820590_INSPECTIONS_20171231

Pri
NORTH CAROLINA
Department of Environmental W4

IType of Visit: QYCompliance Inspection U Operation Review OStructure Evaluation Q Technical Assistance
eason for Visit: &Voutine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: I JX &EtKrrival Time: 4 D Departure Time: County: 51 TN Region: (' �
Farm Name: -W— -T` ZT Owner Email:
i ` ^ r
Owner Name: Gtr [ Phone:
Of
Mailing Address:
Physical Address:
Facility Contact: ! `i �Q� Title: Phone:
Onsite Representative: t Integrator:
Certified Operator: fV (� 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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
S. 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
Design Current
❑ NA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capaci#y
Pag.
C*attle C*apacity Pap.
Wean to Finish
[:]No
I ILayer
I
Dairy Cow
Wean to Feeder
I JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1&0 j
D . P
I Layers
Design
Current
Dry Cow
Non-Dairy
Beef Stocker
Gilts
I Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
,..
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
S. 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
l.7 1""
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[] Yes
[] No
E+WA
❑ NE
[] Yes
[:]No
[g -NA
❑ NE
❑ Yes
❑ No
[;a,<A
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[:)Yes
El"No
❑ NA
❑ NE
Page l of 3 2/4/2011 Continued

F'acifi Number: IDate of Inspection:
dr
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes [P�ts ff9A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [algA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
❑ Yes
Identifier:
❑ NA
❑ NE
Spillway?:
[:)Yes
Q o
Designed Freeboard (in):
❑ NE
the appropriate box.
Observed Freeboard (in): �L� —
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes ❑ No
©.bA
❑ 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
[E VA
❑ NE
waste management or closure plan?
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? [—]Yes ❑ No
Eg-<A
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
(31A
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
EfN o
9. Does any part of the waste management system other than the waste structures require [:]Yes ❑No
L20'9A
❑ NE
maintenance or improvement?
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
jEr'&A
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ No
2lA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [D Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift E]Application Outside of Approved Area
d4w
12. Crop Type(s): S W_6 jU`
13. Soil Type(s): IiiJA' Aq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ 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?
Reouired Records & Documents
[:)Yes �o ❑ NA ❑ NE
❑ Yes V3"'No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�lo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, cbeck
[:)Yes
Q o
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfN o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili umber: Date of Ins ection:
24. -Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �o
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:
Er NA ❑ NE
Cgs A' ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
-PKo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
DNA
❑ NE
Other Issues
2$. Did the facility fail to -properly dispose of dead animals with 24 hours and/or document
❑ Yes
�--.��
©-1
❑ 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
R<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
®,Kb
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2'lqo
❑ 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
❑r NE
Comments (refer toquestion f: Explain any YES answers and/or any additional recommendations or any, other,comments man,
Use drawings of fadility to better explain "situations (use additional pages as necessary). "
_E..
0 ury u
f
Reviewer/Inspector Name
Reviewer/inspector Signature:
Page 3 of 3
Phone: U-3-333
Date: l 3
2/4/2011

S
Type of Visit: ff7Routine
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: , �7_ County: &gZr Region:
Farm Name: T 6-lZ , a r� Owner Email:
Owner Name: A V_ SIL _LI N f.— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A f` s T
Certified Operator: 1 I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream lmQacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑-P A ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Q -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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
Design Current
L }J NA
Design
Curren#
D —es 1 g–A C►etrrent
Swiine
Capacity Popp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
A
Ca ae'
Pa
—Dry
Non -Dairy
Farrow to Finish
W D
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmQacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑-P A ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Q -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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
L }J NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
Page 1 of 3 2/4/2015 Continued

Facility Number: -cl Date of Inspection: T f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] No aJSLA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3 --NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [7'l o ❑ 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
ESA
❑ NE
waste management or closure plan?
Do the receiving crops differ from those designa ed in the CAWMP?
❑Yes
❑ X10
Q NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
Q-Kk
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
[❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
[:]Yes
❑No
[]-N•A
[] NE
maintenance or improvement?
❑ Yes
E]"No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
i
[JNA
❑ NE
maintenance or improvement?
Renuired
Records & Documents
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fffNo [2-9A ❑ 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):-wAI(te4 co—r' 6 a S
V
13. Soil Type(s): tie( :�
14.
Do the receiving crops differ from those designa ed in the CAWMP?
❑Yes
❑ X10
Q NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[3'10
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes/[]�No
❑ NA
❑ NE
acres determination?
IT
Does the facility lack adequate acreage for land application?
❑ Yes
E]"No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L?fNo
❑ 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 CAWMP readily available? If yes, check
❑ Yes
[2 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 ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes d No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facili Number: jDate of Inspection: 11
24- Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]-N"o�' ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[a-N_o ❑ 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 provide documentation of an actively certified operator in charge?
❑ Yes
F"T—No D NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Flo ❑ NA ❑ NE
❑ Yes Blo ❑ NA ❑ NE
❑Yes �o ❑NA ❑NE
❑ Yes 0 o ❑ NA ❑ NE
❑ Yes D-9-0
[—]Yes . "No
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
,( q a` 4,• yrp y - _ y recommendations or: any other coriunents. l"3
g ty' P a( swers an or- pages
_ w
Comments, re er to aeshoa; man }
Use drawm s of:facrb-to{belter et in situations use additionsPY
! a es as necessary).;
acJ U, L�,��-y V
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone ID-
Date:
2/4/2015

Water Resources
04VIROMMENVAL QUALITY
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
M Starling
Starling Farm.
6905 Maxwell Rd
Autryville, NC28318-9720
Dear Permittee,
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Director
July 8, 2016 RECEIVED
DEQ/DWR
JUL 12 2016
WQROS
FAYETTEVILLE REGIONAL OFFICE
Subject: Notice of Deficiency
Starling Farm
Permit Number AWS820590
Sampson County
As of this date, our records indicate that the above -referenced permit issued to your facility has
overdue fees. It is both a condition of your permit and required by Rule 15A NCAC 2T .0105(e) (2) to pay
the annual administering and compliance fee within thirty (30) days of being billed by this Division.
The following invoices are outstanding:
Invoice Number
Due Date
Outstanding Fee ($)
2015PRO 10687
12/6/2015
180
Failure to pay the fee accordingly may result in the Division initiating enforcement actions, to
include the assessment of civil penalties. Failure to comply with conditions in a permit may result in a
recommendation of enforcement action, to the Director of the Division of Water Resources who may issue
a civil penalty assessment of not more that twenty-five thousand ($25,000) dollars against any "person"
who violates or fails to act in accordance with the teams, conditions, or requirements of a permit under
authority of G.S. 143-215.6A. Therefore, it is imperative that you submit the appropriate fee as requested
within thirty (30) days of this Notice of Deficiency.
Please remit the payment, made payable to the North Carolina Department of Environmental
Quality (NCDEQ), in the above amount. Please include Permit Number on your check and mail this
payment to:
Division of Water Resources — Budget Office
Attn: Teresa Revis
1617 Mail Service Center
Raleigh, NC 27699-1617
Phone. [phone]
-contd.-
State of North Carolina I Environmental Quality I Water ResotueeslWater Quality Regional opeations
1636 Mad .e"ke Centcr I Ralcidi, Norah Caroliu 27697-1636
919 907 6464

If you have any questions concerning this Notice, please contact Animal Feeding Operations
Program staff at [phone].
Sincerely,
Imo, J 'S
Debra J. Watts, Supervisor
Animal Feeding Operation, and
Ground Water Protection Branch
cc: Fayetteville Regional Office, Water Quality Regional Operations Section
WQROS Central File (Permit No AWS820590)

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: EMoutine Q Complaint Q Follow-up 0 Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: lJ Departure Time: County: A410 Region:
Farm Name: .w �0.�"h Owner Email:
Owner Name:NEJ
�i-.�i'j Phone:
Mailing Address:
Physical Address:
Facility Contact: P4 F Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
N'4
Latitude:
Phone:
Integrator: I rC.1CI` C N 7 -
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle (•`apacity Pop.
airy Cow
airy Calf
' NA
Feeder to Finish
Farrow to Wean
D , P,oult ,
Layers
Design
Ca aci
CurrentDr
P,o
[Dairy Heifer
Cow
Non -Dai
Beef Stocker
Farrow to Feeder
Farrow to Finish /•r0
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
I I
Pullets
Turkeys
Turkey Poults
I I 10thff
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes DITTo ❑ NA ❑ NE
❑ Yes
❑ No
[SNA
ONE
[:]Yes
❑No
' NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[]
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
��No
g3r o
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes [3'N'o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/1014 Continued

jFaci4ty Number: Date of Inspection:Vff-Dry Z0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes or A ❑ NE
a, If yes, is waste level into the structural freeboard? ❑ Yes ❑ No GD,<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
13. Soil Type(s): fj"�Yti �� `"n4 N '-i'f
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
Observed Freeboard (in):
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Er<o
❑ NA
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1� 1 1"°
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
17. Does the facility lack adequate acreage for land application?
❑ Yes
[O No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
EJOINo
❑ NA
❑ NE
waste management or closure plan?
Required Records & Documents
No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[✓]'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[T 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
[TNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ERlo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurciSludge into Bare Soil
[3 Outside of Acceptable Crop Window E]Evidence of Wind Drift E]Application OutsideofApproved Area
12. Crop Type(s): K 4t
J r�
(� (�]�r`+Y/
'e' otrM
13. Soil Type(s): fj"�Yti �� `"n4 N '-i'f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Er<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[O No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
ZN o
❑ NA
❑ NE
Required Records & Documents
No
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-1qo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements E] Other:
21, Does record keeping need improvement? If yes, check the appropriate box below. [] Yes 2<o [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? [] Yes 2D'�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

FsciI4 plumber: - Date of Inspection:
24. Qid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [R1�o [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a PGA 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 214o ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes E31NVo ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
21 o
❑ NA
❑ NE
❑ Yes
D 11"
❑ NA
❑ NE
❑ Yes
E3"No
❑ NA
❑ NE
❑ Yes
I _I "'o
❑ NA
❑ NE
❑ Yes [p�No
❑ Yes O No
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments w t
Use drawines of facility to better eznlain situations (use additional wees as necessarv).
50,1 se kttr-s ,`_ z D E g
Reviewer/]nspector Name
Reviewer/]nspcctor Signature
Page 3 of 3
Phone: 433-43Y
Dater'
2/4/20!4

Type of Visit: ftyCompliance Inspection V operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Q4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r0 Countyy Region:
�rT ti
Farm Name:-[ r;''y►�f Owner Email:
V
Owner Name: rn -6qt 14,14q Phone:
Mailing Address:
Physical Address: " t 1<
Facility Contact: d E Y�v, est - _ _ Title: Phone:
Onsite Representative: f { Integrator: /Nrt '
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Carreat
❑ Yes
❑ No
Current
Design Current
c. What is the estimated volume that reached waters of the State (gallons)?
Design
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
CjNA
❑ NE
Layer
❑ Yes
[t -Mo
❑ NA
Dairy Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Wean to Feeder
No
J
INon-Layer
of the State other than from a discharge?
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul
Ca acit
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ NA ❑ NF
❑ Yes [:]No E�J^NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
La -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
CjNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[t -Mo
❑ 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
2/4/2014 Continued

lFacilky Number: jDate of Inspection:
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZLNa,-] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No �iA ❑ 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 Laf No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E5 ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I- P4*b* ❑ 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 Gam' o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U i`o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 100A or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Witldow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _f nulAt1w ,` LAALFU-T 1
7l V
13. Soil Type(s):
❑ Yes
eNo
❑ NA
❑ NE
14. Do the receiving crops differ from those designated in the AWMP?
❑ Yes
�o
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[!j'go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
❑"l Ido
❑ NA
❑ NE
acres determination?
[] Yes
r
[No
[DNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[[2No
❑ NA
❑ NE
RMuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[�rNo
❑ NA
ONE
the appropriate box.
❑WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
r
[No
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?�No
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
KNO
❑ NA
[] NE
Page 2 of 3 21412014 Continued

Faeilr Number: - Date of Ins ection:96 P
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes c[]-Ko� ❑ N;k —❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L E7<o C=NA ❑ NE
the appropriate box(es) below. ).
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels u1
❑ Non-compliant sludge levels in any lagoon 1
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 Q -No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 7L ❑ NA 0 NE
Other Issues
2$. 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 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[—]Yes E:dNo DNA ❑NE
❑ Yes
[5No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
Of o
❑ NA
❑ NE
[-]Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments S =
Use drawings of facility to better explain situations (use additional pages as necessary)-
c9�n Q&-t•wQ — b rwd r-Pcv
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: r,5 12Gr
2/4/2614

SNS 6145 0g1"113
Type of Visit: & Compliance inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-up O Referral Q Emergency Q Other 0 Denied Access
Date of Visit: 3 Arrival Time: Departure Time: Q': County:ds01
Farm Name: S+10/ ha ' (,ifm _ Owner Email:
Owner Name: H, F, S 111 a Phone:
Mailing Address:
Physical Address:
Facility Contact: v{ [�!� Title:
Onsite Representative: Hod- StW 16
Certified Operator: n '- NO (w9e grad _
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
[] No
[] NA
Dai Cow
Wean to Feeder
Non -Layer
I
❑ NA
alf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
[—]Yes
Design
Current
I Dry Cow
Farrow to Feeder
D . Paul
Ca aci
P,o
Non -Dalry
Farrow to Finish 150
ILayers
Ig No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Fecder
Boars
Pullets
Beef Brood Cow
Turite s
Otlser
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man -trade?
❑ Yes
[] No
[] NA
[:] NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (if yes, notify DWQ)
[—]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
tR No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
Ig No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection: C( jj 1113
1
Waste Collection & Treatment
[]Yes
Sf
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f No
(a NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
DNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:eL
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
W NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
NA
Designed Freeboard (in):
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
No
❑ NA
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.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
RNA
❑ 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
[Z 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
[a 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 AcceptableCrop Window E] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): fp`t (t j 141 . � � I}_ �C3f4hain-StA
13. SoilType(s):
14. Do the receiving crops differ fromthose designated in the CAWMP?
[]Yes
U No
❑ NA
❑ NE
l5. 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
❑ No
W NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[RNA
❑ 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 [] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes ❑No
❑NA ❑NE
❑ Weather Code
❑ Sludg; j*q
[DNA NEM)
0 NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection-,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No Eg NA ❑ NE
25, is the facility out of compliance with permit conditions related to sludge? if yes, check [—]Yes ❑No [,qNA ❑ NE
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
[RNA
❑ NE
[:]Yes
❑ No
®' NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes Cg No
❑ Yes CS1 No
❑ Yes CKNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain -any YRS answers and/or any additional recommendations or any other commen614�,4�=i*
Use drawings of facility to better,ex'plain situations (use additional pages as necessary). "5 :
dry �ot-,a/Tfib;Oki, C,-fff P_
(JAS e 561 `It�f was not cjore �I aoi l , L ilme Afi (a or a . -Ti is so-wi a, a- ke�c'e ae-
�� However, +h2- M-ei have JA54 aid- 80 +e+j aye now dr 1X eR 4d-
���y
NiAc l PICd Le.,-CCu
NOn-a013-FC-0370
Reviewer/inspector Name: h n4 -o -
A
Reviewer/Inspector Signature:
Page 3of3
Phone: q, .3 (Offif
Date: mo ll� O -IO 13
214/2011

113 Facility No.13 '-5S 0 Farm Name M Date
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
FB Drops
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
—Calibratio-n-Date
Design r _ 0'Actual Niam.
—------
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly freeboard .
Mortality Records
Cu -I Zn -1
1 in Inspections
Check Lists
Needs S (S-1625)
120 min Insp.
Storm Water
Needs- 1leather Codes
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
Verify PHONE NUMBERS and affiliations p
Date last WUP FRO FRO or Farm Records P l�
Date last WUP at farm Lagoon # ac
App. Hardware Top Dike sv r-9 —
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac

13
I ype or visit: ® c:ompuance inspection V operation tcevtew V structure Evatuatton V t ecnnicat Assistance
Reason for Visit: aRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: S � 1 � �Q/ Owner Email:
Owner Name: M, r, ..\ '1Y�111 Phone:
Mailing Address:
Physical Address: I497-tio` Hewn Pd lufyllfltp
Facility Contact: Willi` Title: dtliq �/ Phone:
Onsite Representative:(1 l /1j integrator:
Certified Operator: r} 10 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: FM
k
❑No
❑ NA
❑ NE
❑ Yes
5' No
❑ NA
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capaci Pop.
Wean to Finish ;:;
La er
Dairy Cow
Wean to Feeder
Non -La er
DailyCalf
Feeder to Finish
a.,
Dai Heifer
Farrow to Wean
Design
*U,
Dry Cow
Farrow to Feeder
©, l;ouI
Ca aci
P,a ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
11 111 111111 1 1
Il,111
Turkeys
he
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes g] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes
❑No
❑ NA
❑ NE
❑ Yes
5' No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

• Facilili Number: - M119 1 jDateof Inspection: CfjjR
❑ Yes
® No
❑ NA ❑ NE
20- Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
JR No
❑ NA ❑ NE
- the appropriate box.
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Weather Code
Identifier -
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Spillway'?: �^
J' NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
Designed Freeboard (in):
Page 2 of 3
2/4/2011 Conlinued
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
grNA
❑ 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
fo 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
12 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
O NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application ,•
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No R 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 Drill ❑ Application Outside of Approved Area
12. Crop Type(s): + 11''1
J
13. Soil Type(s): Vy'a No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No O 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
❑ Yes ❑ No M NA ❑ NE
❑ Yes ❑ No � NA El NE
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
JR 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
5& No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
J' NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
jg� NA ❑ NE
Page 2 of 3
2/4/2011 Conlinued

-[Fac Number: - I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 1,;j] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No 5JNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No [RNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes RNo ❑ 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 R 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 [X 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
C'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
�ZNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
S7No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
C'No
❑ NA
❑ NE
Comments (refer*ty question #f): Explain any YES answers and/or any additional recommend`aho or any aterilcomments ...i i'
w. ,.
Use drawmgs'oi.faeility to better explain situations'( use
additional pages as necessary,)
s. R docks wee- ( i6ek I n Apr; J wra , G� MS I b*, -0,e on U17,4� Wald 4S.
J
ai, So tSPJ rv$� a olle (n Q o
Pada, ks WI 11 be s iv �khed_in a brit Q woeG,.
ory lob, o/lti b rorhc ftw h34 r1a w d of -fo I f -
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
z 1�orL__S[ hit 5P 1 fir
h'
Phone: [phone]M Iffiv)
Date: a06�_
214%1011

type of visit: t7 Lompuance inspection t> operation tcevtew V structure tvatuation V tecnntcai Assistance
Reason for Visit: 1$t Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: E15.14 --i Arrival Time: i f Departure Time: County:,50AC#j
Farm Name:�S�� ��}id �Qrn� _ Owner Email:
Owner Name: �"� t + S ar i�a Phone:
Mailing Address:
Physical Address: 167 fiall4Oyn PA_ A/y_�l_lbe_
Facility Contact: w { I� sily I +�pl Title: Phone:
Onsite Representative: �1q Integrator:
Certified Operator: n —no leg= Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region: Fft
Design Current
❑ Yes
Design
•Current
Design Current
Swine
aeitl+ Pop.
a. Was the conveyance man-made?
Wean to Finish
Layer
❑ NA
❑ NE
airy Cow
❑ Yes
Wean to Feeder
Non -Laver
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
airy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dairy Heifer
Farrow to Wean
❑ NA
Design
Current
Dry Cow
Farrow to Feeder
Drti° P,ouitrr; _j.
Ca stili.
Po
Non -Dairy
Farrow to Finish
La ers
❑ NE
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
I 113eef Broad Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
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
ED No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (if yes. notify DWQ)
❑ Yes
O No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation'?
[] Yes
tS No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

• lFacility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No W 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: rfi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? O Yes ❑ No U 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 P 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
I_ Do any of the structures need maintenance or improvement? ❑ Yes ❑ No C&NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No 2 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 JR No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No jK' NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C'No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
B No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
[] No
:Q NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
CR NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
t9 NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J'No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
CB;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 EfNo Vj NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 0? NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No RNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: g - Wo I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No $a NA ❑ NE
25. Is the facility out ofcompliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No J�j 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes 7No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
[]Yes E6 No ❑ NA ❑ NE
❑ Yes [gNo
❑ Yes I' No
❑ Yes allo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any additional recofti &diiii-oon'"'s"'for,an)r.othiir comiiiF s.
Use drawings of facility -to better ex llin situations use additional pages as necessary)'--._--- ; ' 1
-sante Paddocks haye'plmvye�' `to s�do�- sU- h Prue �s j
9
�elmMh d t tiv *ayn�
Reviewer/Inspector Name: Z
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 916-9_3k3,33?
Date:
/4/20 1

7vs ��MS i�lal�
Type of Visit 19Xompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit aRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:® Departure Time: County: S2AjJ01Region:
Farm Name:siw Name:x 1 Fool Owner Email:
Owner Name: _ Phone:
Mailing Address:
Physical Address: ]
Facility Contact: M � � I iM _ Title: QW�1�'' Phone No:
Onsite Representative: ' { .1r I I'/)Integrator:
Certified Operator: n Ig-- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =O =6
=9I Longitude: =° 0 g 0 4,
Design Curnrentr�CEIIENo—�ne-
MJ Design Current
Design C*urrent
Swine Capacity PopulationPoultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
r
❑Dai Cow
a. Was the conveyance man -trade?
❑ Wean to Feeder
Layer
❑ NA
❑Dai Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Feeder to Finish
❑ No
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry, .
❑ Cow
❑ Farrow to Feeder
❑ Non-Dairy
to Finish
❑ La ers
❑ Beef Stocker
UGilts
❑ N ers
El Beef Feeder
❑ Boars
❑ Pullets Mets
❑ Turkeys
El Beef Brood i. Cow
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
RNo
❑
❑
Turkey Poults
Other
Number of Structures:
❑ Other
11/18104
Continued
Discharges & Stream lmoacts
I. 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 -trade?
❑ 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
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
tR"No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
11/18104
Continued

Facility Number: —SqO Date of Inspection
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: h ia-
Spil lway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No E�.NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ® NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ❑ No [}NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No 19 NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No RNA ❑ 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 J'NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D; No ❑ NA ❑ NE
maintenance/improvement? ,,{{,, __ .'
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes El No �lA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) I r it l 6 Annya l F V ✓/n rnI #~ Ti7}I7 a !
13. Soil type(s) Tllllr�d le �fNLiA I k ' hlpq r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
5;� NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
bd NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
UNA
❑ NE
17
( �.' �+ '•.*revsws g;
`Comments refer to gitestiobA.D Explain apv YES answers and/or an recommendations o ar ny other comments.
we drawings of facility ter better explain situations: (ns e: additional pages as necessary,)
M
p I..:; .
CL
) - "
Reviewerllns ector Name
Phone: ( 33— K3
ReviewerAnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facili*y Number: Val- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 15kNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA JR NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JE� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
RNA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
C3NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
tRNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
RNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
tR NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jallo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
t'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
3 l . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[fNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/lnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
19 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IR No
❑ NA
❑ NE
T�_.
Additional Comments and/or Drawings:
IS �6�n 1 Erle YV as s feak 4-h s yr?
a I, goi � some lef we_io i -e', 111`_0111_1r . iP e e_ b-,P-,fue6ticC do +it is al7nvat t
pr �� hDys, ��`hbi � -ef�e_e rnarf�-
p7 Vtzddocle, ha•.e_ Q cot, cnoY r� 4er,
Page 3 of 3 12/28/04

Type of Visit )@ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 116h Arrival Time: ;Q} Departure Time: pt ' 1 County: `'G'h S!n Region: FR -Q
Farm Name: %M Owner Email:
Owner Name: [ r „ . _ 1 r� ►1 Phone:
Mailing Address: FJ alit MQK we � � .� _ t( i
Physical Address:
Facility Contact: �](J 11 S�Q i l t11D1 Title: Phone No:
Onsite Representative: M I I 10'n i Integrator:
Certified Operator: IQ — Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number;
Latitude: = o ❑ I ❑ d Longitude; =0=6
o=6 = N
Design
Ciirrent Design Current
Design Current
Swine Capacity
Population_ Wet Poultry Capacih Population
Cattle Capacity Populanon
❑ Wean to Finish
; ❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Yes
❑Non -Laver
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dr, v Poultry
❑ Dry Cow
[INon-Dai ry
❑ Farrow to Feeder
Farrow to Finish
[I Layers
[I Stocker
❑ Gilts
El Non-ts ers
El Beef Feeder
❑ Boars
❑Pulle
El Beef Brood Cowl
O'tber i
❑ Turkeys
❑ Turkcx Poults
❑ Yes
❑ Other
❑ Other
Number of Structures: ty i
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ � es
[RNo
[INA
❑ 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
BNo
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
t�rNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

l �
Facility Number Date of inspection f0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No IWNA ❑ 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: 7110-
Spillway?:
l1t-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No
tRNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
15�No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
❑ No
1EjjNA
❑ NE
through a waste management or closure plan?
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
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
I tNA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
f5jTIA
❑ 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
JRNo
❑ NA
EINE
maintenance or improvement?
Waste Aoplication
10_ Are there any required buffers, setbacks, or compliance alternatives that need El Yes
D3 No
❑ NA
❑ NE
maintenance/improvement?
I _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
JR NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
N
12. Croptype(s) W111 a) Ann V
13. Soil type(s) AI vi !S' dS � I ✓0 i s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
CRNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
15�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No 10 NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
10 NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
9NA
❑ NE
Comments (refer to question #): Explain any YES anshe s an. any recommendatroris or amy other comments.''
Use drawings of facility to better explain situations (use additional pages as necessa
ry)
Reviewer/inspector Name oAJ t _ Phone: � 4roxal
Reviewer/Inspector Signature: Date: bf� 1(0.3001
12/28/04 Continued

tj
Facility Number: ga, —5g00 Date of Inspection
Required Records & Documents ,,��...`
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes l.APtvo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E' No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 51'�es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis RSoil 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 la NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 97NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No �rNA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No 91 NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No J'NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ff NA ❑ NE
Other Issues
.�,,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'gNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
Sod I Ara,. ,'j
Paddooc. ma
91-
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
OTNo
❑ 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
allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
No
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
[:]Yes
�El
IBJ No
❑ NA
❑ NE
A�ddrtional�Corurtierits�aeidfor D wings: �-
.�,,
,V I &1d s,s wor n o`k- d 01,e
91-ehe- �'O ane -owe 0007
on�
Sod I Ara,. ,'j
Paddooc. ma
91-
T
%,2/28/04

Facility No. T�L— 7 qO Farm Name SW/6 Date rfloki
Permit COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert)
Pop_ Design Current
Type
FB
Drops
Lagoon 1 2 3 4 S 6 7
Spillway
-Design freeboard
Observed freeboard in
Sludge Survey Date
sludge Depth ft
Liquid Trt. Zone ft
Ratio Slud a to Treatment Volume
Calibration Date 1 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date "7
pH Fields
Lime Needed
Lime Applied
Cu -I Zn -I
Needs P
Wettable Acres
WUP _
Weekly Freeboard
1 in Inspections _
120 min Insp.
Weather Codes
Crop rieia i ransrer Sheets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt(lb/1000 Gal
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records kAYvihI��O16�
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 ib/ac; Zn -I 3000= 213 lb/ac

Type of visit W Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up Q Referral a Emergency O Other ❑ Denied Access
Date of visit-. , ArrivalTime: Departure Time: County: Region: FP
Farm Name: CLn'► Owner Email:
Owner Name•, SA&16Phone:
y}
Mailing Address: Qa k 19% , of V1 Ile $3 0
Physical Address:
Facility Contact: Title:
Onsite Representative:-
Certified
epresentative:Certified Operator: 171/0.,
Back-up Operator:
Phone No: 30(?—(p7q
Integrator:>r1A4r�PJ1�
Operator Certification Number: h1iz—
Back-up Certification Number:
Location of Farm: Latitude: El o ET 0 u Longitude: E__1 o=' E__1 u
Swine
Design Current,-s„+�Destgu Cur�nt Design Current
Ca aci Po ulation WetP�►ultrv� Capacity Ppulation Cattle Capacity Population
p ty p _ _�.�,. ,
❑ Wean to Finish
❑Dai Cow
Discharge originated at: El Structure ❑ Application Field ❑ Other
FLayer
Non -Layer
❑ Dai Calf
eerier to Finish
❑Dairy Heifer
❑ Farrow to Wean
` ” YR'� r
Qry Paaltry*
❑ D Cow
Farrow to Feeder
,
' °
"'.e; ❑ Non -Dairy
Farrow to Finish
Q
El Beef Stocker
❑ Gilts
c. What is the estimated volume that reached waters of the State (gallons)?
E] Beef Feeder
❑ Boars
El Beef Brood Cow
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1:1 Yes
11 No
Other q�
1:1 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Other
W No
ber of St r
Num uctures:
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:3 Yes
Discharges & Stream Impacts
El Layers
El Non -La ers
[I Pullets
❑ Turkeys
10 Turkey Poulis
❑Other
``�
I . Is any discharge observed from any part of the operation?
❑ Yes
99 No
[:3 NA
[INE
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
EINE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Yes
[I No
[INA
❑ 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)
1:1 Yes
11 No
El NA
1:1 NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
W No
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:3 Yes
® No
[:1 NA
[:1 NE
other than from a discharge?
Page l of 3
1228104
Continued

Faci1Ry Number: d -S
Date of Inspection
[RNA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Waste Collection & Treatment
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No
[RNA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
Oa 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: nia
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
❑ No
ERNA
Spillway?:
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
Designed Freeboard (in):
12. Crop types) k/ Ar Annyt�/ � .
Observed Freeboard (in):
13. Soil type(s) AAA 91' f
14. Do the receiving crops differ from those designated in the/ CAW MP? ❑ Yes
❑ No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
CRNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
N NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
❑ No
J'NA
❑ NE
through a waste management or closure plan?
RNA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ® NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Q Yes
❑ No
[RNA
❑ 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
[RNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
5JNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
❑ No
ERNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) k/ Ar Annyt�/ � .
13. Soil type(s) AAA 91' f
14. Do the receiving crops differ from those designated in the/ CAW MP? ❑ Yes
❑ No
❑ NA
IR NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
19 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
N NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
JN NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
RNA
❑ NE
Reviewer/Inspector Name %riArM soly C Phone: ILO y a3-3300
Reviewer/Inspector Signature: Date: MIu 41,3001—
Page
1 a 0$Page 2 of 3 12/28/04 Continued

Facility Number: $a — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ 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 CR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No N NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ['NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
WNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
I? NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
rWNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IR NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, frceboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
krNo
❑ NA
❑ NE
AdditioQaltiCumments'andlor`D
Dry Ci- �4o�s �ers, �4 ws�al� fuddki "Ve rad aljff-hklr Week.
`
WA To be, plonk -e- �vi'V4 a week,
Page 3 of 3 12128104

® Division of Water Quality
Facility Number SC/Q 0 Division of Soil and Water Conservation
0 Other Agency �t
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: 1 0 Arrival Time: Q Q Departure Time: County: J'/9y't `r0^/ Region: r`0
Farm Name: 5fal-00i Favor
Owner Name
Mailing Address:
Physical Address:
Facility Contact: Al F, SIOAIy. Title:
ll
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
I
Latitude:
F-10
Owner Email:
Phone:
APhone No:
.1
Integrator: ;aQ .d6l
Operator Certification Number:
Back-up Certification Number:
L Longitude: F-1 ° 1-1 L-1 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I❑ La er
❑ Wean to Feeder I ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish / O go
❑ Gilts
❑ Boars
Other
❑ Other
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 Cur
Cattle Capacity -Popul
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 0�'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
/2/28/04 Continued
❑ Ye
No
Ipi rvA
❑ NE
❑ Ye
No
IFNA
❑ NE
V9NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�No
❑ NA
EINE
❑ Yes
bNo
❑ NA
❑ NE
/2/28/04 Continued

Facility' Number: Date of Inspection / y
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes KI No
�VNA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
RNA
❑ 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 ❑ NoNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes ❑ No
J� NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No O 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No RNA El NE
maintenance or improvement? !l
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes[� No ElNA [:1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) W,�1i�' �nud �Li,o,n,C A►1J
13. Soil type(s) rA., Alort I `tJoA t-tt +h — 066
14. Do the receiving crops differ from those designated in the CA
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
No
[ No
No
No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
retv►� i0 69S
y �LtS- i�u-e l 0.t
/U� �O i o C
El NA 0 N
❑ NA ❑ NE
El NA [_1 NE
❑ NA ❑ NE
El NA El NE
Reviewer/Inspector Name Phone: z13.3' 3.3 Cc
Reviewer/Inspector Signature: Date: 0'7
12/28/04 Continued

Facility Number: IOX— Date of Inspection ! d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑ other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24. did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
OPNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
aNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
NA
❑ NE
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l. 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
�i7] NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
FINA
❑ NI:
Additional Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date or visit: ra Q -Q Arrival Time: /; /s Departure Time: County: Region:
Farm Name: _ S Qtr Iry rQ v wt Owner Email:
Owner Name: ^ /Li . F. -�7t ��w ' Phone: `�
Mailing Address: 0� wVr 11'e�/C, _ �$3l $ - 97
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =I
= Longitude: =O ❑ A [=0
Design Current
It I I Design C►urrent
Design. Current
M NE
❑ Yes
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
iTy Cow
❑ NA
® NE
❑ Wean to Feeder
❑Non -La er
ial Calf
® No
❑ Feeder to Finish
i
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
10 Farrow to Finish / Q
❑ La ers
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
the
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges !& Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page.1 of 3
❑ Yes IN No ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
M NE
❑ Yes
❑ No
❑ NA
® NE
❑ NA
® NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
/2/28/04 Continued

Facility Number: $z —syO Date of Inspection S 3D a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No gNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No '"NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ® NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ❑ No N NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No CRNA ❑ 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 p Yes ❑ No 9[NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EN No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ®NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C Cla-n1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
04 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
®No
❑ NA
❑ NE
Pe -
.5,3 i /C_ o vL c ,'s- /.5
Reviewer/Inspector Name� .1 G�� R�'�! e:iS ', 7T7, Phone: g1DJ r7'Y���
Reviewer/Inspector Signature: Date:
-5--3 0 — 200Cr
12/28104 Continued

Facility Number: $Z — 3_�621 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
® NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
R1 NA
EINE
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
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector 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
IN No
❑ NA
❑ NE
Additiotial'Gomthents aridlor-Drawings. fres
1,2/2VO4

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ denied Access
Date of Visit: /O i /O Tune: S
Facility Number „�. �
F - 0 Not Operational 0 Below Threshold
® Permitted M Certified [j Conditionally Certified ❑ Registered Date -Last Operated or Above Threshold: —•
F
Farm Name: fi a Q r w. ar _. Couto W a 92 MA _
Owner Name: %�=�� 1�q? _5 •h e r 1, inff� " Phone No: C 1 S6 7- Oq 3 a _
Niaihng Address: _ _ .... 4 a c 4� _ %� '+,,4 Mr-- _ fig_ -` '�?
Facility Contact:
Title:
Phone No:
Onsite Representative: r'! s -,�+a - Integrator. ZnAf p
--- - - - --
ff
Certifier) Operator... � � .. . _ _ _�.. _ Operator Certification Number. _
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��
Discharges & Stream Bun its
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man -trade? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notifv DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes R No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (g.No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [] Spillway ❑ Yes - Oj No
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ... A
_ y
Freeboard (inches):
12112103 Continued

Facility Nturber.
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Ars 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 hearth or environmental threat, notify DWQ)
7. Do any of tate structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefrmprovement?
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelrmprovement?
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
❑ Yes M No
❑ Yes 12 No
❑ Yes CM No
❑ Yes 10 No
❑ Yes M No
❑ Yes 13 No
❑ Yes M No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes 55 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes jm No
c) This facility is pended for a wettable acme 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.
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No
❑ Yes IN No
❑ Yes CI -No
❑ Yes (B No
❑ Yes & No
- c-
C.am� tixftr toy "q�#�i�am� a�� sadlor gay a �y�ai�er .
1—� - ( pY ®Feld Copy ❑Fina! Notes
AL
Reviewer/Inspector NaR.
Nam
Reviewer/Iaspector Signature: Date: /v
12112103 Confined

Fimility Number: Sa -S'�0 Date of Inspection !O o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes rg No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WW, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R 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 JO 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 Reviewer/Inspector fail to discuss review/mspec-tion with on-site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes JB No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes M No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes EM No
31. If selected, did the facility fail to instaIl and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certificadon Foran
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence aboat this visit.
Conum�sandfox�Dn -� � '`
d&
12112103

IType of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: �— `Q Time:
10 1~'acility Number d
Not Operational Q Below Threshold
Permitted ❑ Cer 0ed E3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm dame: III - 1z i r ar County IS46
Owner Name: _ ��+ r / Phone No:
Mailing Address: � �C tea /�P, /VP `Z� f
Facility Contact: ©c.c.Jx P4 Title: Phone No: /
Onsite Representative: Integrator:. 77�e
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 " Longitude 0 �• ����
Design
'Swine' W"Ca "acir
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Number of Lagoons
Holdung Ponds'/,Solid Traps
Current -=- De
`: Poriolation _Pouhsv :Cay
Other
Total,Des��1 Capac>Eh
• = � Totai SSLW w.' �.
Subsurface Drains Present
No Liquid Waste Managen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notif}, Dw'Q)
c. if discharge is observed, what is the estimated floe- in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area Spray Field Area I
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 3
identifier:
Freeboard (inches):
0510.f/0I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: 9Z --5' d Date of Inspection - �z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion. ❑ Yes ❑ No
seepage. etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure pian? El Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
El 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
elevation markings? ❑ Yes -1 No
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type �, S ��a U nS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ YesNo
14. a) Does the facility lack adequate acreage for land application? ❑ YesiNo
No
b) Does the facility need a wettable acre determination? E3 Yes
c) This facility is pended for a wettable acre determination? ❑ Yes P?No
15. Does the receiving crop need improvement? ❑ Yes 9'No
16. is there a lack of adequate waste application equipment? ❑ Yes 9 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ' \ o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 10, No
19. Does record [seeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ YesNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El
o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
10 No violations or deficiencies were noted daring this visit- You will receive no further correspondence about this visit.
Dote
tc;"
-.� �draw�egs of fac�ty to better txptmn srtaatrobs (ase addttonal pages as naces.ary)
w e w ❑ F�e]d COpV ❑ F]xtal s
CroPS eL
Farr I#0ki; �O-ad .4 Ue-r7 we -11
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05/03/01 l/ 1) Continued

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification Q 011ier 0 Denied Access
Facility Number L L) Date or Visit: Time: D
Q No! Operational Q Below Threshold
® Permitted 9 Certified _0 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: �.._. �r .../., n! ..... ............... ........
........................... County: ..........:�.t¢'?y,' __ `� ...... _...._� ..•
Owner Name:.......... ,:`� . S/ .............._ ................. Phone No:�,t
Facility Contact: ........ ..... ` .... !' � ........ Title: ...............................:....................... .... Phone No: _ ..... ...
Mailing Address:...... !? L_.._ .eL�.... 14&40(
Onsite Representative:�_�� . ,!',e�c!W ......W .... ......... Integrator:..
Certified Operator: .......» .............. �,,(A........... ........................................................ ..... Operator Certification Number:.... �....... .. »_ . _ .....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • d
Des>igxt current
:_ - Desgn ,Design urttirtt
.;
5wtne _Po tion::
Poultry
Ce ri .: Po illation Cattle -
Ca
= Wean to Feeder
❑ Layer
❑ Dairy
a. If discharge is observed, was the conveyance man-made?
Feeder to Finish
❑Non -Layer ` ❑ Non -Dairy
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
Farrow to Wean
Q No
c. If discharge is observed, what is the estimated flow in gal/min?
Farrow to Feeder
❑Other
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
` �• y '
_19 Farrow to Finish
2. Is there evidence of past discharge from any part of the operation?
Tot Design CApaci_
M No
Gifts
E�No
-.
Boars
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
TotsI-SSL'W':
WNo
Structure i Structure 2 Structure 3 Structurc 4 Structure 5
Structure 6
Identifier:...........A11A...........................................................................................................................................................................................
NuM
10
Subsurface Drains Present Irl Lagoon Area
❑ Spray Field Area
3..
iioldtag Potrds f Solid Tiffs
5100
No Liquid Waste Management System-
--
Discharges & Stream Imoact5
1. Is any discharge observed from any part of the operation?
❑ Yes
1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
IN No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
Q No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
El No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
E�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
WNo
Structure i Structure 2 Structure 3 Structurc 4 Structure 5
Structure 6
Identifier:...........A11A...........................................................................................................................................................................................
Freeboard (inches):
5100
Confinued on buck

Facility Number: kL - PO Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Wo
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 5kNo
(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 [)kNo
8. Does any part of the waste management system other than waste structures require maintenancetimprovement? ❑ Yes 151 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JRNo
a
11. Is there evidence of over application? [3 Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )S No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
C) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving Crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU�he�ists. design, maps etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 19 No
❑ Yes A No
❑ Yes ® No
❑ Yes ,® No
❑ Yes M�No
❑ Yes PQ No
❑ Yes Pa No
❑ Yes E$No
❑ Yes' Iq No
❑ Yes K No
1Q yiQ[a�itjnjs:e d fcie�tc�e et re p$tt�d d trm this:visjost wa#i•t eoiye ti u>Ttit r
• •Tories • Bence: alwtit this :visit:. • ...:.. .... .... - . - . - . • . - ... • . • ..... •
Com uts (refry ta.i�aesttob #) Explain aay YFS answers a��/or apy recoaiimendatsons or any otter co
�.
Use drawrr of fac[irty to: betxer explain Ohm q_ (use addttion$I pages asQecessairy} ;
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: y — D Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes I No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Q Yes 1PNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes CR No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes M'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes OQ•No
31. Do the animals feed storage bins fail to have appropriate' cover? ❑ Yes ANo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes VNo
lAddiflonal-Covinents ao or gg.
rawtn
•
1661
5/00

0, [hvrsmn of Watei
O DivLstob of Soil ai
Batton '�t
of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date. of Visit: / . OD Time: 3 = � Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ......................aS sig[ ..,�q.......x............................................ County:...........�s� �,TQ'J........................... ..........
,
T_ ,
Owner Name. /� �,� �.ri ................ Phone No: _._ .............................
............ .. ..............
Facility Contact:......:-,Y...�........ '..........�le:............................. ...... ............ Phone No:...................................................
... ... ... .... ......... ........
U % 1� z 3
Mailing Address: ..... .f%�'Pr"trF�t .................. ... t r�r. 1. �f `
Onsite Representative: _- Integrator:
Certified Operator :.-•---..........� f ............ ..........- --- -- - ......,..... Operator Certification Number: ..........................................
Location of Farm:
[]Swine ❑ Poultry []Cattle ❑Horse Latitude ' + « Longitude • 6 "
Design Current
Swine (_anarity Pnnulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
a Farrow to Finish / S-0 `
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Num ber of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 111 Spray Field Area
Holding Ponds! Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes ,4 No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes $ No
c. if discharge is observed. what is the estimated flow in gal/min`?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes Iallo
2. Is there evidence of past discharge from any part of the operation? 0 Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Taste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,SNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: /JIA............................. ....... -.......................... ..................... ...-................................ ............... ....................................
Frechoard (inches):
5/00 Continued on back
i
0, [hvrsmn of Watei
O DivLstob of Soil ai
Batton '�t
of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date. of Visit: / . OD Time: 3 = � Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ......................aS sig[ ..,�q.......x............................................ County:...........�s� �,TQ'J........................... ..........
,
T_ ,
Owner Name. /� �,� �.ri ................ Phone No: _._ .............................
............ .. ..............
Facility Contact:......:-,Y...�........ '..........�le:............................. ...... ............ Phone No:...................................................
... ... ... .... ......... ........
U % 1� z 3
Mailing Address: ..... .f%�'Pr"trF�t .................. ... t r�r. 1. �f `
Onsite Representative: _- Integrator:
Certified Operator :.-•---..........� f ............ ..........- --- -- - ......,..... Operator Certification Number: ..........................................
Location of Farm:
[]Swine ❑ Poultry []Cattle ❑Horse Latitude ' + « Longitude • 6 "
Design Current
Swine (_anarity Pnnulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
a Farrow to Finish / S-0 `
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Num ber of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 111 Spray Field Area
Holding Ponds! Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes ,4 No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes $ No
c. if discharge is observed. what is the estimated flow in gal/min`?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes Iallo
2. Is there evidence of past discharge from any part of the operation? 0 Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Taste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,SNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: /JIA............................. ....... -.......................... ..................... ...-................................ ............... ....................................
Frechoard (inches):
5/00 Continued on back

FaciW Number: SZ— Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes W No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes jM No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 4�0 Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ YesIX No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ;S�No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Wo
b) Does the facility need a wettable acre determination? ❑ Yes RNo
C) This facility is pended for a wettable acre determination? ❑ Yes 9 N
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 5allo
❑ Yes Ri to
❑ Yes allo
❑ Yes KNG
❑ Yes X -14
o
Yes No
❑ Yes No
❑ Yes N -No
❑ Yes kNo
t
❑ Yes NNo
❑ Yes N No
IO VIQi �IQI>4S.01' ft iciellCiC'S �FQrC hotC(j• O(Wi lg, �his,vlslt. • Yoti Wl�l-te'Ce1Ve ii0 fui-thter .
cor'res ofide' ce: a�ou this :visit:. • ..... ' • . . • ..... ... .
Com>s enis-Ifefer to question"#)i -ExplaiEany YES answers and/or any reco bmeifi tions or_any-oth r eotn
-
-- .
iJse drawm of facility -to better:explain situations. (use additional pages as necessary) -
�.
�% �it4�/f��%� Sr�'�.�--� �.J p,�i"-�/•� ,plc, ---r r�,rC ,��✓c� /1.e,�� p,.i�.�
A,
44
Reviewer/Inspector Name
Reviewer/Inspector Signature:Date: 5100

Division of Soil and Water Gonservatcon Operation Review. +
4, a 0'Di dsion of Soil and Water Gotnserva�on Compliance L�speciyoa �
a a q
,-
Di" visRin .of Water Quality ,ComPLance In`specdan
`:Oilier Agency. Operattont Rev�evr
Routine O Corn laint O rollow-up
J
of DWQ inspection O Follow -u of DSWC review O Other
Facility Number
Date of Inspection
Time of Inspection
d ff
s !!g1
24 hr. (hh:mm)
13Permitted 0 Certified [3Conditionally Certified [3Registered
IDNot Operational I
Date Last Operated:
Farm Name: .............. .�L... ........
urr✓L............................4...
County:............
....... .................
Owner Name: ......................
c.7..,F/...�..}
.. Phone No: .............L�
��Pl..- �.��...
Facility Contact; ...............!.'1.�.....��7..f.�t... Title: .........................
Mailing Address: .-.----.......69 a5.....�1.. �...... Com ...................
R
Onsite Representative:..___....... ' .. r! W....... ...................... I....
CertifiedOperator: ........ _......................................................................................................
Location of Farm:
.................................... Phone No: ......
Integrator:.... .......... !�
Operator Certification Number: ...... ....... ................... ...
.............. .................... ........................................................... ....... .._........................................................................... ...................................................................
Latitude �e �� �•� Longitude
Design Current a b
Swine
Capacity Population 'Poultrj
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
KI Farrow to Finish / Q
❑ Gilts
Boars
❑ Layer
❑ Non -Lays
❑ Other
Deign Current _ ; Design Current
9'Cal aci Poulation Cattle Capacity Population
❑ Dairy
ELINon-Dairy
_.
. Total Design 'Capacity �O
Yom'=-� - --_ . - �-•Tota1. SSLW -
= NtttLtbcr of Lagooni '� ❑ Subsurface Drains Present 11EILagootiArea ❑ Spray Field Area
a
Hoidtng Ponds % Sohd:Traps ; ❑ No Liquid Waste Management System
Discharges & Stream Imeacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the Conveyance man-made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
& Does, discharge bypass a lagoon s stent? if es, notify DWQ) ❑ Yes ❑ No
6) p g Y- ( 3" S Q
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes il No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway `tl14 ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..................................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,// %]❑ Yes No
seepage, etc.) ! �� -
3123/99 Continued on back

a
(Facility Number: g;L —�jp Date of Inspection �a
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? /✓�/�- ❑Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? /✓/ ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenaticelimprovement? MIX Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
�r
/�/ ❑ Yes
❑ No
elevation markings?
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Waste Application
f
10. Are there any'buffers that need maintenance/improvement?
Cl Yes
No
r❑�
11. Is there evidence ofover ap lication? ❑ Excessive Ponding ❑ PAN
E] Yes
No
12. Crop type Di
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
13. Do the receiving crops Mer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
WIN
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 tack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Al%h❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
II
f
(iel WUP, checklists, design, maps, etc.)
❑ YesNo
,I II
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
E] Yes
Na
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie/ discharge, freeboard problems, over application) /✓/� ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
. /
N6.yiolafioris or defeiencies ry r6 0WO dix`ing th.s.visit' • YO wiil•feegiye ijo #'ui-th� . .
corres oridenke: abu"f this visit~ :.::: ::.::: _ : :
Comments (refer ta.queshun #) Explain any YESanswers and/or aniy recommendations or any other e miments:V x
Use of facrlity to=better explain situahons (use adcLt nal"pages as necessary) — _ �� _
_drawings
•-.
f
5
,I II
Reviewer/Inspector Name ( Br
a — �--
Reviewer/Inspector Signature: Date:I d6-9-46
�/ /� 3123199

❑ Division of Soil and Water Conservation ❑ Other Agency
IN Division of Water Quality
1612outine O Complaint O Fallow -up of !)WQ inspection O Follow-up of DSNVC rcview O Other
©ate of Inspect ion
Facilitr�'.�umbcr Z �-G D
Time of Inspection ffYoa24 hr. (hh:mm}
Registered 8 Certified © Applied for Permit [3 Permitted E3 Not O eratinnal . Date Last Operated:
Farm Name; . .................. •✓ ...... iq�z�
.....................................................County:...........�.e d'J
OwnerName:..'.........!................................................. Phone No:.a..G.....................
Facility Contact: ......, `K.........-` ... ...... Title: ................... Phone No:......-------------------....------------.......
Mailing Address: ......................... ..........................
Onsite Representative: ......
.....................................Integrator'......... �...........
Certified Operator,......-...:..._ ..,.. �.:......---------------- Operator Certification Number:..................
Location of Farre:
..& ... /
.. .............. ... .................................................... ••-------------- --------.--
Latitude �'� �« Longitude �• �° t i°'
Swore '
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑Gilts
number,of'Lagoons
le§rgn . '"current _
Design- -. ;Current ,Desi{
,pacify Papulation
Poultry...'Ca
pa6ty Popitfation Cattle;'�.:tl 'Capai
❑ Layer
I0 Dairy
❑ Non Layer
❑ Non -Dairy
r f�
❑ Other I`
` Total Design Capac>fty, C
a
;Total M-1
i[rg P,onds.> �$, ❑ Subsurface Drains Present ❑ Lagoon
0rY�
❑ No Liquid Waste Management System:
Current
3
Spray Field Area I..
General
M
1. Are there any buffers that need maintenancelimprovement? ❑ Yes RNo
.L
2. Is any discharge observed from any part of the operation? ❑ Yes &No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes J@ No
b. if discharge is observed, }did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Wo
c. If discharge is observed,'what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes IS No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 59,No
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes C -No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 21 No
7/25/97 Continued on back

.l .
Facility Number: A-
8.
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Po
Structures (Lanoons.Holding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 19No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
�.IIX
Freeboard (ft)
10. Is seepage observed from any of the structures? ❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes a No
12. Do any of the structures need maintenance/improvement? ❑ Yes JXNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? /v/,¢ ❑ Yes /KNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes N'No
(if in excess of WMP,or runoff entering waters of the State, notify DWQ)
15. Crop type JN/.1............................................................................................................ .....
.....................................................................................
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes jR No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[]: No.violationsor. deficiencies'were,not'ed-dt iiiig this:visit.- .You.will receive.no:ftirtlier .:
cOresp¢nd640d out-this:vWt:•;
'r-ow"r.' Ar�
❑ Yes KrNo
❑ Yes �Vo
❑ Yes No
❑ Yes ,� No
❑ Yes N No
❑ Yes P@ No
❑ Yes 1� No
❑ Yes 4 No
❑ Yes ❑ No
7125/97

Facility No. 1?Z- 59D
DIVISION OF ENVIRONMENTAL MANAGEMENT
f. ANDAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �l ` , 1995
'Time:
Farm.Name/Owner: ME
Mailing Address: X905
County:
Integrator:
On Site Representative:
Physical Addressii.ocation:
Phone: (9 t a) 5b?- 0 S
Dn r 4L t- &+,t'er er
JFC1-
Type of Operation: Swine _X_ Poultry Cattle
Design Capacity: 00-10 so_uxs Number of Animals on Site: SOD -F lte _!
DEM CeJtific ition Number. ACE DEM Certification Number: ACNEW
Latitude:' Longitude: 0"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yw tAIN Actual Freeboard: N& -Ft. inches
Was any seepage observed from the lagoon(s)?�Was any erosion observed? Yes or&
Is adequate land available for spray? Yes or No Isv�r crop adequate? Ve**r%o VJJA
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? dD or No
10D Feet from Wells? &9Qr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 00
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or( i� 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
Additional Comments: re r r+re ro-J .,
ruks, H- t
P carte s
Inspector Name Signature
4:v,.rort .c/h= A&Tlrc
=: Facility Assessment Unit Use Attachments if Needed.

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