310519_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access T�
Date of Visit: Arrival Time: Departure Departure Time: County: Region:i w
Farm Name: t� NMI Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: dt&j� i
Certified Operator: Lq5Lea1�
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: I q u, 4 2—
Certification Number:
Longitude:
Design Current
Swine Capacity Pvp.
Design Current
Vint Poultry Capacity Pop.
Cattle
Design
Capacity
Current
P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
2bb
00
Design C*urrent
Dairy Heifer
Dry Cow
Non-Dairy
Dr, P,ouiti, Ca aci P,a P.
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qt A
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Condnued

1:,6`cilit Number: DI- Date of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No D NA 0 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3^ _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
[:]Yes kNo ❑ NA ❑ NE
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 TNo
o ❑ NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ra No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 4 Sum- � QAM
13. Soil Type(s): U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes g4No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
t No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA D. 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 ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
gZ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Zicifity Number: - Date of inspection;
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes N(No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes V No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes QRNo
❑ NA
[] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�9 No
❑ NA
0 NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[NNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[>j No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[N No
❑ NA
❑ NE
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t<�,�R0
Phone: IN
Date:
2141201

Type of Visit: 0 Compliance Inspection V Operation Review () Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: n Arrival Time: ® Departure Time: County: t1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: YV.Ul-C
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: !
Certification Number:
Longitude:
Design
C*urrent
Design
Current
Design C**urrent
Swine Capacity
Pop.
Wet Poultry
C«apacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C►►urrent
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑�Vo ❑ NA ❑ NE
❑ Yes ,L,j( o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: 7j jDate of Inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3
Identifier: pl�fi�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
❑ Yes [:]No [DNA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 16 No ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
a threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LLJ N ❑ 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 El"No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D1 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ao
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
FNNo
❑ 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
eNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Zo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued
�OHOF)ai— iqc -�'V

Type of Visit: Q C mpliance Inspection V Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: l S Arrival Time: Q 2b Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
001 C1 qo�
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
Dr, P,ouit , Ca aci P,o
Layers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N' ❑NA ❑NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date ct Ins ection: 1,6 1 I $
Waste. Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: c
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ 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 environmFNo
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yeso ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? dyes ❑ 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 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 6"No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ®No
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design . ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes O 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 rPN
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yeso
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 211 - Date of Inspection: 101 r l
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes &No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;�<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes�'No
❑ NA
❑ NE
Comments (refer: to question'#.) Explainj`ariy YfES at swerssgndlor any=addit�onel recominendiitions orIany other:cvmments' - ' 3
. ::.�� .:�?..'.....r�L3a-sr�
Usedrawings,of;facility. Ftoibetter:explain:situations"(useaddition.al,pa�es�as,necessary);;
�5�1 WEED CANJILOL, N6E0e-V
Reviewer/Inspector Name: Phone( % 1
Reviewer/Inspector Signature: All Date: 1
Page 3 of 3 21412 b 15

Type of Visit: U Co fiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 03b Departure Time: County: ,� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number. I [o q
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish Rkon-Layer
Wet Poultry
a er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Design
Ca uci
C*arrant
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Dr. P.oultr.
P,o ,
Non -Dairy
Layers
Beef Stocker
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
L_jOther
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No
[:]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes rN
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
'p,
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412014 Continued

facility Number: Date of Inspection:
Waste Collection & Treatment
4` Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): !✓ r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pl<o [DNA ❑ 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 VINo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [ 1V ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2f]No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ey�"o
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[o
❑ 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
❑ YesF2'<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 Inspecti�NJF]
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �/()
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F'acili Number: 17,- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes N ❑ NA ❑ NE
'4
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes WNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ 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 0 No ❑ NA ❑ NE
❑ Yes i o ❑ NA ❑ NE
❑ Yes Ld o ❑ NA ❑ NE
❑ Yes ZNo
❑ Yes No
❑ Yes
❑ Yes No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /
Date: L10136 1141
214h 014

Type of Visit: (ZCCopliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
i i u ■iirrrrw.Mrr�r.
Date of Visit: Arrival Time: Departure Time: county: t Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J6►.lfthAjJ PIV,L 6A Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 110
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
C►a1 Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
Dr, l;oultr. C+a aci P,o
Layers
DairyHeifer
D Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
[] Yes [] ❑ NA ❑ NE
❑ Yes VN
NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: ;I i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
b o
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answerer/ yes, and the situation poses an immediate public health or environme tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
U. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
es
[; No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
Yyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
eNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
rNgo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
go
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectirNoZ
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Vo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes U40 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes FNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: U6'�� �t�� Phoneo10 r`— 3g
/. -S
Reviewer/Inspector Signature: Date: I t/
Page 3 of 3 2 412011

Type of Visit: (D Com ance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: bL Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: cJ6"ATt4Cj (VIM FRIntegrator:
Certified Operator:
Phone:
Certification Number: 19 {a4 2—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
I
Design Current Design Current
Wet Poultry C*apacity Pop. C►attle Capacity Pop.
JLayer 1 Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
it7
Design Current
Dt, P,nultn Ca aci Po
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes a ❑ NA [] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 ❑ IV ❑ NA ❑ NE
[:]Yes u Lv ❑ NA ❑ NE
[]Yes [No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fpcili Number: 31 - 515 jDate of Inspection: it jj&I-�
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�}
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
�No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes eNo ❑ NA ❑ NE
❑ Yes ;3"/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C2/No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
dNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [�J/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
131-NI"CO
❑ 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
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes eNo DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;'Ngo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 2KC ❑ NA ❑ NE
2' . Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 13/N o
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fait to notify the Regional Office of emergency situations as required by the ❑ Yes 2No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name: f7
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `( �
Date: I 1 I
21412011

S
(Type of Visit: Q Cogtpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: f o County: DuQs Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: J.,j !F M j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: I% 4
Certification Number:
Longitude:
Design
Swine Capacity
Current Design
ou
Pop. K t Pltry Capacity
C►urgent
Pop.
Design Current
Cattle Cpacity Pop.
a
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
g�
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
i
Desig n
Dr, P.oultr} Ca aci
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Current
P+a P.
D Cow
Non -Dairy
Beef Stacker
Gilts
Beef Feeder
Boars
Beef Brood Cow
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 ZrNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes F3"N-o ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Faciliq Number: - Date of Ins ection: I I III
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
�_A &wJ
31
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
o No ❑ NA ❑ NE
❑No [3 NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
[:]Yes [2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I XNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ''iiVo
TTTT'' 9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ 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 E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
WN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ff No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1_J No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ef;o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Oth r:
21. Does record keeping need improvement? If yes, check the appropriate box below.
eryes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking g�Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rj"No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: li 4,p Itj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3 Yes VNoNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes 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 E�J/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 [ No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Z❑ NA ❑ NE
L Nqo ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any;otherecomments.: .
Use drawings of facility to better explain situations (use additional pages ainecessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
--HAS IAtrWI U
Phone: I d
Date: r7
2/4 011

�IJA � ��. rsa� � � �`g .,�4+, c�a., 3 �.�, t= w � .sdSS tea. tMvIsjoniot1W
ater Qpultty
��r�i� :-__ It lea t, x r�td.s'ra3 i�Git a Y
Factltt, Number $f g Q�Divisioi'rSoil and'-WaterConserva
Rt II VA, i'sax ....Fx'
Type of Visit 6 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (C Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: !D 3 Departure Time: County: ."VPLm Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: L10WA-rkA+j M=,L."- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o Longitude: 0 0 ❑ r = rr
aqgk Y� �'�`�,�'� � �f �
gas 4, ^Desi n!`Cure1&it �.4:'p t k'r DCSI t]: ai CIIIY@Ilt 4� 'i $ ;- De51 C1'. G�urPenf, 4^.
a �'. Si �-: .� t ....xj ,, ; .z ®t ,.r 1$... g; 1`..: r3'.tti. i-.$:� rj,,. ?� �.7�..0 r V41 2
Swtne: "iCa act Po ulation Wet Poultr '�;Ca acit Po ulahon' �. { .,i t p ty p Y .XCapacit3,.P}opuration, #y Castle t+, t �.��z.t? y p
it
El Wean to Finish ❑ Laver ❑ Dai Cow
❑ Wean to Feeder ❑Non -Layer I El Dairy Calf
Feeder to Finish I'tnro 0OD ty k§ a i ' ❑Dai Heifer
❑ Farrow to Wean 't'' g ' ,z 4'' ❑ D Cow
Dry Poultry }
❑ Farrow toFeeder j:a ?W:is.t�;�a> "1i's.
� ❑ Non -Dairy
i ❑ Farrow to Finish❑ Beef Stocker
1 ❑ Gilts ❑ Beef Feeder
❑ Boars ` El Beef Brood Cow
r . t.
❑ Other t (Number of Struc]t�u�}r�egs�
bx is 47"T; a 3'i, %1 i tl I di a
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Puults
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes LI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
El NA
N
El NE
El_,
Yes
,❑/No
� No
❑ NA
❑ NE
❑ Yes
<o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: J —515 1 Date of Inspection t1 D
•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: U4 6'00#v
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/�J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,_ /
5 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [! No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 13No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo ❑ NA
.❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2P o El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
L; Nc ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Cottinicnts (refer tv q'uestictn;#): lJzplain any YE$Fansvver..s and/or any.recommendatrons or any ether comments, x
UseArawings of facility to better explain situations, (use additional pages.as necessary) ; ' 5
- .. ..a __. -.-.. • _ .�a.... �., o'AF i ,. R.L w h,,. .'%ax 8.�1 x.. �.i 5
IReviewer/Inspector Name o r. l:%. ,: ` ;;; �,g ", F. j,u Phone{ J. H1✓ R►C.. �,
Reviewer/Inspector Signature Date: 111410
Page 2 of 3
12/28111d C'anlinuod

,]'Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
E�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f/J o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
( No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C3"No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 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
E)4o
❑ 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
eNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
��:: _
Additional Comments and/or Drawings: � � -
Page 3 of 3 12128104

r:
E
f Visit Co pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
n for Visit Routine Q Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: lab Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r rs XrMA r/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 = N Longitude: = ° = , =
Design
Current: Design Current
Design Current
Swine
Capacity
Population Wet Poultry @apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
iryCow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
® Feeder to Finish
FTO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
El Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
No
[I Yes
�❑
fVNo
El NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued
4

Facility Number: — Date of Inspection Iu
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L AGM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0No ❑ NA ❑ NE
❑ Yes [ l No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E 'o ❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LlJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) WNo
9. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Wpmments{reamer tI)-,. s on #,):) xp din any-Y4�ES answers and/or any ecommend'Ations or any other comments.
Use drawangs of f2. lit y to better explain situations. use additional pages as necessary}:
�t V
Reviewer/Inspector Name ��'��' :a .mot' '�' �,to
Phonet aV
Reviewer/Inspector Signature: Date: v
12/28/0 Continued

Ficility Number:)s Date of Inspection G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists
Mn esign ❑Maps ❑Other
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑X
❑ 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?
El Yes
,I:'J
Le<oo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ 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
EKo ❑ 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<o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Vo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
U❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El�2/0Yes
NA
❑ NE
AddiIAon.alCxom�nents and/or Draw;ngs:
12128104
12128104

Type of Visit 7compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (! Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1p ltv pfj Arrival Time: Departure Time: L� County: Q Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -1),JMtH ►J MT-J—LE Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 =16 Longitude: = ° = ` = «
it Design Current
��
Design C*nrrent
Design Current
Swine Copacity Population
Wet Poultry C►apaci�y Pop lation
Cattle Capty Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -La er
El Dairy Calf
Feeder to Finish
IZZ
Dry Poultry
❑ La ers
❑Non -La
ElDai Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑Gilts
❑ Boars
Elers
Pullets
❑ Turke s
El Beef Brood Cow
Other
❑ Other
10 urkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ 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
W.�
ElNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
Noo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

FAcility Number: 3i —Slq Date of Inspection a d
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UA(oco►-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
,�
L(J 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 environmentalFtheat,
notify DWQ
7. Do any of the structures need maintenance or improvement? []Yes[
o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
IJ[
❑ 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 El Yes
3 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
UNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift: ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
20
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Llse drawings of facility to better explain situations. (use additional pages as necessary):
15.� WEED co►.rTQo�. 0640E-0 ESWE (IJC77 WUP XJ
18t=QKr UPD9K9
SCMD r:rCLDt Net- £D. tZYAC I
Reviewer/Inspector Name `reds "'; °T '''
� i o 1-�Y+� (t=.� •` r " Phone:
•�1
pt
Reviewer/Inspector Signature: Date:
lv 1 to $
Page 2 of 3 1 12128104 Continued

facility Number: 1 —5171 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes <o ❑ 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
BNo
❑ 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E ?N'o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Io
DNN
El NA NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,[3
2<01
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�J�
L'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 <o ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 7No
❑ NA [I NE
33. Does facility require a follow-up visit by same agency? El Yes ❑ NA ❑ NE
Page 3 of 3 12128104

10 Wean to Finish
❑ Wean to Feeder
ElFeeder to Finishl I ,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
`Q Vlsion of Water Quality
actliry Number j Q Drv�sion of Soil and Water Conservation
_,. Q'Other
'Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q-F(outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: 00 Departure Time: County:
Farm Name: _. 5'--LS1 a—' �- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: = c Longitude: = ° = .
Design Current Design Current Design Current
Swine Capacity Population Wet -Poultry - Capacity Population Cattle Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes _L3ivo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes E]'No
❑ NA
❑ NE
❑ Yes
P TVo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3[ — Date of Inspection
i
WaAe 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes —d"No ❑ NA ❑ NE
❑Yes ❑No El NA ❑NE
Structure 5 Structure 6
❑ Yes ,0"No ❑ NA ❑ NE
❑ Yes E-No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J-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 ED-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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)
13. Soil type(s) �V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ofilo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes •ff No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes .0 No ❑ NA ❑ NE
❑Yes 0No ❑NA El NE
Comments (refer to question ##): Explain any YES answers and/or•any recommendations,or any other, comments
Use drawings of facility to better explain situations. (use additional pages as necessary): d s
/d;-7 Carr/hG �
tiC
Reviewer/Inspector Name ��✓/h _ /�G,t�� Phone: t/O lY "' 7���
Reviewer/Inspector Signature: l Date: iP eo
rage � of J 12/28/04 Contrnuea

Facility Number: Date of Inspection
4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ 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 [:1120 Minute Inspections ❑ Monthly and l " 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 L] NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 2-&A ❑ 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 []-TVA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA 0 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
y
cvs
t, o i ►� dln d f -7jreaoo,�
ctJYc�
mcitfc9cev,
t/V �����Cr p Xle � re 4r/-
NO
A 1 ►'� r'`
/f"' e ln7n
h v mouseH,
1
' � s�%C'C�fO'Yr Q ✓� /I�7 G�' CG'n��p �� ��I�%
Page 3 of 3 12128104

.Facility :Number
/
�Ilrvision of Water Quality
O Division of Soil and Water Conservation
.0 Other Agency
Type of Visit O'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint _,4?'1Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (p a Arrival Time: I IL'); C Departure Time: County: Region: r
Farm Name: s;:,s— v�j t� T� Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
`Desiign Ct
Swine Capacity .oP
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish I AC)-3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other.
Back-up Certification Number:
Latitude: ❑ a 0 g 0 Longitude: = o ❑
Design Current
t Wet Poultry- Capacity Population
�j ❑ Layer
41 ❑ Non -Layer _ _I
Dry. Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ' Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifer
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
El No
El NA
❑NE
[I Yes
[:I No
❑NA
❑NE
12128104 Continued

Facility Number. — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
w
Reviewer/Inspector Name .�� T Phone:
Reviewerlinspector Signature: Date: tw
Page 2 of 3 121"A104 Continued ;,

FacilitrNumber: -31 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes AE!rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .0"No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El 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
,OrRainfall ❑ Stocking 16crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J2 o []NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
[:]Yes
;?fslo
❑ NA
❑ NE
❑ Yes
❑ No
;�NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes
[;I<o
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑�lE
❑ Yes —ZfNo ❑ NA ❑ NE
❑ Yes '�?No ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
❑ Yes1No ❑ NA ❑ NE
❑ Yes7No
o [I NA El NE
El Yes ❑ NA ❑ NE
Additional Comments and/or Drawings:
491
-t. 7
9_-_
�- 3
5-eferc:6e ,ro'A'C'1k ec,orct5
ICC300r. _0 o -C— _:VQ4Lz
slzV trtsS
• ra v_z gr - cr°f Y
Page 3 of 3 12128104

(Type of Visit gfCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit QlRoutine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit: f
[3 Permitted [3 Certified [3 Conditionally Certified
L Registered
Farm Name: »jg.F_�e... ._. .r�.................. ».........._...._............. _
[I Denied Access
tZ] Tune:
Not Operational O Below Threshold
Date -Last Operated or Above Threshold:
County: ». ��.Y��...»....».................._.. .
Owner Name: » ..........» .....__ ..» »..» » » ...»»..»..... ». ...... 'Phone No:
MailingAddress:.........»... _._._....... _ ................_.» _....».......»._.._..... ........... ....»._.»....»._.» .»...._ _....... _. _......._..................... ...
Facility Contact: » . __.__ _ ._ Titles .. __ .» . » __ __. __.. Phone No: • •,» », . ... .
Onsite Representadve:.. ,lf! .5 .._...................... .._ .. Integrator:Rag
.......... .._ . _..... _..
Certified Operator:... _ »....».».......... __...... „» »».„ »»., .» »»....., » _ ._....__ Operator Certification Number:
Location of Farm:
/
J2Swine © Poultry [3Cattle ❑ horse Latitude �• 7,�' /�" Longitude �• �(�' �«
Lt1rient Deanr�rurreatr,
ll
Swine Ca ;Po ''iiltition 4' Poultrytron., Cattle z acr ' Pa illation
Wean to Feeder ❑ Layer ❑ Dairy
"
Feeder to Finish O '' ❑Non -Layer Non -Dairy
Farrow to Wean
Farrow to Feeder Outer
Farrow to Finish "1 l
Gilts �.� �„ P$c1tY ♦:
El Boars
W
Tatil'SSL ti
-Ei�FJ1JW �'�'�wb�Qi.-vr L�rJ'c "5w-t
' N
dLnacDii�ide e►1idC r'w�rt€tt
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Struclure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: _ . l ....»» .. »_. _.....» .._._..... »............._._.».... » .................» .....» __ ._........».................. w ....
Feecboard (inches):
12112103 Continued

Facility Number.. — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
INseepage,
❑ Yes N0
'It.,r etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes XNo
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes it imo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 'P1110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes �No
elevation markings?
Waste Apphcation
10. Are there any buffers that need maintenancelimprovement?
❑ Yes ZON' o
I I - Is there evidence of over application? If yes, check the appropriate box below.
❑ YesE214o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ opper and/or Zinc
12. Csnp type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes XrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 0 No
b) Does the facility need a wettable acre determination?
❑ Yes _2No
c) This facility is pended for a wettable acre determination?
❑ Yes ,ET No
15. Does the receiving crop need improvement?
❑ Yes - No '
16. Is there a lack of adequate waste application equipment?
❑ Yes P_110
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Two
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Z[V10
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,290
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes JIda
Air Quality representative immediately.

Facility Number: 31 —S;'O Date of Inspection
Reguired Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available? O'Yes [:]No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,0'90 _ n
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ yes4�
❑ 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 '�Ko
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;21Q'o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J21T4o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Zf90
28. Does facility require a follow-up visit by same agency? ❑ Yes .21TTo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
NPDES Permitted Facilities L�
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes E•Pf"o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dl)Reas6 kCep C66 Wi4h 0yl~6i I-e, r'eCa(Cl S.
r /l�h
/".1 "L. Pohl '� 41ZWV1A6V'
.� 3) P 1easo,
dt1:
_PQ
rn os+ rice r?+
kle V! n�oi,.A [a r�_C/
9lo'_3S0 -Oay
,sc-1 ) Rp r+
12112103

IType of Visit O Compliance Inspection Q Operation Review Lagoon Evaluation I
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified
0 Conditionally `Certified 0 Registered
Farm Name:
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _y erLb'—� I-/
Time: 402
Date Last Operate4jr Above Threshold:
County: ®L�
Phone No:
Phone No:
Integrator: /&�X�Y
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° C Longitude
Design Current Design.; Current .Design Current
Swine Capacity Po `ulation Poultry Capacity Population '.Cattle Ca aei " Po ulation
❑ Wean to Feeder ❑ La er I Dairy
❑ Feeder to Finish I0 Non -La er 1 10 Non -Dairy
i
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish = Total.Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of.Lagoo,:ps Subsurface Drains Present
Holding Ponds 1 Solid"Traps,-.
❑ No Liquid Waste Mana en
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste CoIllecti2n & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
av Field Area
❑ Yes "1Z No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
?Yes
❑ No
Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

1
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ 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 ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Document
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
,fNo
23,
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
'VNo
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
AL >
Comments�(refer4o.questian #):Explain}anYES answcrs.andlorarsy recomm�endationsoranyafhercomments.� ,
�lJse drawings of`facility, to better explain situations: use additional pages as necessary) ... _
., ❑ Field Copy ❑ Final Notes
„^ =u��. ��.
�y s
Hr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

(Type of Visit ACompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason For Visit 0 Routine f2(Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number S' 1 Date of visit
0 Permitted [3 Certified �[3 Conditiona y Certified [3Registered
Farm Name: Cy 0 , f 4 / e"
Owner Name: `S�eV e Ceti 1 r1 S.G,
Mailing Address:
Time:
Date Last Operated or Above Threshold:
County:
Phone No:
Facility Contact: J Title: , Phone No:
�` Onsite Representative..l eve ` t S� --- Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° 44 Longitude 0 ��11
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacitv Population Cattle Capacltv Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I JEJ No -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number df.Lagoons I 1 I' ILJ Subsurface Drains Present IIU Lagoon Area JU Spray Field Area
Holding Ponds/rSolid Traps. �;' ❑ No Li uid Waste Mana ement S stem {
Discharges & Strggm Ind
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑'Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? /❑ Yes ❑ No
Waste Collection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches):
05103101 Continued

Facility Number: - -
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? Zxcessive Ponding ❑ PAN Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA\krMP)?
14_ a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
19. Does record keeping need improvement? (iel 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 D�VQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems. over application)
23. Did Reviewer,'Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You wilt receive no further correspondence about this visit.
" K .lmr - F,. m, y. '{4.;r' -.� -... - - —},.. r q ..«;d - :'.:ar'.L''•S.iL ..i -aa} ,•w;' A} �,. G ri^'NP ew El +tcN�� a lW.k11 i tY 4 w
t~ommettts"(refer tto gnesbon i 'Eiplaut:any YES'adswers:and/arany t ommentiations ar any;omer>cotnmm#s.
f / / f i 4 E 4°E /'S• '.. %( - f i•P°4 f i'%a E.d st41 i�f 11.1ii.iia.1. ....4: r.4u,...,I.E.�i'�i,1, ., �a� Y..e if Y
Use drawings of factlity.tD better explain s1biite6ns .(use addltlonalpi'iages as necessary) { ;
4❑ Field Capv ❑Final Notes
lt��i�d !�s'J9Ydk'v.'=ire'�sw��.-e--•ae�»s-:.werrn�--�.+^+.a-.>--r--nra-^f+fcr�e<..v..----�.... :h,�t.��
4aloA+lkaa_S.1'�i{'i'�r���.S�teaiS§"�?�.�.I
-Trsrc-4icti Gdont III ✓rf�n►,SC 4z5 Gi I A r n e -gickDovPtwa-Oc
peaNdino ,'1 4 1P P,"elal. L�e7v,­,
as-�t �^v•�o�f �,`rckA,
6� Ae sT—' /4 h Cf i S e_r4 i /­-4gG0( qT !g. Q I t eh s d , r ,"eq a d
vq 1 '' � � sA f 1eT 4 x-td p iC_ 4Q ,-e r re 4a k e pi . '7"Aie l ag ao -�t,
1w1,
11we
FreeaeA,',0( WA,-r I-}-Trr �� ;hG4oS `1 rCe--%:'h.T arl �'i?G !'tD- :�'t'Gq}ivto LtJaS
pJ iVen • �Yjr. E'�S�tSh SAr'd /ZO ijod ,'b, Lt 'cg4i /L✓e,-r Q;ve,, bengtrSe
-
^
�'Reviewer/Inspector Name aB
£, .;,c
Reviewer/Inspector Signature: Date: •� L"�
05103101 Condnued

f
Facility Number: — j,J Date of Inspection ? O
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
2?. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. NVere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�e ���f loL9oa'-% level t"041al be Cowe e'A �n et, s4pe4 -�►mac
5,,e-Svv,0111 (i-;k 6VX7,;�LPw) aho( 4-1,d poles aye deAd
ah e "i "ve, '4 - he e . 1
Pt. /7 .�� 4he " rt�c 4 6�, -Mr. Eh y t rx4 C.rea4 epl A d q q,)
-4ke ro�ded -ifea 4o preven4 -^uelhe✓ runoff^` ove-Jkr we,-$9e
q+ld he pl vv 4o reelai-n fondPvl wo-4e �o -)ire sy x4e*
05103101

i
IType of Visit T Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I hate of Visit:
0 Permitted [3 Certified 0 Conditionally Cuprti ed 13 Registered Date Last Operated�es Above
.Threshold -
Farm Name: /1^ County:
Owner Name: lrv� L Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: TF 1)
Certified Operator:
Location of Farm:
Phone No: — l
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0. OK Longitude �• �• ��
Design Current Design Current;`Desigta".•` Current
Ca achy :Po" Mahon' cattle...
!
'Swine',Ca acity Po `ulaiion "Poultrv., "`Ce'acttv.' Population'
❑ Wean to Feeder JE3 La er I I❑Dai
[Siteeder to Finish ❑ Non -Layer I ❑Non Dai I i
Farrow to Wean
❑ Other
❑ Farrow to Feeder
, WT "�j
❑ Farrow to Finish 3; i Tt)tal;UesignCapaCity`` i
Gilts l �, �"li ;.� �
❑ Boars"Total'SSLW:
Numberof Lagooas ILI Subsurface Drains Present ❑ La oon Area JE1 S rav Field Area
;,1 raps ❑ No Liquid Waste Management System
Holdtng_Ponds'SoUd',T
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: El Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Js there evidence of past discharge from any part of the operation? ❑ Yes ilNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collecti.9n 8& Treatm-eat
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Ye No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: &L— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion,
❑ Yes
(;No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
YesINO
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Analication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence A over applications ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
)ZNO
12. Crop type cowds
13, Do the receiving crops di er with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
;6No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
PrNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
RMired— Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PNo
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
VINO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes
ONo
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
IdNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�(No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
�* r
q, ) p Y
ter to uestian # Ex lain an YES aasr�ers and/or any recommendations orany athear cmments
e dtraw nos of fa4 `, to better ex lain situations.. sc addi nec .��
p (u tionahpages as necessary):,-
� Field Conv ❑Final Notes
„{ty l ,: i
.N'� le
00e,4 61,/r - zo^)
✓E,� Ts C�iP�P-� s .
NOI.G: �v�, f�, �-r,� �s Gr��c� �.�z�r�,✓�r,R ��c���s
Reviewer/Inspector. ame
Reviewer/Inspector Signature: Date:
05103101
Continued

Facility Number: Date of Inspection Ew�oa
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes AXNO
No
El Yes
❑ Yes 'VNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional_Co'dinients and/or Drawln s "
05103101
05103101

Type of Visit fyCompllance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 013outine O Complaint O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number
Date of Visit: 0 23 01 Time: d Q
3 )
Q Not Operational Q Below Threshold
0 Permitted ©Certifie�rdr © Cyondl1ii�donally Certified © Registered Date Last Operated or Above Threshold : ..................
FarmName: .. C t.Ar rh �...!......................................... County: U,'."'..............,............................................
Owner Name: C Zr r Jgs r it , � , vt1<�2 � S. vim: r l' ........ Phone No: .......................................................................................
rl
FacilityContact:.....................:........................................................ Title:
MailingAddress: .....................................................................................................................
Onsite Representative:
I ................................................
Certified Operator* ...................................................
Location of Farm:
PhoneNo :...................................................
Integrator: ..M �'.........................................................
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 46 Longitude • 6 61
Design: Current
Cauacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design . Current Design Current`
Poultry Ca ad ...Po ulatioe Cattle ' Ca aci Td etiatloi
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 1[3 Non -Dairy
❑ Other
Tdtal Design Capacity .
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Trap ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes 1�No
c. If discharge is observed, what is the estimated flow in galhnin? ti 1 �
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes P'No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'T10
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway ❑ Yes 1pNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi rier........................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on hack

Facility Number: 3— 5 � Date of Inspection 1 Q 2 3 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes J9 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 ONO
(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 dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes '0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes -ffNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes 9No
12. Crop type C a r -on 11e'4 Sa u 1W_r4 J'j S
.,..,..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ZNo _
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
-0Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ljzNo
16, Is there a lack of adequate waste application equipment?
❑ Yes pNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Iffyes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ErNo
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 'ONO
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 XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 2No
1�Q YiQl l�i�njs'oi� 0e1elegeie$ •wtre noted• 00169 01s:visit; • :Y00 Will t eoito 00 otthO
corres' otideiki ab6iif this visit.
o.mments(refer#o.questlon #): Expla
e clxawiings of facility to ;better explai
1�• `T7 e 4"-;1'+y neCd� 1h We#4bie acraS A
• uvr-sk FlAk Av-%d recoroS 4e be ker3 GtCGdrei;✓tp
1d"ylrr �3e;hk1cy Gu"114�7
►nAkes 3�o UIIS in F;e1d Z o{ e acres avtA ;h �e1d.� eF'/��cres�
fie sa\1s . qT e �,�t2-� �s s�.ew Z Pu jfs o.{ 2.,5 4crer eact, i►, �;cld
c%►Id Z V11s 0 Aces 0i Fes►eld -L! '+ apfeVrs -4kg4 -fke
records c o noACGV'-0'+e1 y �'e 1ccf ''; eld �r-Ac4-; ces / pav-11- y.0 4'k; s
C o-n 6e ", rec4cd a.;4L 4 ke wee gcrel de4er'r1; nq4r',o"'►rj y'P') W;lh ;1,
C.y-_/� _i
Reviewer/Ins ector Name „� ��1'1 41%G�f I. �.;` .iGG it ° E:s p� y,il !P Y�; i t li iYl' ;E
p �. E, ..,.. �3 ..i. d e, 1 il�, i i,. !ti d. L,
Reviewer/Inspector Signature: �i/L]� Date:

I
Yacility Number: --rJ Date of Inspection J 0 23 p
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Fo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JZ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 8 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an or ra ngs:
11
19, Need 4D 6ve, cec jssved Ta G1.,Aelcs j3rtnk1c\1 a" -Sieve f�,, L)t,Rsf, •
ih 4e record f
2! . G2G MalhQ4• bpcorr'eG}f� I;�,"- 1 �Ca•�e i�r. 13 'nkle� i-L
6ZC e-k q,-y -ror wn 4 oaskcd 46a-f 4c A.
5/00

IgDivision of Water Quality
Q Division of Soil and Water Conservation
:
010ther Agency` ,
Type 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
Date (S visit: 1 iltle: r Printed on: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
Permitted 13Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: 1: 3.).'A.L.M..V-L.E:`f`.............. ............................................ County:.....�5,..P..i—l.t1...................
Owner Name:.. .L�.'z.E ,..T�..C7t....'ti.n......... Ac.Ca..�'1!lrt,�..r...J i Phone No: .15.0.0..►... .L...�.r...q.�-i. ....K4.Sf3q
Phone No:
Facility Contact: !�111 .i.. .......�`1. .fd-C.�„l.S....... .ritle:...l t4.b.. ice...... ................
MailingAddress: .... ,.}...k.....o.......... k................................................t-C........ ...1..Y............................. ��..�a�..
Onsite Representative:!.i......G.. L,:1�................................. Intel;rator:.....................................
Certified Operator..j-0.Nt.l...... a ....................................................... Operator Certification Number:...8?
Location of Farm:
ta-d✓t�vl L 41 i ��t7- �L'[ t CD ri
5 t i t-4 C% ./ C rN i t d- -1 * f .-n ,/ u _ 11 w s 1 A, L1"9 r-A r- C cl t 1 P_ i' i 7 F,
ne ❑ Poultry ❑ Cattle ❑ Horse Latitude • IF 1, Longitude ©• �1 �«
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 ❑ Dairy
❑ Non -Layer 1 1 1[3 Non -Dairy
❑ Other
Total Design Capacity 1 Z©
Total SSLW C Z
Number of Lagoons } ❑ Subsurface Drains Present JU Lag,7on Area spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System SP.`C
h0
Discharges & ,Stream Im acts Lira -!fit t'Z5 , [l)-4-
I. Is any discharge observed from any part of the operation? ❑ Yes W'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Exqo
b. If discharge is ohserved, did it rca4h Water of the State'? (If yes, notify DWQ)
c. II'dischat-c is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structure I Structure 2 Struclurc 3
Identifier......... ............................................ .......................
❑ Yes ONo
❑ Yes KNo
❑ Yes jso
❑ Yes XNo
❑ Spillway ❑ Yes NTo
Structure 4 Structure 5 Structure G
Frechoard (Inches):
5/00
Continued on back

-I f --...

Facility Number: -- t— Date of Inspection Printecl on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes CTo
(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 maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JE�No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes TKNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes `K0
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ERNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes 1�(No
c) This facility is pended for a wettable acre determination? ❑ Yes W, o
15. Does the receiving crop need improvement? ❑ Yes '5�No
16. Is there a lack of adequate waste application equipment? ❑ Yes KNo
Required Records & Docu►netlt_s
17.
Fail to have Certificate of Coverage & General Permit readily available'!
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U(No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
1KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑ Yes 'KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes XNo
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 li�No
o yiolatitiris:or ileticiencir?s mere ngt;eti doting �his;visit' Y64 vvi�l r'eeeiye �iti furthirr;
�tirrtes orideirce: AaU .this visit .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): 5'�t�h� 'A-�V5S0L) tz�-1 ST`Cc_G HOC) L,-) LTH
C-0 -t-0 b c) GC. U0 �T-tea-- T-0 1-._ k-
5TAl-t p r-N S
Reviewer/Inspector Name C_�_
Reviewer/Inspector Signature: f—An A— ,&1 ,, .YD-In_ Date: 1 n _ I rt 5100

• ,... . T�': ' ' ti' . .,. _� � r:� : •..+ryr� _•.r.: a°Y'�r;ma+(} tii'��,.,w-r••�Kws,..:....,, a -..-- .., �.: "c�. '�!"r *+ �4��.:Y�'!'k i.,,. `'r , _ �.
1
r

r . 'Facility Number: \ — j Date of Inspection ®co Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes TOO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 `R 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 5<No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes TKNo
Additional Comments and/orDrawings:
AL
-1n �T
5M Lt4b ' utat_hr1�Y
\�N L S
h
4©
sroo

"� . Fw�J-..�a,�. - . ..:�?t . ,.in _ � I �fi .7y'N"-� .�... ��ryry x�,� ,lr. _ r-c.w�r. i. , ._ ..^. .-.. +r _.w .. �'?, rr��:; �:.� - W .. „=-l�k �vP:Sif�.r��...". ., s&.

Facility Number: — Date of Inspection }printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15, Does the receiving crop need improvement?
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/ 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?
u; TiQ •violafit?tis;oi- d fl.0 ncies #w . re :ngted_ d.nvisit; (W g fhis. • Y:oo :will reedit, 1io (urther • .
correspondeike. about. this :visit. ::::: ' ' ' . ' '
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
r11
W
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor holow
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes]
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt,
[] Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ 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
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Aldditional Comments andorDrawings:
i
5100

}� DevrAonrof Soil and Water, Conservation Operation Review i °' i ' t k;
O,Dtvistotn of Soil and Water Conservation Compliance Inspection t
k E C: s
�,Dtrnston of Water- Quality Compliance Inspection i Vt';��
,
,
Other Agency' ReviC ,
Routine 0 Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 Date of Inspection
Time of Inspection 60 24 hr. (hh:mm)
0 Permitted Wertified © Conditionally Certified 0 Registered 1103 Not Operational Date Last Operated:
Farm Name: ......................................................
......:..h.....e.�P...................................................................... C ounty:........... ...�.
OwnerName : ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ......................................................:.......................'l'itic:................................................................ Phone No:
MailingAddress:............................................... ...................................... ........ :......... ................................................................................................... ..........................
Onsite Representative:. ..... .. .......................................................... Integrator:......t.. ..................................................
......
Certified Operator : ................................................... ............................................................. Operator Certification Number:............ ................
Location of Farm:
�k
Latitude ' 4 - 44 Longitude 0 4 ILL
Design,. Current Design Current Design Current
Swine Poultry Cttea''Pp„Ca acit ,Po6ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish J❑ Non -Layer I Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number'of Lagoons -' "'' JE3 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding,Ponds / Solid Traps ❑ No Liquid Waste Management System I
Dischartres & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes JVNo
Dischargc'originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (Il'yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the eStitnated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifycs, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D 'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway YesNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldcntilier. `
Freeboard(inches): .............II.............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: -3 S1 1 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�*o
(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
P(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
ONO
12. Crop type W Le.-I-5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
ayes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
5ZNo
16, Is there a lack of adequate waste application equipment?
❑ Yes
Wo
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[�(No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
t4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
P No
(ic/ problems, over application)
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
KNo
0: Rio yiglaiicjris:or• dgfciendt,s -were noteo• do-• ing •t)tis:visit' • :Y:oii :wil<i-rec iye Rio uttht f • :�
.corres�onciehc' e. about. this .visit • • • • • •
,, # €# ' ` ' ` ; y `.,. , 'iiny other comments a p t 10
Comments (refer to questson #):' Explatn'an YES answers and/or any recommendations or
Use drawn Sof facilrt tq`better. ex lamsttuatynns ` us
g• Y ]t (eVadd�ttonal-pages as necessa.Y'Y) .. i�f t j `��•��€�+z�;�� �;el.s3�°P I I f ,?.�"�,�,"4 ,;t ,�,
A,
0 ess �,OTRR-_
Reviewer/Inspector Name l �;
Reviewer/Inspector Signature:
Uf
Date: —7 77 1�
3/23/99

Facility Number: 3 — [late 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
NyYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27,
Are there any dead animals not disposed of properly within 24 hours'?
❑ Yes
�*No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;�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
L�`No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
k
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage hins fail to have appropriate cover?
❑ Yes
[�No
32.
Do the flush tanks lack a suhniergcd fill pipe or a permanent/temporary cover?
❑ Yes
dNo
Additionall'Comments and/orDrawings:
3/23/99

II E3 Division of Soil and Water Conservation [3Other Agency
�J Division of Water Quality
Date of Inspection qP
FacilityNumber � 1 �q� Il
Time of Inspection � 24 hr. (hh:mm)
Registered 99 Certified 0 Applied for Permit 17 Permitted 10 Not Operational Date Last Operated:
FarmName: ..............
A-1 ..... IV,...... ttrVA........................................................
County: ........
rk/oin ...................................... .......................
Owner Name: ..........................
awy.. r.. %! .......... Q n...........................................
Phone No:....
I.'J. !.........y......433.1.............
Facility Contact:
qa.................. Title:................................................................
Phone No:.... 91R.).. 9G...:S(ely. .......
MailingAddress: ...........
P.0.... LA ..... ia-a............�.................................................................&5.e...lf�.!.1..,.NCA..,................................................zYi'a
........
Onsite Representative:
............F.6w..t.....MAT.Yt�.W5.........................I.....I.......I...........
Integrator:........
A�IUY...
Certified Operator;
...............................................................................................................
Operator Certification
Number;.........................................
Location of Farm:
Latitude 0'=1 =41 Longitude =• =1 =11
O ` 4
"-Design ,Current;,
,'. ' ,
Design ; Current
Design! Current
Capacity Popalation
Poultry
Capacity Population Cattle, "-
Capacity Population. '
❑ Wean to Feeder"
❑ Layer
.'. ❑ Dairy
-�
".. Feeder to Finish
❑ Non- Layer
„, ❑ Non -Dairy
❑ Farrow to Wean
-� ❑Farrow to Feeder
- ❑ Other
❑ Farrow to Finish
Total DesignCapacity
❑Gilts
ToS
x. tal SLW '
❑ Boars
Number of Lagoons / Holding Ponds 0 ❑Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area Fs
-
ar.
r� ❑ No Liquid Waste Management System
r..�
�t
sUr,x
General
1. Are there any buffers that need maintenance/improvement?
Yes
i% No '
2. Is any discharge observed from any part of the operation?
❑ Yes
E6 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
14 No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
13No
c. If discharge is observed, what is the estimated flow in gal/min?
Nx
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
1P No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
10 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Yes
❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
V1 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

Facility Number: 3 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes No
Structures (LagoonsBolding Ponds, Flush_Pits,_etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I'!lst�?..........................111�.....................................................................................
............. .
......................................................................
Freeboard(ft):.............. 3.,5............. ............... 2................. ................................... ....................................
.................................... ....................................
10.
Is seepage observed from any of the structures?
❑ Yes
PNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E No
12.
Do any of the structures need maintenance/improvement?
M Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
P No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
)q No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop hype ................ fnItwh........... A1W.......................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 1P 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 Reviewertinspector 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?
❑ Yes
ZPNo
❑ Yes
fgNo
❑ Yes
jP No
❑ Yes
W No
❑ Yes
M No
S Yes
❑ No
❑ Yes
0 No
❑ Yes
No
❑ Yes
Pd No
0, No violitions'or. deficiencies.were"noted-dtiring this;visit. You:r'ilhreceive•noltiriher
• correspQtadeh0 about this:visit:.
�. 'StyYe ` ib MLL.aYm[DCYf rh1 ✓`S {,�yt}fr Lip?- G�, 4e Y US��I AELM'l;0Vim -
�, Ca11ip� n ( f c� IC`I lit 1-iJrl SYIO�� N8 �1l 4u, I,+ ��v (lakm}c�Q +rL- c�Yt�r�i f� i�C�trry (`)
0 �G �0�oe,.. 4 Y1crUi� bz gVb?ertj C (qie� cU 1 �_ vuce ssv�Yu
12. CG4,nu[ �i'tOr�S �o �{�Iet a G ArcuS o� Xv_c. UXj1 Of Weal ) joah•
7I25/97
Reviewer/Inspector Name 4
Reviewer/Inspector Signature:
Date:

® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: g] Registered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.................................................................................................»..............»..................................
FarmName:....�............................................................... County:.*D.u+.h.h............. .................. ....
Land Owner Name:.. .W,crf. .. .I`.........Es :................ Phone No:.Lz..Q Q.. ..ai.Z..`..... �. �. � ..... CK3.5 1
,..
FacilityConctact:..Lar:rr y....l` `.tl. .!....
...........................
Title:................................................ Phone Nv:..........................................................
Mailing Address :... :... ......1.
k..t _......1
....................................................... ...�. � S tr....� c..�..�.}.....tJ..C........... ........... ..... y y..5s....
Onsite Representative:.. .......
..............
_..............
.............W....... Integrator:.P..V.:r.i2........................................................
Certified Operator:.....................5.1! �!{".................................... Operator Certification Number:.. 01±1.................. .....
Location of Farm:
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ,LNo
❑ Yes Q No
❑ Yes
® No
❑ Yes
® No
0JA
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
$j Yes
❑ No
Continued
on back

Facility Number: j.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
S . an i
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes O No
❑ Yes IN No
❑ Yes M.No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Applicat44�
14. Is there physical evidence of over application?
(If in excess of W}MP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....... ..................................................................... .............. .............. ..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certitled Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
iecc
❑ Yes 2�No
® Yes
❑ No
Yes
❑ No
❑ Yes
IT No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®. No
$9 Yes
❑ No
❑ Yes
21 No
g[ Yes
❑ No
❑ Yes
RNo
❑ Yes %No
❑ Yes No
Yes ❑ No
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Reviewer/Inspector Name
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Reviewer/Inspector Signature:
Date:
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cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires inunediate Attention:
Facility No 1 — 1
_ DIVISION OF ENVIRONMENTAL MANAGE?viENT
` U ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: —14, .1995
Time:S 2� �►+�
Farm Name/Owner: �+T. bL- 6 Id Ad— C � ea5—n - -
Mailing Address:
County:
Integrator.
P
of r f G? RV • Z ff 3 C(
Phone:
On Site Representative: q V2A lT1 Phone: 9107,R5 4WO
Physical Address/Location: Fr T- �'�� ( 'JI t I4 Qn 5 /Z ra m
Bc hb 'G i 1 Z r'�r �2�r.h e. tr:
Type of Operation: Swine Poultry Cattle
Design Capacity: 1206 Number of Animals on Site:
F171'
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 'A ' 4-6 'A '' Longitude: _M ' 51 '51 . �V Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Pea�oon(s)?
rNo Actual Freeboard: �Ft. Inches
Was any seepage observed from thYes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No IS Crop(s) being utilized: _ 1 �(�� griin Sc
Is the cover crop adequate? Yes or No
M.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
L. 5
Inspector Name
cc: Facility Assessment Unit
OIL
Signature
Use .-attachments if Needed.

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• Complete items t and/or 2 for additional services. I also wish to receive the
1 m • Complete items 3, and 4a & b. following services (for an extra cmi
i • Print your name and address on the reverse of this form so that we can fee):
t or return this card to you., '
m • Attach this form to the front of the mailpiece, or on the back if space 1. ❑ Addressee's Address y
does not permit.
t • Write "Return Receipt Requested" on the mailpiece below the article number.
2. ❑ Restricted Delivery
'' • The Return Receipt will show to whom the article was delivered and the date
d-livered. Consult postmaster for fee. m
�� Article dressed to- 4a. Article Number =.
m��: - oaf = / � Ei
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o+ ❑ egistered ❑ Insured CM(
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Cr r? y � Merchandise
7. Date of Deli ery
a of C� ,GW 0 ^51Y / rS�.-
j Ix 5. Signature {Addressee) 8. Addres ee's Address (Only if requested v
and fee is paid)
CC 6. Sig ature (Agent/ i
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r P5 Form I, Dece ber 1991 *us.GP0:1003—=-71l4 DOMESTIC RETURN RECEIPT
N

•
State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr. Division of Environmental Management Jonathan B. Howes
Governor WATER QUALM SECTION Secretary
CERTIFIED MAU, HZ 405 591 306
RET M-RECEIPT REQUESTED
Mr. T.T. Brinkley
Box 106 Rainbow Road
Warsaw, North Carolina 28398
August 15, 1995
Subject: J.T. Brinkley Farm
Duplin County
Dear Mr. Brinkley: + �,
On August 14, 1995 Staff from the Wilmington Regional Office of the Division of Environmental
Management inspected your animal operations and the lagoon serving these operations. It was observed
that the level in the waste lagoon at the farm was - V-7" from the top, on the verge of not having
sufficient freeboard.
NRCS guidelines for Best Management Practices require a minimum of one foot seven inches of
freeboard. This is based on the amount of storage space needed to contain a 25-year storm event of 24
hours duration. You should pump down your lagoon to provide the required freeboard. The wastewater
spraying activity should be done in accordance with NRCS standards which are designed to prevent runoff
from your spray fields.
To remain a deemed permitted facility, all corrective actions must be made within seven (7) days.
Failure to do so may result in the facilities losing • their deemed permitted status and being required to
obtain individual non -discharge permits for the facilities.
Please be aware it is a violation of North Carolina General Statutes and Rules to discharge
wastewater to the surface waters of the State without a permit and/or to fail to follow a certified waste
management plan. The Division of Environmental Management has the authority to levy a civil penalty
of not more than $10,000 per day per violation.
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

J.T. Brinkley
August 15, 1995
Page 2
When the required corrective actions are complete, please notify this office in writing at the address
below. If you have any questions concerning this matter, please call Linda Lewis or Dave Adkins at
[phone].
Sincerely,
IA'�/C' f , � e"
Linda Lewis
Environmental Engineer
S:\WQS\STEVEW\HOG\BRINKLEY.895
cc: Dave Adkins, Regional Water Quality Supervisor
Duplin County Soil and Water Conservation District
Duplin County Health Department
Tom Jones, NC Division of Soil and Water Conservation
Operations Branch
Rhett Schaef, Murphy Farms
•
E -I
0

Site Requires Immediate Attention:
J Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
X? DATE: 4J , 1995
Time: • /�C%
Farm Name/Owner: J, r
Mailing Address:
County: _ __
�OlA/XG6't
Integrator: Uff-PI Phone: -I —Jill
On Site Representative: Phone:
Physical Address/Location: _- -I� �� /l _ �� �7✓�
. o�c__
Type of Operation: Swine ' %/ Poultry Cattle
Design Capacity: Number of Animals on Site: l Zd7�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 �L' _3 ' Longitude: 77 S�' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ufcient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Ye r No Actual Freeboard:' / Ft. Inches
Was any seepage observed from the lagoon(s)? Yes r No as any erosion observed? Yes r No
• Is adequate land available forpray Qr No Is the cover crap adequate? Ye r No
•
Crop(s) being utilized: R 17
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es. r No
100 Feet from Wells es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yesoste
If Yes, Please Explain.
Does the facility maintain adequate anagement records (volumes of manure, land applied,
spray irrigated on specific creage with cover crop)? Yes or No
Additional Comments: 04-1 SST" �'ySi��i � Uj � A927 86-p_
cc: Facility Assessment Unit Use Attachments if Needed.