:_ C.K-y s F� s c _ _ Phones
On Site Representative: PyA %. Phone:
Physical AddresstLocation: f i"'Ate .0es�-
Type of Operation: Swine x Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number:
Latitude:_J.,r " cim " Longitude:°
Circle Yes or No
ACNEW
ail
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard:___I_Ft. —f.,Inehes
Was any seepage observed from the lagoon(s)? Yes or�as any erosion observed? Yes or(&�)
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? r No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or,No "Ot-
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or No If Yes, Please Explain. 't a
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No *s ­eL
st
-Additional Comments: 'ec1-kv*jk
s rpta.w11Z, r—n, . ;g3Z&4- ��
Inspector Name VI-= ,� cik..,:ft1- a?c��..a! o t�tc Signature
SU -C '7r4 +,\3&tL0%,.0. [31d.
[=oLy t4*k (le NC .2aso 1
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: /JO
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J 1995
Time:
Farm Name/Owner:
Mailing Address: V- -. i i' C j`Li U-1_�R'% o,jE - - - - -
County:�,�� - - - - -
integrator: Phone: - q(C) Sct 2_ _rn 141 _
On Site Representative: 6VDa.fPhone:-Q , o_ Zjf
Physical Address/Location:
Type of Operation: Swine
Design Capacity:
DEM Certification Number:
Latitude: " 01
Poultry Cattle
Number of Animals on Site:
ACE
Longitude:�7 Y° .da'_"
Circle Yes or No
DEM Certification Number: ACNEW
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard:,2 Ft. _0 Inches
Was any seepage observed from the lagoon(s)? Yes or & Was any erosion observed? Yes orjj o
Is adequate land available for spray? Ve or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _ _ r sv._ �l a Cca s k- -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Tes or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 1P
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or(j�) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.