090140_INSPECTIONS_20171231

Di�i"sign of Water Resoarces
=ACHRINdimUer - " Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: INIIc Departure Time: County: 18 gj9I ` Region: r I`
Farm Name: r S Owner Email:
Owner Name: rLy+-t Phone:
Mailing Address:
Physical Address:
Facility Contact: Jet-rW-5 1-0-, Title: Phone:
Onsite Representative: Integrator: p
Certified Operator: 1-Q wo C.- 5y,"-►~ Certification Number:y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design `Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Finish
Layer
Dai Cow
Feeder
Non -La er
DairyCalf
o Finish
Design Current
D , P,oult . Ca aci 1'0
DairyHeifer
o Wean
o Feeder
FF
�; b 6
D Cow
Non -Dairy
o Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Pullets
Beef Brood Cow
PWither
Turkeys
Turkey Poults
Other
Other
Discharges and Stream -Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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
0 Yes [-]No
❑ Yes []No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
® NA ❑ NE
[U NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of inspection:
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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r�
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.)
10 No ❑ NA ❑ NE
❑No 0)NA ONE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No 0 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 [�5 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? 0 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[�DNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Win Drift ❑ Application Outside of Approved Area
'
12. Crop TYpe(s): i % k
13. Soil Type(s): f"p L Cp 4, NO A- { A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Cbecklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r�l No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Kumber: G) - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes y� No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
Comroeti.ts(refet„gaeshonf:4Explatn3aoyYES.snswers and/an aay addtf�oaal recommendations ar'anyother-
Use drawings ofafactltty to W .4- eaptatn,situahons (nse addrttonal'pa�es as necessary): '"V.
Reviewer/Inspector Name:DbYil`
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
®NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA D NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
2141201 S

i ype or visit: ® t-ompuance inspecuon lJ uperanon Keview lj atructure r,vamanon v i ecnmcai Assistance
Reason for Visit: ® Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: lb Arrival Time: Departure Time: County: Region: 49V
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact- S' l�'^�� Title: Phone:
u
Onsite Representative: i integrator: ae.84 tw
Certified Operator: aw-1 o ,.%`� Y4 Certification Number: �
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentMpml.
Current
Design CurrentCapacity
Pop.
WCap ity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Tt
n Current
7aa
wrmimt1,c
Dairy Heifer
Farrow to Wean
Cow
Farrow to Feeder
D , P,o.0 Cci Pao ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
T.-rke s
Other11211 iTurkey
Puults
ig
Other
Other
Discharges and 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
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No;NA
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
'�;l NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: ZI jDate of Inspection: 47300/16
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [OVA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in) _
Observed Freeboard (in Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes _ I� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes 0 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 DriftApplication Outside of Approved Are
12. Crop Type(s):44 /' a � S qa� SM . D
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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[n No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
El'No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �jNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes � No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes ro ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
J410
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5j4lNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
W No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
® No
❑ NA
❑ NE
• tions or any other comments. "' Comments (refer to. question p y:_ y Explain an answers and/or an a ions recommen a
Use drawings of facility to better explain situ'ahans (use`additioual pales as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1?7�0 `
Date: I /&/b
21412011

Type of visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: j Departure Time: Z' County: �" Region: rA0
Farm Name: r ,� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: U Integrator: -
Certified Operator: 5Q.ml e 5111t --A Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dign Current
Design
Current
Design Current
Swine 1—es
apacityWet
1Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P.aW
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Poults
er
H.:u�rkey
r
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 r No ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
[:]Yes
[:]No
NA
❑ NE
[:]Yes [:]No
❑ Yes No
[] Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facili umber: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus stone 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):
7iy 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 M No ❑ NA ❑ NE
waste management or closure plan? Wr
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 4 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Pj 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 #0 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnliCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Jr'"' No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Pq 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): LJZZQ> " L�.ii'h�c(4(q l J'a J ,, _
¢j
13. Soil Type(s): o
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
❑ Yes
[ja No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9W No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 F 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 21412014 Continued

FBeiliNumber: Date of Ius ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
[-]No
P5 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
y� No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
[] NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
to
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[)—a No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
f� No
❑ NA
❑ NE
Reviewer/]nspector Name: MO MO.," Phonel/
Reviewer/Inspector Signature: W*A�Date: �Nl—
Page 3 of 3 21412014

i'ype of Visit: W Uompliance inspection U Operation Kevicw U Structure Evaluation U f echnical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: g 1 Z Arrival Time: Departure Time: b County: Region: FPO
Farm Name: Owner Email:
Owner Name: �(�s'� —•{�M �j�� Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title: Phone:
Onsite Representative:, anm r .Lim Integrator:
Certified Operator: Ja,rY,1 P Sri, A _ Certification Number: Q
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
t Design Current 2 1 Design Current
Design Current
Capacity Pop. W.et Poultry_ wCap ity Pop.
Cattle
Capacity Pop.
Wean to sh
Layer
airy Cow
Wean to Feeder
I INon-Layer IDai
Calf
Feeder to Finish
airy Heifer
Farrow to Wean
/S
Desigu Current
Dry Cow
Farrow to Feeder
Dr, P,ottlt P.�Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharyes 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 [PNo [_]NA ONE
❑ Yes
❑ No
[jg NA
❑ NE
0 Yes
❑ No
`P NA
❑ NE
[—]Yes ❑ No
❑ Yes `jam No
❑ Yes U3 Na
�NA ONE
❑NA ONE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 9 2.6; 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ro No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�j NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
1___
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�t No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®No ❑ NA ❑ NE
maintenance or improvement? ��
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100/. or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Applliic�ation Outside of Approved Area
12. Crop Type(s): 1�C,5 (�e,�,.d L:s 5 D
13. Soil Type(s): t-YD
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
`ice No
T
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[„] No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
E] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[p No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: g - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [ No ❑ 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 W No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes CP No ❑ NA ❑ NE
❑ Yes `9 No ❑ NA ❑ NE
[�; Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes C�j No
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
21412011

for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ��5 rnb Title: Phone:
Onsite Representative: Integrator:
��(Y1 [� Integrator: c5
Certified Operator: �Q V1K-. Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design ;CNil 1111111111 IN 1111111111 lip
urrent
Design Current
Design Current
Swine Capacity . Pop.
Wet Paultry Capacity Pop. •ante
COApacity Pop.
Wean to Finish
Layer Dairy Cow
Wean to Feeder
er
Dairy Calf
"
Feeder to Finish
UNon-La
Dairy Heifer
Design Current
D . Pao Ca aci P.o
Farrow to Wean
Dry Cow
w
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Ill
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes N3 No ❑ NA ❑ NE
❑ Yes
® No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
❑ Yes ®No
❑ Yes Ej No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - i Date of inspection: j
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 Ef NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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
® 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
Ea No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Drift ❑ Application Outside of Approved
Area
��Window
:�LrWind
12. Crop Type(s) l .C�TCt_i&CjO2�0_ �QSs 4 ty-1_ c Ltl �
Uo-
a. rl,�_
13. Soil Type(s): f aYt k )
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
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
K] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D 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 Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ED No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: CV- [ Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[[ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes © No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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.
VApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ej NA NE
NA NE
NA NE
NA NE
Yes ® No ❑ NA [:] NE
Yes ® No NA NE
Yes [g No [] NA NE
PD Yes ❑ No ❑ NA NE
Yes ® No
Yes No
❑ Yes ® No
NA [] NE
NA NE
NA [] NE
Phone:
Date:
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: i ounty:"11
Farm Name: S Owner Email:
Owner Name: 1�Sue S-tC� Phone:
Mailing Address:
Physical Address:
Facility Contact:
r
Onsite Representative: �GLI'Vhs LlJtrl
Certified Operator: J i e_ Jf►' 1
Back-up Operator:
Location of Farm:
Title:
Latitude:
Region:
Phone:
Integrator: �YQCy�
Certification Number: !9 i
Certification Number:
Longitude:
Swine
Design Current
Capacity Pap.
-
Wet Poultry
Layer
I INon-Layer
Design
Capacity
I
Current
Pop.
— Design Current
Cattle Capacity Pop.
aia Cow
a' Calf
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
"' � -
D tPo.Wt .
Layers
Desi n
g
Ca aci
C
wurrent
P,o
airy Heifer
p
Dry Cow
E S Farrow to Feeder
Non-Datry
Farrow to Finish
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
I
Pullets
Beef Brood Caw
tither
Other I
Turke s
T-rkcy Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 potcntial adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes [:]No
❑ Yes NMNo
❑ Yes No
PNA [,] NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 47 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ;RNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
C
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
T
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
EP 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
01 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tN 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
of Wind Drift f�'❑,,,Applliijcation Outside of Approved Area
12. Crop Type(s): c0a§ l r"" 6 Lm7 -�J ] 6;1, • "'w+1 loved4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LN
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Qg No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® 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
M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ g No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ 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 N No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. 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
PApplication 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
No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
[]Yes
�_gj No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any outer comments:
Use drawings of facility tobetter-exolain situations (else additional vases as necessary):
Rec"5 re0 : ,0, _ j y-i l'
0 n �'-(91/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
] Arrival Time: �;� Departure Time: County: Region:
15 Owner Email:
Owner Name: S 1'►'ZSC a Phone:
Mailing Address:
Physical Address:
Facility Contact: Ie Title: Phone No:
Onsitc Representative: �Q� t-''J Integrator: S1424
Certified Operator: �( iM Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6= [f Longitude: = 0 0 I 0 u
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Finish ill Layer
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
arrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Layers
❑ Non -La ers
❑ Boars
Pullets.
❑ Turkeys
I
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No lb NA ❑ NE
❑ Yes ( No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
Page 1 of 3 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 ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No A ❑ NE
Stru ure I Structure 2 Structure 3 Structure 4 Structure 5 S60ure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t/7U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA ❑ NE
through a waste management or closure plan? 0
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 [q 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 0 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?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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 [I Application Outside of Area
12. Crop type(s) AabS 04' cvzq— '+ Lw
13. Soil type(s) —GbA ] FQ I No �1 _
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 fi� 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 PNo ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
Comments (r'efer to'questtod #) Explain anv YES..answers and/or any' recommendations or,U. other comments
Use drawingsrof facility to better ex'plarn sifnations (use additional pages' ras necessary)
.. ,
f4s
Reviewer/Inspector Name �fflld-
Phone:Reviewer/inspector
Signature:Date:
6
Page 2 of 3 12/2&04 Continued

Facility Number: 9:-iw Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes {P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check ❑ Yes 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No PiNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
-;3No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P 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
'9 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
Page 3 of 3 12128104

Type of Visit 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: [ &__,100 IPAJI County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title: Phone No:
Onsite Represcntative: �QL011VI t Integrator: frt"e__
Certified Operator: Operator Certification Number: �7?�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 0 f 0 tl Longitude: = 0 0 6= fl
esign C•uCrent Design
Swine F�IDpacity Population Wet Poultry Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Wean to Finish
❑ Layer
[:]Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish I I
❑ Farrow to Wean Dry Poultry
Farrow to Feeder .Z ❑ Laers
Farrow to Finish
❑ Gilts ❑Non -La Non -Layers
❑ Boars ❑ Pullets
❑ Turke s
Other ❑ Turkey Poalts
❑ Other ❑ Other
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures: EJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VPNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
��qq
NNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
P
❑ 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
10 NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q�No
❑ NA
❑ NE
other than from a discharge'!
12128104
Continued

{
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes INo
ElNA
ElNE
a. if yes, is waste level into the structural freeboard?
ElYes [[❑ No
rNA
❑ NE
Stnicture 1 Stnicture 2 Stnwture 3 Stnicture 4
Structure
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
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes q%o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes O.No
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f�LNo
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs [:]Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside,, of Area
12. Crop type(s) , rn �_S �)'J M. �ti` ©g �C�l
13. Soil type(s) AVhW4K_. Cam{ ✓1*0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
l S. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA ❑ NE
El NA El NE
r�No
❑ NA
❑ NE
50 No
❑ NA
❑ NE
19 No
❑ NA
❑ NE
f4No
❑ NA
❑ NE
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):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
IZ125104 Continued

Facility Number: — Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes FoNo ❑ NA [IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the approprratc box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
nNo
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I�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
RNo
❑ 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
54 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
1P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[%No
❑ NA
❑ NE
AdditionalComments and/or Drawn s
Page 3 of 3 12128104

Type of Visit 4bCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:Departure Time: County: R�&V Region:
Farm Name: ` —/ Owner Email:
Owner Name 1" I"K t w �S Phone:
Mailing Address:
Physical Address:
Facility Contact: �1� tic-f`�3 �D� _ Title: Phone No:
Onsite Representative: �Larn6 Integrator: ��—
Certified Operator: Operator Certification Number:
Bach -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I El" Longitude: = ° = I Ej u
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet PoultryC�apacity Population
Cat#le Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry P.a�ttty�"
El Dry Cow
Farrow to Feeder O
❑ La
❑ Non -Dairy
❑ Farrow to Finish
ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Other
❑ Turkex Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
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
PNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
PSNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
0171
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
' An
❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Q9No
❑ 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
ElNA ❑ 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
MNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. 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?
❑ YesIWO
4p 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
in No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
EpNo
❑ NA
❑ NE
Comments (refer to"quesh n #)' Explain
Use drawings of facrlity%ta3better ezplam
any YES answeand/or any recommendations or any other comments.
situations. (usc a ddthotallpages as necessary):
Reviewer/inspector Name F
Phone: 10)3 '3360
Reviewer/Inspector Signature:
Date: ot%
Page 2 of 3 12128104 Confinued

Facility Number: — Date of Inspection
Requiumd Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rpNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1P No
[INA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
[�? No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes V No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JP No ❑ NA ❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
99 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
P 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
V No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawmgs
Page 3 of 3 12128104

O
a. .
D-evision of Water Quality
Facility Number O Division of Soil and Water Conservation
C) Other Agency .
e..
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I IJ/iipp����'
Farm Name:
Arrival Time: Departure Time: Q County: Region:
Owner Email:
Owner Name: pry
Mailing Address:
Physical Address: f ,�
Facility Contact: �d+^Y'>1 'Title:
ti
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
}� Phone No:
Integrator: f I esa�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0== Longitude: =° 0 I 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity. Population
❑ Layer
J ❑Non -La es
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
(P NA
❑ NE
❑ Yes
❑ No
(P NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: -' i Date of Inspection 07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ® NA El NE
tructure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Observed Freeboard (in): r I 6w
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 EpNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [13 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 [�l No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1P 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 [:IPAN > 10% or ] 0 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) [kJI' 10luy) i,�r, • . ��
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
f9 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
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[PNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A,
Reviewer/Inspector Name • e �. Phone: /O) q33 334DOO
Reviewer/Inspector Signature: Date: q
12128104 Continued

1
4
Facility Number: Date of Inspection 17/aT_
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
`�' No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IF No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
et�
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
El NA
El 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
[�INo
❑ 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
[allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �Arrival Time: j Departure Time: /r�- CO County: 6lQa� Region: ny)
D
Farm Name: 10 I� Owner Email!
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: P�±I.,�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = u Longitude: = 0 0 I 0 "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry C*opacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da' Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
1 a.30
❑ La ers
❑Non -La ers
❑ Pullets
❑ DairyHeifer
❑ Farrow to Wean
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
DischarVs & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
90 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
CPNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
M 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
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
❑ Yes 'V No
❑ NA
❑ NE
other than from a discharge`?
Page 1 of 3
12128104
Continued

Facility Number: — Lk}
Date of Inspection �6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: P1Sft
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3111
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes bNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) '
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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
maintenance/improvement?
❑ Yes P No ❑ NA ❑ NE
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4 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) Qt- t -56- iT Q71,J
13. Soil type(s) 00 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(5� 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
V9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
Comments refero oestion # Explain any..VES answers and/or any recomm endations or any,other comnients'� ,
Use drawings, of facility to better. explain situations. use additional pages as necessa
Reviewer/Inspector Name -p, fb�p ,C31pr. —� Phone:
Reviewer/Inspector Signature: Date: 'a-'� '�
Page 2 of 3 I2128104 Continued

4"
Facility Number: — Date of Inspection
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 El Checklists [I Design El Maps [I Other
❑ Yes $1 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility 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?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
1�?No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
DNo
❑ NA
❑ NE
❑ Yes (� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
roNo
❑ NA
❑ NE
Page 3 of 3 12128104

/ya
S
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Counh': j8)ao9cti Region: FRO
Farm Name: Owner Email:
Owner Name: __ �ts c _ ___ Y m S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: X, aa-f-
Certified Operator: 4111Sa Lk (3AY �av
Back-up Operator:
Location of Farm:
Swine
QQPhone No:
Integrator: C�j 4a a p
Operator Certification Number: 1 779,e
Back-up Certification Number:
Latitude: = o ❑ 6 = « Longitude: ❑ o ❑ l 0 u
Design Current Design _ Current
Capacity Population Wet Poultry Capacity Population
❑ La er
f! ❑ Non -Layer
❑
Wean to Finish .
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
CO
Farrow to Feeder
/ yid
/,7 13
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other IE
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Appheation Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: i
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes ®No [I NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
©No
El NA
El NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: — p 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): c—_ 23 "
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
M 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
[P 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
�a 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
m No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �t.m � .�%a a �r.2! OS
n!'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?
❑ Yes
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i
❑ Yes
T No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R] No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA ❑ NE
Reviewer/Inspector Name �_�f r y'.'` x * Phone:
Reviewer/Inspector Signature: Date:
/V 12128104 Continued

Facility Number: — /4/0 Date of Inspection 1G
Iheauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fZ] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check"the appropriate box below. ❑ Yes Lo No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [,9 No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27.
Did the facilityfail to secure a phosphorus loss assessment PLAT certification?
p p (PLAT)
❑Yes
-�
'� No
JX NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ 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
09 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
12128104

r
(Type of Visit 4B Compliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
D: A Time:
Facility Number ate of Visit
O Not eratioriai � Below Threshold
04ermitted Qtertified© Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ...........__ /�Q II �7 County: 0914
3
Owner Name: _ _ _ I res7 • Olin S _ _ _. Phone No: 4 ` s`1� ` s -7 ,
1VIaiilmg Address: f. 169z
Facility Contact: ifAnd,ram- Title: Phone No:
Onsite Representative: R"'J &a. s Integrator. i�,� a c
Certified Operator. --6ale Neel � Operator Certification Number.
Location of Farm:
[ wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • Du Longitude a 6 OK
Discharges & Stream Imp its
1. Is any discharge observed from any part of the operation? ❑ Yes 940
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes Leo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 2No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes DNS-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes BIG
Waste Collection & Treatment �,�
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Leo
Structure 1 Structure 2 Structure 3 Stuctrre 4 Structure 5 Structure 6
Identifier: _... __ I_
Freeboard (inches):
12112103 Continued

,r lFacility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �To
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance./improvement? ❑ Yes BVo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes BNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Jallo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancermtprovement? ❑ Yes L3'No
11. Is there evidence of over application? If yes, check the appropriate box below_
❑ Yes [$4o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Beni•, 4/ G ra , t4/. S.h«!f_ Gna1� __
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)? ❑ Yes [31�6
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 01Ro
16. Is there a lack of adequate waste application equipment? ❑ Yes BNO
Odor Issues
17. Does the discharge pipe firm 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?
19. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ffRo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2No
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 ONO
Air Quality representative immediately.
�CLS Q3Ti' �Y� l!►![SSr�IOa— a�Y u
[Ise d ro�n> of fa it' t� better a�gl�'s� „{u Prasinecema
—"!K opy [] Final Notes R
AL
�ecor6/s
i
T
EReviewerftnspector
er/Iaspector Name, 1#� �.
Signature: Date: »
1211 jUj Gonunued

Facility Number: — b Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M4-W
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 G�No'
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B-90
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
E�ro
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
Q'�o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
01 o
28. Does facility require a follow-up visit by same agency?
❑ Yes
290
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[1 Yes
�1 fro
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
l5'r 9
❑ No
31. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment?
❑ Yes
Olgo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
EPio
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
B-Yo'
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
E 'No
❑ Stocking Form ❑ Crop Yield Foam ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up
O Emergency Notification
Q Other ❑ Denied Access
Facility Number
Date of Visit:
'ime:
10 Not Operational
Belo' Threshold
�.
'�/
Permitted
❑ Certified 0 Conditionally Certified
13Registered Date Last Operated or Above hreshold:
P-
/ e.
Farm Name:
-�
-- _. - County:
-
Owner Name:
I—C `"1 S
Phone No:
Mailing Address:
Facility Contact: Title-
Onsite Representative:
�✓ q ��
Certified Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude U' 0 « Longitude a �•
= - - ."Current = ' . 'Des' Current D Carrettt _ -Design .._
�
:swine -
_
C aciri :Po iulateon _-Poulin. _ --c
- scitv::Po ulatioa_. ___Cattle._ - �C criv Po isEatiou
-
❑ Layer
❑ Dairy
-
_
;= ❑ Non -Layer
Le
Non -Dairy rAr
=; ❑ Other
-
Tt)tAI DeSI Ca RCI
" P` -
R
- Number -of tons..t I [] Subsurface Drains Present ❑ Lagoon Area ❑ 5 rav Field
I'
�.a _
°Holding PoadifSolid Traps , 0 a ❑ No Liquid
Waste Management System r.
❑ Wean to Feeder
❑Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Z O
❑Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If ves, notify 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 par[ 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 lle tion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes o
❑ Yes Wo
❑Yes R'No
El Yes
I
Z�No
❑ Yes
A�No
❑ Yes
�1Qo
�� ll�To
❑Yes
Structure 6
dentifier:
Freeboard (inches):
05/03/01 Continued

s
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El 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? answered
(If any of questions 4-6 was ansered yes, and the situation poses an
Yes
El No
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
❑ PAN ❑ Hydraulic Overload
11. Is there evidence of ver application? ❑ Excessive P7j;
❑ Yes
❑ No
12. Crop �e ri !` ' 4le/ �rl_
13. Do the receiving crops differ with those esignated in the g6fified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
I7_ 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/ WLsP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-
CommtKtts: refer to -uesWh`# Ex lain an YES aaswis and/orsany re�cvmmendattons or any other=comments. ;
( 9 ) P Y
Use drawings of facaity to better e:plam sttuations.,(use sd_didonapges siecssary) ' ❑ Fveld 'C�on-v - Final Nnte:s
%�C tisn� ,
Reviewerlinspector Name f
Reviewer/inspector Signature: - Date: ` "0
05103101 V Y Continued

f
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X'Routine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Date of Visit: Z--6 ime:
Facility Number E 40
Q Not Operational 0 Below Threshold
0 Permitted 0 Certified M Co ditionally Certified D Registered Date Last Operated or A ve Threshold:
' 1�.�::�/ ............... ...... ....... .
Farm Name: .. ..... County:.---...�`�. �........_. . ___....
Owner Name..... F l» ........... _. .. �_.....» ..... Phone No:
FacilityContact: ............................................................................... Title:................................................................ Phone No:.................. _ . _____.......
MailingAddress: ........... . . ....... . ...................................................... ... _....
Onesite Representative:..,u.. ........ ...........M.Y..�_._........
�....e.
Certified Operator: ................................
Location of Farm:
Integrator: ...... . . ........ . . ................................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude a Du.
Design,; Current Deii .-Current Current
!�
Capacity IPopiilateod Pool :..Ciipa6ty._.•Populatioa- Cattle , -. Ca
Swine try _. paeityr Fiipulation .1..
Wean to Feeder
'
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Total Destgu "Capacity C
Total SS w : C
Dischares & Stream Im acts
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 ANo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes Po'
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes RNo
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 0
Waste Collection & Treatment
\\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes PJQ,No
Structure I Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identilier:..........................................................................................
Freeboard (inches): 3�
5100
Continwd on back

Facility Number: 0 = Date of Inspection - •-O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
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 maintenancelimprovement? ❑ Yes IM No
& Does any part of the waste management system other than waste structures require maintenance/improvement? [IYes Ro
9. Do any stuctures lack adequate, gauged markers with requited maximum and minimum liquid level
elevation markings? ❑ Yes 4�,No
Waste ARPlication
10. Are there any buffers that need maintenancetimprovement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �KNo
12. Crop type Cr4 z[4cl / ;W, (h ro.s1 Aver
ertified Animal Waste Management Plan (CAWMP)?
13. Do the receiving crops differ with those designated in tcatlion?
❑ Yes -1'N0
"A`�
14. a) Does the facility lack adequate acreage for land ap
❑ 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
� 0
�'
16. Is there a lack of adequate waste application equipment?
❑ Yes
`
' 70
Required_ Records & Documents
\
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0
r
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
5No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
MNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[&No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
*No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JdNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
dNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
WN 0
�:- e¢rjcBdre 00" d00this' - You1-eiye0�oo futi�tr
66res6, t deii& A6i this :visit ..:............:.....:...:..::.:. .

Facility lumber: — Date of Inspection Z ��
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?
Oyes ❑ No
❑ Yes
No
❑ Yes
o
❑ Yes
LA No
❑ Yes
AP No
❑ Yes
ELrVo
❑ Yes
1 o
O5103101

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
Facility Number d Date or Visit: // O/ Time: : Ott
Not Operational Q Below Threshold
MPermitted ®+Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .............
Farm Name: s `.�. /���4 ..�iJ ...................
....................................................................................... County:.._.....a...........................g......._................. -.
Owner Name:............ �i4'@�� Phone No: i��....!....�r...._..................
FacilityContact:...... ....44 �. ..........Title:..................................._.......................... Phone No:....................................................
7 �/�
Mailing Address: .._......Y._:...�,�...-...7�?...... . -.-f!-.��..P..............................................................................
Onsite Representative:.....,%fr .......... Integrator:
Certified Operator :........... � ,-....... /... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• 0` �•
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
Farrow to Feeder u" Zak
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
Boars
Total SS.LW
Number of Lagoons Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
- -- -
Holdtrtg PondsTraps ❑ No Liquid Waste Management System
Discharges Rt Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes 9No
b. If discharge is observed. did it reach Water of the State? (il" yes, notify DWQ) ❑ Yes E�tNo
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 PjNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FTNo
01/01/01 Continued

Facility Number:,o
Date of Inspection MG /
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ............... .............. ..........
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?
❑ Yes fiff No
Structure 6
❑ Yes )4 No
❑ Yes 4No
❑ Yes K No
8_ Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
CNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
INo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
P No
12_ Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P#No
b) Does the facility need a wettable acre determination?
❑ Yes
�fNo
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
❑ Yes
PVNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
17. Are rock outcrops present?
-des -LNo %//A
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
0 *&, �o /V1,#
❑ On -site ❑ Off -site
ReQuired Records _&Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes $No
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, map etc.) ❑ Yes NVNo
✓ , r �/ ✓ -�
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ANo
23. Did the facility fail to have a actively certified operator in charge? ❑ Yes DjNo
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) []Yes pj No
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
26. Does facility require a follow-up visit by same agency? ❑ Yes D(No
27. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below VrYes ❑ No
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4Q No
01/01/01 Continued

Facility Number: -lxo Date of Inspection
Printed on: 1/4/2001
30. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
3I. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes K No
❑ Yes [P No
❑ Yes Wo
❑ Yes Wo
34. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date.
OI/OI/01

Facility Number Data of Visit: % —4 Time: 17= Printed on: 7/21/2000
Q Not Operational Q Below Threshold
0 Permitted [3 Certified © Conditionally Certified 0 Registered Date Last Operated or
Above Threshold:
Fsrm Namp- PJ /,�— County: 1
Owner Name: ..
Facility Contact
all.S................................................. Phone No:......................................................................................
r / /
a....e................. Title: h..?^.......... !. ...................... Phone No:...................................................
MailingAddress: ................................................................................................................
Onsite Representative: „ 7. .. ................
Certified Operator.-._. .......................... /.
Location of Farm:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude
Design Current Design 'Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca aci Population
❑ Wean to Feeder ❑ Layer I 1 10 Dairy
❑ Feeder to Finish ❑ Non -Layer I jr-lNon-Dairyj
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity �(f
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ Lag—n Area J0 Spray Field Area
I-1 No Liquid Waste Manasement Svstem
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed. wits 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. II'discharL-c 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 E(I
qo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structury 1 Structure.? Structure Structure 4 Structure 5 Structure 6
Identifier: ....................... ........ ............ ............ —...................... .......................... — .......
...
Freeboard (inches):
5/00 Continued on back

Facility Number:0 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, ❑ 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 �j 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any quctures 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? ❑
12. Crop type
Ponding ❑ PAN ❑ Hydraulic Overload
F
13. Do the receiving crops differ with those designed in the Certified Animal Waste Management Plan (CAWMP)'?
14. a) Does the facility lack adequate acreage for and 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?
Renuired 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? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit"
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative"
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violatioris;o... .. e.�t. ..mere noted during this:visit; Yoi� ;wi#1 ti eeeiye Rio; u�t. .. ;
correspon�eitce: a]sotil 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):
N9 -t�•� h Q l/s Y CL i e< SO ray ej L,,_ .
06nQ
❑ Yes No
❑ Yes XNo
❑ Yes �<No
❑ Yes o
[]Yes o
❑ Yes A
No
❑ Yes PO
❑ Yes P'No
❑ Yes F_No
❑ Yes P�No
❑ Yes RNo
❑ Yes `k No
❑ Yes P�No
❑ Yes ANo
❑ Yes tNo
❑ Yes 2No
❑ Yes ANo
❑ Yes 9�No
❑ Yes JXNo
❑ Yes firNo
L
n
Reviewer/Inspector Name
Reviewer/Inspector Signature: — Date: q—/ ,_ d1D S/00

Facility Number:04? v 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 ;A/or below Ayes ❑ 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 r
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 'O�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Iro
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? )Yes ❑ No
lAd4itioomments`an. or rawings:
J
5/00

O=Division of S©il and. aterConservation'- per on Review
0,Division of Soil and:Water-Conservation'''- Co'm--liance Inspection
Division of Water`Quality- Compliance Inspection =
O;Other Agency, „Operation Review r `
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review • Other
Facility Number 09 140 Date of Inspection 2-24-2000
Time of Inspection 9:40 24 hr. (hh:min)
® Permitted ® Certified [3 Conditionally Certified 0 Registered 113 Not Operational I Date Last Operated:
Farm Name: PAS ....................................................... ..... County: 812dell.....------........ ...... FRO .............
...................... ........ ............ ......................
OwnerName: ................................................... Fjr.vjtAge.F.arm& ...................................... Phone No: 910::591-57.71 ...........................................................
Facility Contact:
Title:................................................................ Phone No:
Mailing Address: F0..Bay..958....................•--...........................------.................................... C1i U91t..).!IG................................................. ..... 20228.............
Onsite Representative:
Integrator: ErestageXArm ......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude 34 • 31 6 12 u Longitude 78 • 36 < 48
Design Current
Design
. Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
1250
❑ Other
Farrow to rEU
Total Design Capacity
1,250
Gilts
Total SSLW
652,500
Boars
Number of Lagoons 1 ®Subsurface Drains Present ❑Lagoon Area ®Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... ...
Freeboard (inches): ............... 2,1................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back
Printed on 3l812000

Facility Number: 09—I40 Date of Inspection 2-24-2000
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
Cl 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/irnprovement?
❑ 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
❑ 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
lb. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NoMblations.or deficiencies.were:noted;d"uriagthis visit 'You Will receive no f irther : :
corres oudence about this Ni .. .. . . • ....... . - ...
Comments (refer to question #):` Explain any YES answers and/or any recommendah or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary)
Site visit was made to check the level of the lagoon. The lagoon contained the required freeboard at the time of the site visit. This
was the facility that received wastewater via tanker trucks from the Coastal Farm in Columbus County.
Reviewer/Inspector Name Jeffery Brown
Reviewer/Inspector Signature: Date:
W
on

F
FEB-08-2000 TUE 02:01 PSI PRESTAGE FARMS
4651 Taylor's Bridge T-ighway
P.O. Box 438
(linton, NC; 28379
Phone-, 910-592-5771
Fax: [phone]
FAX N0, 9105929552
RECEIVED
F 8 2000
:r
FAYEVV� T-E
REG. OFFICE
To; JEFFERYBROWN FRandyBarefoot
Company. NCDENR Date: Febnary 8, 2000
ROC 486.0707 Pages CmcUes cover): 2
Phone: Initials of transmitter. Chi X275
Rc:
i;
KCbnvnents: ?
P. 01

FEB-08-2000 TUE 02:02 PM PRESTAGE FORMS FAX NO. 9105929552 P. 02
Prestage Farms, Inc.
February 8, 2000
Mr. Jeffery Brown
Environmental Engineer
North Carolina Department of Environment & Natural Resources
Fayetteville Regional Office
Division of Water Quality r
RE: Plan of Action for Lowering Lagoon Levels at P-15
Dear Mr_ Brown:
This letter is to inform the Division of Water Quality of what actions are going to be
taken in order to lower the lagoon level at the above facility.
1. We will start irrigating as weather permits and spray fields dry out.
2. We will cut back our fresh water usage.
Please contact me should you need�additional information.
Sincerely,
Al�
-&2�
Randy Barefoot
Department Director of Land and Nutrient
Management
RBJch
HIGHWAY 421 SOUTH • P. O. BOX 438 • CLINTON, N. C. 28329-0438 - PHONE [phone]

Facility Number: L 9 L 4 O
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Tune:
-- -- s,�neral Informatiow
Farm Name,_-1 S County: l4 d ••�
Owner Name: No:
On Site Representative: c s��►-�4,; oT, -- inter.
Mailing Address• TPo ass !J3 S _!
Ct;u-6u NC- -z.-83Zg
Physical Address4,ocatiow Frov-- i r �.xsc_ 4+�e.v o S9 1i1 O 5R I-71Z ([Js" •►?--1
5y 3/ct w.�,le s 52AJ I�IZ�4s�
Latitude: j--J Lon •tude•
Qperationj2escrption: (based on design charactsrisla)
ryV of Swine NoErsaw` of �� o�uLa}� Xo. ojAai�aLt T � No. of Mimals
O NaMMY �— O Non. -Layer O Bad
O Feeder
0Me!nEC of UVesWd-- Number ofAniina&.
Number of Lagoons: ! (include in the Drawings and Observations de freeboard of each lagoon)
FaCHIty ImptWone
Lagoon
Is lagoon(s) freeboard less than l�foot + 25 year 24 hour storm storaget
Is seepage observed from the lagoon?: -
Is erosion observed?. -
Is any discharge observed?
0 Man-made 12 Nor Mangna&
Covet Crap
3 -At- Yes 0
No Cl
Yes ❑
No tar'
Yes O
No (Y' -
Yes D
No 0'
Does the- facility need more acreage for spraying?:
Does the cover crop need improverna tt
(no the crops which need bVrori mm)
Croptype• AcreageL_
Setback CiitenFet
Is a dwelling located within 2W feet of waste application?
- h a well Iocated within 100 feet of waste application? -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI - January 17,> M
Yes 0
Yes O
No Cl'
No Di
' Yes ❑
No i -
Yes O
-'No
Yes 13
No M-'
Yes O
No Or--,

Maintenajuw '
Does the facility maintenance need improvemeti? Yes O No O"
Is there evidence of past discharge from any part of the operation? Yes O No C30"
Does record keeping need improvement? Yes (3 No t"
Did the facility fail to have a copy of the Animal Waste Management Plan on soft? Yes 9' No 0
Explain any Yes answers,- ;7�,; s_
; s rc
e . 4,
g -" "/ , n.
_ e )a c l--j a s f G fM-a N c t o
( �4i brN , b Aj
p L j b�
e FhairyAssessment Uair
PrkwjnSS or Observatio=
IT
Dale: Z -/VL - S
Use Amwhmew (fNeeded
;j [}�- .•.�; r . r - • t ♦ fr y �..+ +�. • ..+. h ae-..rr f ' '4 -' 72
-
7.
V iS y• � ..-. ! - - ', ::'r:t'.':':fl•"`�':. •T►�ir•. 'rZi .�: •��' !?i'•11�• :*'J'!�'�'i:'7:ter! �"`l•-- - _-

q�v
Site Requires Immediate Attention: No
Facility No. SZ - 4 / V
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - 7- " / 9 , 1995
Time: /3 / S
Farm NanWOwner:_ P IS --- / Prc s 6" e- s .--1ivc-. .
Mailing Address: PO l3r,
County: 6!o cre nr
2, S43 S - -C /: •v�.v WCG
Z S*3; z S
-Integrator:
Phone:
On Site Representative:,
_ -- Phone: l 9io) S 9 Z- S-7-7/
Physical Addrns/Location:
Se 1-1t z o K 1 -p4- nc ra 2L.
3/4 m; le. �{'Ya ..�► - .5 7! O
A/ e.a ti-
L rs_6e rJ / B bt de_ /
Type of Operation: Swine
v Poultry Cattle
Design Capacity: / a S0 A -- F+J Number of Animals on Site:
_ /t50
Number:
ACE DEM Certification Number. ACNEW
Latitude: Y r
Latitude:_
Longitude: o r w
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I
Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (!rp)m No Actual Freeboard: z Ft. --!a-Inches
Was any seepage observed from the oon(s}? Yes ozo Was any erosion observed? Yes ordP
Is adequate land available for ray? r No Is the cover crop adequate? dii)or No
Crop(s) being utilized: ccs Cc
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? r No
100 Feet from Wells? ;W No
Is the animal waste stockpiled within 100 Feet of USGS Blue line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue line: Yes o;! i
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes odsp If Yes, Please Explain.
Does the facility maintain adequate waste management Two
(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
C ill a r i e_ _s H ` V e 1r Z /S "Z4 /` .-, C.
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. F Z - 4/ V
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - - / 9 , 1995
Time: /3 /_S
Farm NamelOwner: P- /-"J"
Mailing Address: PQ 13c,,
N
County: L51a de N
-Integrator: Phone:
On Site Representative: Phone: l 9i0) S 9 z- S 7 7/
Physical AddresVLocation: .5 1Z I'l t z. 3^4 n4; le. 4Yo ,, t 5 Q / 7/ 0
A/co i, L.rsbo r4 /_
Type of Operation: Swine v Poultry Cattle
Design Capacity: / 7-S0 A.--A-4 Number of Animals on Site: _ a50
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' Longitude: ° ' •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) <!!j'Pnr No Actual Freeboard: Z Ft. 0 inches
Was any seepage observed from the la oon(s)? Yes ox Was any erosion observed? Yes ONG
Is adequate land available for spray? pr No Is the cover crop adequate? �or No
Crop(s) being utilized: Cods CL f
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e r No
100 Feet from Wells? ems. r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o(s)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o<
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi�W If Yes, Please Explain.
Does the facility maintain adequate waste management recur (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
C kQ Y Ins A i e r�z �U..�•�— -
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

i T 4Nd ty 810 4 e'4 Cp IV
•� S�a� Id �� / "s Site Requires Immediate Attention:
nr° t- -Sc psi C. . Facility No. 82 -HIV
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANRAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
I -1-V-vow
Farm Name/Owner:
DATE: "7 4If 11995
Time: ) ' / S_
xi._15 / Pres 46f -C, fir. —s -ivC—.
Mailing Address: P.0, }o-g 4439 �AIC z83Z3
County: 31a d c'v
Integrator: Phone:
On Site Representative:, _ _ Phone: 9/ 0? Z - 5 77 /
Physical Address/Location:_ SR i7/ 7- eev _ /cf'f Ug b,, -5-14 ^1;& 5-&_ l7/0
Al e4 r 4. ,60A✓ 'CC)
Type of Operation: Swine Poultry Cattle
Design Capacity: �i. Gc _ Number of Animals on Site: _12 5-n
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:— ° Longitude: o "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)(9or No Actual Freeboard: 2- Ft. Inches
Was any seepage observed from the lagoon(s)? Yes ozj&Was any erosion observed') Yes or<Q
Is adequate land available for spray? es or No Is the cover crop adequate? &Dbr No
Crop(s) being utilized: C o4 s l
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwel ings. a or No
100 Feet from Wells? Y or No
Is the animal waste stockpilers within 100 Feet of USGS Blue Line Stream? Yes ordo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or lZ
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or P10 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)? �9 or No
Additional Comments:___ L4 ljuxe<
I
Jiffs. 31 f995
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

WORM CAROLII9A DXPARTMMM OF , EEALTB & NATMUL REso Rms
DIVISION OF ENVIRONMENTAL JUMAGENEW
Fayetteville Regional office
Animal Operation Compliance Inspection Form
P- f 5 Press e Farms In C, .
�/"�'oy..'�W:.��c.a`/?'i�'My%.r{�+.p..�y���:/:�w��r¢..,�;.�-,yf�/Y_�,o.��1.�-�.. �..:.
{il��sai�i.�,.1ri3Vi\r`i/ii.'aaAi��-.a
P.D. Box 4� Cllnbn,
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION r
Animal Opgration P-t-rowi K-c � SDusS
Horses, cattle, Swine, poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) Criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
systsm)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED Rapp
fiiA&TE 1+IAMGEKENT PL71l�?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
6- Does this facility meet the SCS minimum
setback c_iteria for neighboring houses,
wells, etc?
_. v 3 1995

MCTION_IZI
Y Lq Co ANTS
Id ite Management
I. Is animal Waste stockpiled or lagoon
construction within 100 ft. of a USGS
?tap Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CBRT CATION FLAN?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management practices
(SDO) of the approved CP,EtTTFICATio
7. Does animal Waste lagoon have sufficient
freeboard? How much? (approximately )
S. Is the general condition of this CASO facility,
including management and operation,
satisfactory?
SECTION IV
Comments

� 1 3 c
SA L rERS ' L�
k
1-4 KE
BLADEN I
e ' LAKES Tsr•.:-
..
U
aI ai l \ 14 ' R «I u •
37
fr11 " t
E'_1ZABETHTOWN
AAA
`Mo WYS
LdNALy
V. i LOC
� f 1
J� � t• � � � FshR F�(d T1' `''
f�S —'AP
0 Jw � 1•
.y
•r
-
1.
! \ 7ta
A
DIRECTIONS TO PX-15 (GREEN FARM)
Lr �i w
E�' 7 40,7U, From Clinton take 701 S to Elizabethtown; go through town
and turn left at McDonaIds onto Mercer Road {SR 1700. Go
5 3/4 mules and hum left onto Elkton Road (SR 1710). Go 2
�y t L! w 16 "' 1 /4 miles to Lisbon ban Road (SR 1712; turn right Go 3/4 mile;
v �" 84wA Id 3712 farm is on left
1�
ST3a c S, A 1� .
C
I TOA -2 1 j : a ? p
17ea
L •s., 17"
POP
:.--
1 _: ivl _ 211

C,Gl5 =AT:0N FORM FQR ANIMAL FEEDLOT OPERATIONS
Department ofEnvironment, Health and Natural Resources
Division of=nviran ental Management
Wale- Quality Section
if the
animal waste management system
for
your feedlot cperaticn
is
designed to serve more than or
ecual to
100 read
of cattle,
75
horses,
250 swine, 1,000 sheep, or 30,000
birds that
are served
by
a liquid
waste system, _::en _his
form must
be filled
cut and .mailed
ty December
31, 1993 pursuant tY
15A NCAC
2H.02=7 (c)
in order to
be
seemed
permitted by DEM. __ease
Print clearly.
Farm Name l J
mailing Address:
Count
Owner (s) Name:
Manager (s) Name
lessee Name:
Farm Location Ge as specific as possible: road names, direction,
milepost, etc.) 1',Av.a �-o
.3 +—,, (cJk e+ rli g 15... , W s /'vier, cza lP- . �V ( 5.2 . ! 7oo f _ Clio - }, nt, ley ,' -)-, ti 44
a.dt-o 1E/kTa.' 2.-d i-_:2_ 1i/oA %ems 'Z = M, reS 4- Z—', -- Chun1 (S It /7!-2V-f..,.-N rie At_ Ga
Lan inode/ Long !nude if known: 5i� �0�3 1 1— /1, - 0 _
Design capacity of animal waste ma aaement system (Numberl7 and type
.. a c=n f _ned an _ma'_ m } ,'��eel,ro..� +.. �e�e�e T
Average animal-coulation on the Farm (Number and type of animal (s)
raised S�My�s ACE -
Year Production Began AL ASCS "Tact No. /75 35
Type of Waste Management System Used: LiNjorl AM i1zz7y r�
Acres Available for Land Application of waste: lC Q
Owner (s) Signature (s) .

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Randy Barefoot
Prestage Farms, Inc.
P.O. Box 438
Clinton, NC 28329
Dear Mr. Barefoot:
1DE.=HMF;Z
DIVISION OF WATER QUALITY
April 11, 1997
SUBJECT:
Annual Compliance inspection
Prestage Farms Swine Farms
Registration No. 09-127 WJ40! --. -_— --
Bladen County
On April 14, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 48b-
1541.
Sincerely,
, *—le" Al�
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714, Fayetteville *• FAX [phone]
North Carolina 28301-5043 N%`
fr C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 5096 recycled/ 10% post -consumer paper

FO Routine 0 Complaint 0 Follow -sr R of DW kspeetion 0 Follow-up of DSWC -ewl; ev, 0 Other
Date of InspectionF, c
F. FzMty Number Tim of Impec&n Use 24 hr. time
Farm Siam:: Toul Time (in hones) Spent onliMew
. lor Inspection (Indudes travel and proembio
comar
Farm Name:
Chmer Nam 2;--c- _Phoueft: 1910J S-92%r-77Z
MWUnAddress: JR 42, e, 2
Onsite PtepremItatim-
htep,,,
Cutiffed Operator. Operator Certification Number: 2 7 5k-
Lomflon of Fum:
Latitude lAugftde
UCI.Not rational Date Last Operated:
Type or Operation and Design Capacity
P�.
5
W� 34
Fee Law -
,der W= to Daim
Feeder to Finish Non-L
VC 93 Bad I I
Wean
Farro
w
Farrow to Wegm
Farrow to Feeder /Z T-6 V do
!mW_ to Finish Other Type of Lkwtock
7.7
Nnmbes of Lagoons /Holding Ponds Subsurface Drains Present
Spray FieldAm
Lagoon U _7
1. Are there any buffers that need mainteimm
13 Yes A No
2. Is any discharge observed fim any part of the opund=?
13 Yes
ZINO
a. If disdharp is observed, was the conveyance mm*aaft?
D Yes
ti No
b. If discharge is observed, did it reach Surface Water? (IfM no* DWQ)
E3 Yes
)M No
c. If discharge is observed, what is the estimated flow in pMnk?
d. Does discharge bypass a lagoon "=? (If ym notify DWQ)
E3 Yes
W No
3. Is them evidence of past discharge frc= any W of the opmadm?
Yes
19 No
4. Was there any adverse mqmm to the waters of tht State other than from a discharge?
13 Yes
tR No
S. Does any part of the waste management system (other than lagoon&%olding ponds) require
Yes
E3 No

66 1s ScHity not in Compliance with nosy applicable selbfck criLdria?
7. Did the 6cility sag to have a certified operator in responst'ble dnatge (if mspection after inj"7
L An these lagoons or storage ponds an sioc which need to be properly dosed?
Structures (Lagoons and/or Maidiaa Yoads)
9. Is structural 8eeboard less than adogmft7
Freeboard (t})r lagoon I Lgoon 2 lagoon 3
10. is seepage observed from any of the strucortes?
1 I. is eaosion, or any other &Mats to the integrity of any of the Structures ohaerved?
12. Do any of the structures stied I improvement?
(If any of questions 9-12 was answered yes, and the dtuation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adgriate markets to identify start and stop pumping levels?
waste Aotalieatlaa
14. Is there physical evidence of over 9pplicstion7
(If in excess of WMP, or runoff entering wawa of the State, notify DWQ)
15. Crop type ��e.►�..a�.t daa4el1?..rs.
crops dts — ._
dr
I& Do the active ops differ with those "paled in the Anima] Waste Management P1aa?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need Wit?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to eomp3y with the Animal Waste Management Plan in city way?
22. Does record keeping need
23. Does facility require a follaw-up visit by same a~
24. Did ReviewedInspertor furl to diz= ieviewfmspection with owner or operator in char?
tl Yes IR bw
13 Yes ® No
D Yea §jNo
Yea ® No
Lagoon 4
D Yes $j No
❑ Yes JINo
13 Yes IgNo
© Yes RNo
© Yes Z No
Yes 10 No
13 Yes ;RNo
O Yes ®No
13 Yes AINo
13 Yes )KNo
p Yes J9 No
AYes []No
13 Yes JN No
E3 Yes PINo
CIO( ty question��� aaj► f �wi iMii f.�rM1Vi �1iy V{Y1 1/� r1�:{i{(••���., {��, ,��gi - nL e
'ya �. ..c'*" _. •r. ,.r:r'z sp y,c- �it'"�"Rj ? Y ��.
e c S`� 0`
cud ,4-��.�,��•�40%
2.2. �RA�✓
0
Revkwer/lnspector Name
Revtwer/Lnpector Sigaatore: Date: y /
~r liioicio' of lielrr analip.- WgW.. n.r.rllw. C-.r:..- a:..dlA%. A---- Ff_a.

State of North Carolina
Department of Environment,
Health and Natural Resources iVb
•
` W'A
Fayetteville Regional Office IV
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary FE H N FZ
DIVISION OF WATER QUALITY
April 11, 1997
Mr. Randy Barefoot
Prestage Farms, Inc.
P.O. Box 438
Clinton, NC 28329
SUBJECT: Annual Compliance Inspection
Prestage Farms Swine Farms
Registration No. 09-127, 09-140
Bladen County
Dear Mr. Barefoot:
.1
On April 14, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714, Fayetteville N%qC
FAX [phone]
North Carolina 28301-5043 An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 199MMEMMIRMIll 50% recycled/1096 post -consumer paper

Ratitiae O complaint Q Fallo= of DW Inspection O Follow-up orDSWC review O Other
Facility Mamba O D F=.of
lnspedfon l: o use u hr. time
Farm Status: fr .�.�� _ Total Time (in boors) Spent "Review
lor Inspection (indudes travd and processing]
Farm Name-.
r J' • - r '�+r��
Owner Name: Phone No: IF
C9��) S 2 --r- 7 ?
Matting Address: 922- /9x �3� �'/..✓%-r? !% ;2 ,P,-72
Ondft Representative:
Coed Operaw- 2t==P-/ a �._ operotOrCert n"dou Number: l 7 Zgk
Location of Farm:
Latitude M Longitude
113 Not Operational J Date Last Operated:
Type of Operation and Design Capacity
• x-w. -F- k�." 5.,,�,�,•y,."-R�w.^``�,►,c. ".«.y ,�,".e�ir9- :'.�. �."L4e., _ "��'i rasiF�Gn%. ,ti;'. v'
:Swine �� z"Nnmber,�"POuitry .Ilittalber:v.�3valnberI °
'
i`�law
10 Now Bed �. to Otha
T'�Ic _,"'
Wean to Feedcr
Feeder to Finish
Farrow wean
Farrow
2
F w to Finish
Number of Laoans 111alding Panels s ' ' Subsurface Drains Present
Lagoon Ar�n � ��;, Sp Fidd Am �.
1. Arc there nay buffers that need maiaterranoelimpQvvIC11:1211:0t'1 � Yea eM Na
2. Is any discharge observed tines any part of the open? ❑Yea , ®No
a_ If discharge is observed, was the conveyance man-made? E3 Yes ki No
b. 3f discharge is observed, did it reach Surface Water? (if yes, notify DWQ) O Yes ki No
C. If discharge is observed, what is the estimated flow is gaVmin?
d Does discharge bypass a lagoon system? (if yam, rmtify DWQ) 13 Yes 12 No
3. Is there evidence ofpast discharge from any part of the ? 13 Yes 9; No
4. was there any adverse impacts to the waters ofthe State Other than fits a discharge? O Yes 51 No
S. Does any part of the waste management system (other thaw ]agoauslbaldiagpouds) require ,� Yes D No
rG

6. h 621fty not in ooaipl MM with say applicable setback aitc is?
Yes X No •
7. Did the facility► fail b have a certified operator in mVoast'ble charge Cif mom after MM7)?
L Art~ there lagoons or storage ponds on site which need to be properly closed?
Stroetures CLaymns and/or RoMne Pond!)
9. Is sftc4iral freeboard lean d= adegnste?
Fr+xboard (8): Lgoonl Lagoon 2 LWM 3
2Z y
10. Is seepage observed from any of the sauceiaes?
1 L b erasion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need rnimint
(If any of questions 9-12 was answered M and the sitaadon poses an
Immediate public health or environmental threat, no" DWQ)
13. Do say of the structures lack adgnate markers to identify start and stop pumping levels?
Waste Aat+liraHoa
14. Is there physical evidence of over application?
Of in excess of WW. w runoff entering waters of the State, notify DWI)
3S. Crop type�� �e�r�lPat
�
df
16. Do the active crops differ with those designated in the Animal watts Maasgstaent Plan?
17. Does the facility have a lack of adequate adage for load application?
29. Does the comer crop need improvement?
19. L then it lack of available irrigation equipment?
Far Certified Fac4ifies Only
20. Does the facility fail to have a copy of the Animal Waste Management Flan readily available?
21. Does the facility fail to comply with the Amara! Waste Management Plan in any slay?
22. Does record keeping need imgrvvezzient?
23. Does facility require a follow-W visit by same agency?
24. Did ReviewcrAhspector fail to discuss review/mspection with owns or operator in charge?
CI Yes ® No
Cl Yes JjNo
13 Yes ® No
Lagoon 4
(3 Yea JO No
0 Yes 11No
El Yes 19No
E3 Yes Flo
❑ Yes Z No
13 Yes Ej No
E3 Yes PkNo
E3 Yes 13 No
0 Yes J3 No
D Yes )RNo
0 Yes tE No
MYes © No
0 Yes JS No
0 Yes PCNo
CO
(refer to qutsdoa #)M., Explain any YES amwara aadlorazly_ieco�mmdatians or saryathar coaimntnts:°.
Use drawn gt of facility;tn btttaa e�ipiam srtuahoas. inae addrttamal pages as4a ._neaasaryj <� j . tar x .
ooWkew
,4��i�✓ � �,rt±,�u,,�rav �,,c /Po�"'i Go�.�ito�
Revitwer/lnspsctor Name
ReviwerAnspertor Slgaatnre: -i Data:
err rmvidnn of Knlrw fhafinr_ .Wn1N Awnyhw i'...rinw A0041iry I*VAWWMM-* lh.d I t It d/df.

® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
(Facility Number 6 b �---�
Time of Inspection !—L " 7,1 Use 24 hr. time
Farm Status: Total Time (in hours) Spent ouReview
or Inspection ('includes travel and processing) Z
Farm Name: - ` �' / S -- County:.... _ "'._. .....�.�
Owner Name:._. Pa&jA;&f f� ._.._.�.... Phone No• C9/°� 5-Y2 -X-7 7
Mailing Address: - �� �-✓�' N C' ;;z A7 2
Onsite Representative: -- ��`"� T ���� f� Integrator.-f�/zn�w C
Certified Operator--� ��-�a Operator certification Number./ 7 22�
Location of Farm:
Latitude Longitude �• ��"
© Not O erational Date Last Operated:
Type of Operation and Design Capacity
�Swiaer'Number�, oultry Ai Cattle, �7ber�'
' Kumber. .2\
Wean to Feeder Dairy
Lowx
❑ Feeder to Finish 10 Non- ❑ Beef
FarrOW to
Wean,. xT ,•zizr�
Farrow toLeSSIU Z f .
Farrow to Finish ❑ Other Type of Livestock-
�£-
Number of Lagoons !Holding Ponds ❑ Subsurface Drains Present
Lagoon 3
Area Spray Field Area
General
1. Are there any buffers that need maintenancelinwovement? ❑ Yes ANo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
a. If discharge is observed, was the conveyance man-made? ❑ Yes hNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes )9 No
c. If discharge is observed, what is the estimated flow in gaMmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes (RNo
3. Is there evidence of past discharge fium any part of the operation? ❑ Yes JgNo
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes tO No
S. Does any part of the waste management system (other than lagoons/bolding ponds) require N Yes ❑ No
maintena ncdmrprovement?
f'a"WiTniA nn hark

fi. Is facility not in compliance with any applicable setback criteria? ❑ Yes JR NO
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes El No
Structures (Lagoons and/or Holding Pondsl
9. Is structural freeboard less than adequate? ❑ Yes ® No
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
2—Z �
10. Is. seepage observed from say of the structures? ❑ Yes Q No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes IRNo
12. Do any of the structures need maintenance/improvement? ❑ Yes EffNo
(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 adquate markers to identify start and stop pumping levels?
M'aste Ats ideation
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typeIr T --
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Faellities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management PIan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewerllnspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes Ito
❑ Yes 0 No
❑ Yes 10 No
❑ Yes ]ANo
❑ Yes IN No
❑ Yes ;& No
❑ Yes RNo
❑ Yes jM No
NYes ❑ No
❑ Yes tN No
❑ Yes CffNo
Commeats (refer to quesrion #i) Facpiarniaay yES aasweis sailJarsnyreconsmandationsyAoraay erKrp_amreats��£ �3
:Use drawings bf facil►ty to better explasn`srtusirons, fuse addrtronal pages as rrecessar„y����,�,
/QO�J6Al Gj04-00�l
Reviewer/Inspector Name 1
Reviwer/Inspector Signature: Date:
cc.- Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

0 Division of Soil and Water Conservation [3 Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review 0 Other 1
Facility Number
Date of Inspection d�,A?__ '�
[� f��
Time of Inspection iad 24 hr. (hh:mm)
Registered ® Certified 0 Applied for Permit © Permitted 113 Not Operational j Date Last Operated: •„•
FarmName:....... ...... j2.'.............................................................. -........................ County:............... .............
Owner Name: Cplo) .z
....... ..•L•`1...... _........................................ Phone No. �771
...!9...... ..........
.
Facility Contact: '�"� ...itle: ......... Phone No:..... ..........................................
......... .
Mailing Address: ........ �... { -(%.............•`J . ye -
Onsite Representative:........�:r',':� �� .... Integrator:----.--r-.-----------
....--------....... ---------------
Certified Operator; ......... 5....................................... Operator Certification Number;.../
Location of Farm:
.�
.............��...�......f . ...... ..... ................ .......... ..................................... ... ...............
rr
Latitude ram• �� �« Longitude177777
�• 0` �
.
.., : r. Current <. Desien urrent'z`:Desi:" , . uirent. .
'capacity- Populahaa .Poultry Cal
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Z
1
❑ Farrow to Finish
❑ Gilts
❑ Boars
La er
❑ Non -Layer
❑ Other
tty Population Cat#
❑❑ D
V Tatal Destg©;Cal
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes XNo
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
RNo
❑ Yes
fid No
❑ Yes
P'No
❑ Yes
RNo
❑ Yes
JR No
❑ Yes
JQ No
❑ Yes Wo
❑ Yes CR No
Continued on back

Facility Number: —
$. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes RNo
Structures (Lagoons,Holdine Ponds, Flush Pits. etc.)
9- Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure. 5
Structure 6
Identifier:
Freeboard .....
(ft): 1l�................................................................................................................................................................
. ..... .......................................
10. Is seepage observed from any of the structures?
❑ Yes 0 No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes XNo
12. Do any ofthe structures need maintenance/improvement?
❑ Yes X 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 Callo
Waste Application
14. Is there physical evidence of over application?
❑ Yes P9 No
(If in excess of MP, or runoff entering waters of the State, notify DWQ)
15. Crop type i•-••
...... ........................ ....--�i'................_................................... ......._... -...._._................................................................. ................. -
f
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes M No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes Y!&No
18.
Does the receiving crop need improvement?
❑ Yes
XNo
19.
Is there a lack of available waste application equipment?
❑ Yes
19 No
20.
Does facility require a follow-up visit by same agency? -
❑ Yes
It No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(gNo
22.
Does record keeping need improvement?
❑ Yes
Wo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
No.violitions•ot deficiencies were noted;dtiring this;visit~- You:wili ireceive-Ro:furrtlie
correspatideitce about this:visit: .. ; ..
y
7/25/97
Reviewer inspector Name
amc ;A: :a� - � ' x ��"` "` ���•=dam . �"�,� , . �; ...�
Reviewer/inspector Signature: Date:

` [3 Division of Solt and23,
=Water Conservation -Operation Review `' �:g� ��
E3 Division of Soit and Water Conservation} Conspliance Inspectaonx : d
F
® Division of Water Quality Compliance Inspection a
M
�.: �.
N� Cj Other. Agency. Operation Review _�
-P
® Routine O Complaint O Follow-up of DWQ inspection 0 Follow -tip of DSWC review O Other
Facility Number Date of Inspection I ��JL 99i
Time of Inspection � 74 hr. (hh:mm)
® Permitted © Certified [] Conditionally Certified © Registered 0 Not O erational Date bast Operated:
FarmName: ........... :....I........................................................................................... County:........... 1*AF,,--)-....._.......................................
Owner Name: ,...,. _., t2 , --. %.Z-S.. Phone No: lU
..... ......... p .............. J �-
Facility Contact: .......Z�e c. .......7SA4F era�/l�+A. .........Title:... .............................. q...... Phone No: ...... .......... ...................................
Mailing Address: ....... /. :. ... !r.....s�.�1�.....T....� o..�/....4��.✓/b.J�.,CF C....28�Z./.......................................................... ..........................
Onsite Representative:ff ....cCJ..,et� Integrator:....................................................
Certified Operator: .........ram,�J��1'/........................ Operator Certification Number: .�,is��
....................... .........................
Location of Farm:
Sh /71Z
..................................................................................................................................................................................................
Latitude Longitude • �' �"
-Design Current Desiign -T; Curtreiet: Design Current
--•
Swir►e Capacity Po ulaiioii:.:_pon�ti3',.. .Ca_pacity ,Population Cattle Capacity .Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
O
Z G
❑ Farrow to Finish
❑ Gilts,
❑ Soars
Discharges & Stream Impacts
1_ Is any discharge observed from any part of the operation? ❑ Yes] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is die estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes F 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: A
Freeboard (inches): .................... 4.110 ...........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back
L

Facility Number: ODate of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
❑ Yes `KNo
(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 maintenatce/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
❑ Yes )(No
12.
Crap 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 J No
c) This facility is pended for a wettable acre determination?
❑ Yes XNo
15.
Does the receiving crop need improvement?
❑ Yes KNo
16_
Is there a lack of adequate waste application equipment?
❑ Yes XNo
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Y No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes CgNo
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IRNo
:.Ito viol _tioris:or• deficiencies -were noted during phis:visit; - You wili-feceiye trio fu4 thgr
:: corresporiciei>Ece: abaniti this visit. ::.. ::: :.::::::...:::.:.. .
3123/99

Facility Number: p — /Y6 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below xyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes d6No
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J,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 KNo
M 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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? OkYes ❑ No
)Vdditioinl:omimene 'an orb rawrng$.
3/23/99