820038_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

i ype of visit: px;ompiiance inspection lJ rjperatton rceview V �rructure xvaivanon lJ i ecnmcat Assistance
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: )IR Arrival Time: Departure Time: j a County: S'J k1(Ix0A1 Region:
Farm Name: �-13 H C- g A / Owner Email:
Owner Name: to 3 a 4A&C av-& S Phone:
Mailing Address:
Physical Address:
Facility Contact: Cc,w.4 r-j j3a ,,-W t`e4k_ Title:
Onsite Representative: i
Certified Operator: muttr�w�
Phone:
Integrator: /kfi"— S
Certification Number: rob 9 1 y L"d
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Current
Design
Current
Design Current
Swore .Capacity
Pop.
Wet Roaltry
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
GI�55Feeder
Non -La er
Dai Calf
Feeder to Finish
6000 -561,1ry
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , $Dolt ,
Ca acf
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Y
Turkeys
Turkey Pouets
Other
Other
_Discharges and Stream Impacts
_ 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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)? W
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 L7 'ro ❑ NA ❑ NE
❑ Yes [] No [�NA ❑ NE
❑ Yes ❑ No 6-NA ❑ NE
❑ Yes ❑ No
❑ Yes Ea No
❑ Yes [rNNo
[/]NA
❑NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Faciliq Number: _ z - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [D ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure b
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cg-<
❑ 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
Ul o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ETNoo
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�Xo
❑ 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 AEtplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
_�
�No
❑ NA
❑ NE
maintenance or improvement?
. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ea o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0,15 t P 5 c 0 _
13. Soil Type(s): 10 "0%-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L2"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes FL-54o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []J o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes []''qo ❑ NA ❑ NE
0 Yes [E No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
©-1Q6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QXo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? 1f yes, check the appropriate box below.
❑ Yes
[]LNK
❑ 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
E�/ o
❑ NA
❑ NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ET/No
❑ NA
❑ NE
Page 2 of 3 214120I5 Continued

Facility Number: jDate of Inspection:
2,4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑'Ko` ❑ 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 ED-Iqo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EZJ<o ❑ NA ❑ NE
❑ Yes HKO ❑ NA ❑ NE
❑ Yes [.Kj o ❑ NA ❑ NE
❑ Yes 2< ❑ NA ❑ NE
[]Yes Q o
❑ Yes ❑No
❑ Yes ❑i 'ICfo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: U Date: f '{
Page 3 of 3 21412015

` = i
.4 jjjKj
�„�*� �� - �:4 � . "� L'� ':�,..,yy�� ,'� * ".-�_ � sf ��, •oaf :� �, ;.�:r�7� sir- ,d
Type of Visit: (;Kom liance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint p Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: 7Arrival Time: SO Departure Time: �� County:_
Farm Name: qA- Owner Email:
Owner Name: a 3 &,*j Phone:
Mailing Address:
Physical Address:
Facility Contact: atkfs •t d` G✓C Title:
Onsite Representative: V
Certified Operator: [ CW10C-uj/
�I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:Fx
Integrator: 1k (5rS
Certification Number: --�
Certification Number:
Longitude:
Design C►urrent Design Current Design Currenit
�.
tr
5wme Capacity Pop. Wet Poultry Capacity Pop Cattle :.• Capacity Pop.
mrr
Wean to Finish Layer RDairy
airyCow
Wean to Feeder Non -La er Calf
Feeder to Finish bvoo Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D Poultr Capacity Po Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts on -Layers Beef Feeder
Boars Pullets FIRMBeef Brood Cow
4,. Turkeys
Other Turke Poults --_ -I
;*
lot er Other _
Dischar es 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 ofa. 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 [do' 0 NA ❑ NE
0 Yes ❑ No 1 1A ❑ NE
[:] Yes ❑ No ETNA ❑ NE
0 Yes
❑ No
[31NA
❑ NE
❑ Yes
E3111 o
❑ NA
❑ NE
0 Yes
1 IJo
❑ NA
0 NE
Page I 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
fo ❑ NA ❑ NE
❑ No F__4'1�A ❑ NE
Structure 6
❑ Yes ®-No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E2rf�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�' o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
2No
❑ 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2'(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): SG O
13. Soil Type(s): O Wq
14. Do the receiving crops ditTer from those designated in the CAWMP? ❑ Yes_ io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P�rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E24NO
❑ NA
❑ NE
Required Records & Doe uments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E21Rio
❑ 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
E�To
❑ 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
C2'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: - Date of Inspection: 4&AA1-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�qo
❑ NA ❑ NE
2.5. 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
[K 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
[3"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
dNo
❑ 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
[2lo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]r�qo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
a/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G6,f t��l 3a��
u� 0, 3o� -
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phonel104333t3 Y
Date:
21412015

Type of visit: #dCompliance inspection U Operation Review U structure Evaluation U Technical Assistance
Reason for Visit: 12rVoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:, Arrival Time: Departure Time: County: 7 Region7:;P_0
Farm Name: . GL Owner Email:
Owner Name: 3(Ciro 4-4- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
fr
Title:
Latitude:
Phone:
Integrator: f
Certification Number: A 151l r
Certification Number:
Longitude:
Design Current Design CTrent Design Current
Swore g a Capacity Pup. Wet PoultryCapac tyPop. Cattle Capacity Pap.
Wean to mis I JI-ayer Dai Cow
Wean to Feeder Non -La er Dai Calf
.� . ,_
. Feeder to Finish µ =:m Dairy Heifer
��Farrow to WeanDestgnCurre_nt Dry Cow
Farrow to Feeder D , P,ouI Ca � ci Po . r Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Layers Beef Feeder
Boars Pullets F 113eef Broad Cow
fie
Turke s
- = Otrs .4 9mow, Turkey Poults
01 Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [;J41° ❑ NA ❑ NE
❑ Yes
❑ No
[�J-1stt1
❑ NE
❑ Yes
[:]No
�A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No �fA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [;IMo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �10 ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: -Z7 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:
Spillway?:
¢ o ❑ NA ❑ NE
❑ No Rq—NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ti; o
❑ NA
❑ NE
(i_e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Vo
❑ 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
E; o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[],Ko—
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E](No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑'Applicatiion Outside of Approved Area
12. Crop Type(s): 1�1'rJu^ a S G -o GA,-Ze,
f
13. Soil Type(s): I.J C,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [DNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ilNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Pa"No DNA ❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
(f
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
eNo
❑ 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
Ea'�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Yo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 e o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412014 Continued

I~aciliNumber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CDXo ❑ 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 Q-Wo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes []�Xb' ❑ NA ❑ NE
❑ Yes [;LV6 ❑ NA ❑ NE
❑ Yes M'No ❑ NA ❑ NE
❑ Yes [3lo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑'IGo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone: LM_1326 -
Reviewer/inspector Signature: ! Date: R 1
Page 3 of 3 21412014

lv S L4Y 13-r5 0
(Type of Visit: Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
_Reason for Visit: Qikoutine O Complaint p Follow-up O Referral O Emergency O Other aQ Denied Access
Date of Visit: tidJ—'t3 Arrival Time: Departure Time: Q f County: SIB Region:.���
Farm Name: (t t,L tf — Owner Email:
Owner Name:ff m �11C<_ Phone: ps
Mailing Address:
Physical Address:
Facility Contact: a[fh, sC1 Title:
r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: IS 2-7
Certification Number:
Longitude:
s
3Design Current
r
DesignCurrent =
Design Current
Swine
Ca act Po x T
tY
Wet Poult .
Ca'aci Po = --
Cattle
Ca act P h' P-
La er
Dairy Cow
Non -La er
Dairy Calf
t�
�� -_
Design Current
D . P,oul Ca ace i:.. Po
h Layers
DairyHeifer
D Cow
on
Beef Stocker
Ocher
Other
Non -Layers
Pullets
r e s Tu
w,,."?i r- ., ,Y TurkeyPoults
Other
Beef Feeder
Beef Brood Cow
Wean to Finish
Wean to Feeder
Feeder to Finish
60 �
S o 0,7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
i. Is any discharge observed from any part of the operation?
❑Yes
❑.pF6
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
❑i.P�A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[—]Yes
❑ No
Ej,Pd'A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
[:]No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
CyNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes ETNo C] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - 13 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 l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[3_bie—❑ NA ❑ NE
❑Nod ❑NE
Structure 5 Structure 6
❑ Yes Eq-N-o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3,M
❑ 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
❑-'N°
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D Na-
❑ 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
❑
❑ 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?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S�
13. Soil Type(s): (IV b L2o
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 [2` o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2'go ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes E] No ❑ NA ❑ NE
[-]Yes L_L ^o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [D-<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P,-Iqo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FBciliNumber: jDate of Inspection: 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g-1qo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E914o
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 G_<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E 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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[:]Yes afro ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes [31 o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [2rNo
❑ Yes No
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exulain situations (use additional na2es as necessary).
C:�c(
5("A,e 'SC'f W41
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�--Xb- N 6—s-7
P— 31'3
Phone: ' �3 J
Date:
21412014

Type of Visit: (D-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4r I� Arrival Time: Departure Time: CountyL Region:
Farm Name: OLLLZa Owner Email:
Owner Name: tDIJ5 ZE&kPhone.-
Mailing Address:
Physical Address:
Facility Contact: 17.) t,V J"JVfk)- Title: Phone:
Onsite Representative: � Integrator•. 613
Certified Operator: { t Certification Number: 77
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Currents
C$pacity Pop
Wet Multryc-21021".;rty�
gnCurrent Design Current
Pop =Cattle Capacity Pop.
.ti �s
n to Finish
La er
Dai Cow
to Feeder
Non -La er
Dai Calf
er to Finish
�t
- = :.
Dai Heifer
w to WeanDesign��Ctirrent
D Cow
w to Feeder
[an
D . P.oult .
Ca achy Po
Non-Daw
to Finish
La ers'
Beef Stocker
Non -La ersBeef
Feeder
s
Pullets
Beef Brood Cow
Turkeys
Other
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I� "o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made
❑ Yes
❑ No
❑r- -NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[!I<A
❑ 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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E34o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
F3 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection L}
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EE 3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �❑ 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 ❑< ❑ 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 Q ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�r<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
I__I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
El"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil TYPe(s):
T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3"No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EfNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes LJ o ❑ NA ❑ NE
[—]Yes TNNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [!j'53 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes lo^ ❑ 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 E] No [DNA ❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes l `J No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Al
10
Fac' ' Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ED.N6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2 oo ❑ 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 0'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P No ❑ NA ❑ NE
❑ Yes III "'o ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [DO —No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
CNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
[l No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations ,(use additional pages as necessary).
hA
P4
Reviewer/Inspector Name:
14
Reviewer/Inspector Signature:
Page 3 of 3
PhonIA—333
Date: '14- I q
21412011

Type of Visit: Q) mmp�pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: alikoutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: pu Arrival Time: Departure Time: ounty: Q'Q Region:
Farm Name_ T�. Owner Email:
Owner Name; �t L Phone:
Mailing Address:
Physical Address: {'
Facility Contact: i�rz/Lj Title: kko-v%4L �� Phone:
Onsite Representative: t� Integrator:]
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:�J
Certification Number:
Longitude:
-
Desi gn
Curren t- -
Design
Current
Design Current
Swine
E Capacity
Prop
Wet Poultry
Capacity
Pop k _
Cattle. Capacity Pop.
Wean to Finish
K
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
D p
7-y
DairyHeifer
Farrow to Wean
Design
4
Current
D Cow
Farrow to Feeder
D . Paul
Ca aci
P,o f� �1�
iry
Farrow to Finish
.:
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poutts
Other
f
Other
a"
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [DA'o" ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [P'l IAA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [J�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 [E]NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ©'IQ'o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �1N ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[r30No
❑ 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
[:I -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z�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
2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Fj -1►No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K 'Flo ❑ 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): CS-4 G "/,,j N
13. Soil Type(s): A' Pt-
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
[ Slo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[DAo
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
LINo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EB/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D-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 Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfalI ❑ 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 [�10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: o t�- Date of Inspection: ju M 1 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E44o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �io ❑ 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 eo ❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U3"No ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []I'Iqo ❑ 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 Wo ❑ 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
[ rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[E"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[B"N o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
2r/No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawinss of facility to better exulain situations (use additional eases as necessary).
quAt" S14'Vt'-y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t
Nam, CRY uot
c
2 012,
6 - 5-, q -, F - 3--,"7
.50
Phonj 1 a —3 31 4
Date o cr u 1.5
21412011

I
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (3'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 j Arrival Time: 10 : f Departure Time: qM County: Region: L&a
Farm Name: (J Owner Email:
Owner Name: �� �j FACE rn5 Ov: epft s 1. hone:
Mailing Address:
Physical Address:
Facility Contact: \pry [)!E V AI%A Title:
Onsite Representative:
Certified Operator: C\Tns��.�N �E UA�14
Back-up Operator:
Phone:
Integrator: hj'.P'QS'j FSfkotjrj
Certification Number: +�y
Certification Number:
Location of Farm: Latitude: Longitude:
,i DeZi Ca nt
t� g
Swipe x ;` Ca act Po
Wean to Finish
�_ g nt
rJ' Depsi > Currpe
Wet Pout Ca acts Po
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
LdppQ
' '
' D sign & ' eat
I] . P,ouI a a acl P..o .
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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
2NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ED 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
[Sa'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: 'a, - 3$ Date of Inspection: 7
1,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[g/NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[g"�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Ycs
[;�rNo
❑ 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
. I�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
B"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
ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9/No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 52"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): CgPMja\ Pi! Rtr,,jCRASS �A`i ��ASTuRty Cotter t +�i`,C�►l_ . btu
13. Soil Type(s): �jd �� P
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes [g"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 E�`No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2"'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[V"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [—]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4No
❑ 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 [ o
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes d No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -`� Date of Ins ecfion:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ (No D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ES4No [] 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 Ejy<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No [ rNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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? ❑ Yes E�fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
$PvM'1P1 e_
Cca�sbap.�s,en nse�wJ Aro bra A o N t_ z44
g R c 0mo�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [j3'No ❑ NA ❑ NE
❑ Yes [V'No ❑ NA ❑ NE
❑ Yes CglNo , ❑ NA ❑ NE
[:]Yes [ rNo ❑ NA ❑ NE
be lz-amptttfo Ta
Phone:�t1U-��$5
Date:
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: % Departure Time: , ` Q County: ywawrj Region:
Farm Name: �L�1 ILXY% Owner Email:
j)
Owner Name: �i/:� f';`virrl}S p �1•r `Cv
1
Mailing Address:
Physical Address:
Facility Contact: Pe -yet r,t- Title:
I1
Onsite Representative:
It
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
t
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Gu n Design Current
Swine!
FW-ean
.-
Cad-c t} Pop. Wet Poultry Capacity Pnp Cattle Capacity op.
Layer Dairy Cow
to Finish
Wean to Feeder
Non -La er
Discharges and Stream Impacts
. is any discharge observed from any part of the operation'?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
[:]Yes
❑ No ®NA ❑ NE
❑ Yes ❑ No ®NA ❑ NE
❑ Yes
❑ No
[q NA
❑ NE
❑ Yes
j� No
T�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 214/2011 Continued

F'acili Number: - Date of Inspection: L
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? El Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
(� No ❑ NA ❑ NE
❑ No NA ❑ NE
Struct re 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats two 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 en-vironmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C,No
❑ NA
❑ NE
8. Do any of the structures 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
IM No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
1 1. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility tail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�j No
❑ NA
❑ Yes
§g No
❑ NA
❑ Yes
® No
❑ NA
❑ Yes
[� No
❑ NA
❑ Yes EQ No ❑ NA
❑ Yes No ❑ NA
❑ Yes 4 No ❑ NA
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1 f yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes © No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

A '
Facility Number: - Date of Inspection:
3 l f
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
(�j No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
P
❑ 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.
❑ Yes Q No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes]
No
❑ NA
❑ NE
permit? (i.e.. discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: + 1 d --q33-3,-7ep
Date:
21412011

I Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
IReason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: MINI
�Ayr/rival Time: �7i�jDeparture Time: County: Region:Farm Name: l"l � -'�� Owner Email:
Owner Name: r., 1n Phone:
Mailing Address:
Physical Address: _
Facility Contact:"'] _ Title: Phone No:
Onsite Representative:
Certified Operator: Rg ooce- _ --
Back-up Operator:
Integrator:
Kil
1" sys—
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= e = 6 = Longitude: = o =1 = "
Design C•nrrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to FinishE=j
El Dairy Heifer
Farrow to Wean IDrY
Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
El Farrow to Finish
❑ La ers
El Beef Stocker
Gilts
on-La
❑Non -La ers
❑ Beef Feeder
PBoars
❑ Pullets
10 Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t9 No ❑ NA ❑ NE
Dyes
❑No
®NA
FINE
❑ Yes
❑ No
W NA
❑ NE
NA
❑NE
❑Yes
El No
❑ Yes If No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: —
Date of Inspection I /// ►//�1J 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
St7cture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6-04
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes "No
❑ Yes ❑ No
Structure S
❑ NA ❑ NE
❑NE
?NA
ucture 6
❑ Yes M No ElNA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? l
Waste ApDlication
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE.
maintenance/improvement? Ir
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes y No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift EL Application Outside of Area
Q
12. Crop types)h'lJiiPas GtfA
13. Soil type(s) No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 1� 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 [P 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 Dame Phone: 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12,128104 Continued

Vacility'Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
F No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
Cl NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
Cl NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
r
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3
12128104

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: t0 3D Arrival ,rime: 07,Gdlb Departure Time: 'G h, County: 39r"'f`'Su " Region:
Farm Name: _ G' ! v4 _T_ Owner Email:
Owner Name: Lknr7 802 Phone:
Mailing Address:
Physical Address:
Facility Contact: G'V r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: /n� �11
Integrator: _�,��{� — s �t.JI.1 CLC
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 = Longitude: =° = 4 = it
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
690n
1 32 <b
Dairy Heifer
El Farrow to Wean
Dry Poulttry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
-_
❑Turke s
O#hAJ
er
❑ Other
❑ Turkey Puults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [,'&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No PQ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): tl
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. noes any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FINo ElNA [INE
ElExcessive Ponding ElHydraulic Overload [IFrozen 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 ❑lEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s4Q7S11 �'m (41 6'054 "
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!
❑ Yes
�F No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
53No
❑ NA
❑ NE
Reviewer/inspector Name ° ` Vla%✓UIi Phone: w
Reviewer/Inspector Signature: /1 Date: 10A10M
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PDNo ❑ 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
)�Q 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
FNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
FNA
❑ 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
[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
P 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
I2128104

4.
Division of Water Quality
Facility Number _ a_ Division of Sail and Water Conservation
MQ Other Agency
.91n—n --- - - 11111111 M
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: it �7�� Arrival Time: Departure Time: County: SAMP-50AI
Farm Name: Cs M Owner Email:
Owner Name: J l r Phone:
Mailing Address:
Region: r-RO
Physical Address: Facility Contact: (3rP_A Gu'r Title: A A Phone No:
Onsite Representative: Integrator:
/V l r L�-PI1 -63m cy n -Lc-
Certified Operator: 0_ i _ Operator Certification Number: ocy07�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I = u Longitude: = o 0 , = u
Design Current
Desgn Cnrrent
Design Current
Swine Capacity Population
Wet Poultry Cap ity Population
Cattle Capacity Population
to Finish
❑ I_a er
❑Dai CowWean
RWean
to Feeder
❑Non -La er
❑Dai Calf
ER Feeder to Finish
El
`� �„�r5 ""
*
DairyHeifer
❑ Cow
Farrow to Wean
.
D . Eoult
ry ry..
Dry
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
x _ ...
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
0 No
El NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P9NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
MNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
i
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ y
No
�6A
❑ NE
2. is there evidence of a past discharge from any part of the operation? !'
❑ Yes
EbNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ;'
❑ Yes
5rj4o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:
Date of Inspection
I J
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
El NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
�PNA ❑ 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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA [INE
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
29 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
PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EpNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Wo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, ,Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) " V-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�I;No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
)tNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
I &
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
ReviewerlInspector Name {UjQ v Phone: 3j�3
ReviewerAnspector Signature: Date: 1112-1
Page 2 of 3 12129104 Continued

a
Facility Number: Lk-35 IDate 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes lq,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?
33. Does facility require a follow-up visit by same agency?
❑ Yes
;9 No
❑ NA
❑ NE
❑ Yes
IF. No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
❑ Yes
[El No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes CpNo ❑ NA ❑ NE
❑ Yes 9'No ❑ NA ❑ NE
❑ Yes ff] No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
❑ Yes
$,No
❑ NA
❑ NE
❑ Yes
CANo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
F 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival 'rime: M Departure "rime: 3�� County:
I Owner Email:
Owner Name: +' F braopl Phone:
Mailing Address:
Phvsical Address:
Region: _ -P
Facility Contact: r Title: Phone No: Q
i' M 242"
Onsite Representative: Integrator: r'OW +1
Certified Operator: a I " -c Operator Certification Number: o>r->
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = 6 ❑ « Longitude: ❑ o ❑ , ❑
Design Current` Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yes I F�A
❑
Wean to Finish
❑
Wean to Feeder
52
Feeder to Finish
ODD
El
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
Pullets
U Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non- Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? ([f yes. notify DWQ)
c. W'tat 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 N No ❑ NA ❑ NE
❑ Yes ❑ No P NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes rlo ❑ NA
❑ NE
❑ Yes t No ❑ NA
❑ NE
12128104 Continued

Facility Number: — nbl Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1
9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Tt9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
F
ElNA
(INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
[INE
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
1] No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
ElNA
[INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement? L
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ElNA ❑ NE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy 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 ❑l Evidence of Wind Drift ❑ Application Outside of Area /�
12. Crop type(s) rho c V44,--t), cj S , W
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No El NA [I NE
17, Does the facility lack adequate acreage for land application? ❑ Yes No El El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: L 3 07
12128104 Continued

Facility number: — Date of Inspection �7
Re uired 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 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 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
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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
IF No
ElNA
ElNE
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
IF 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
T No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
to No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

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 ❑ Denied Access
cloln
Date of Visit: ® Arrival Time: I /:cVA9— I Departure Time: County: spn Region: I-w
Farm Name: ` m I Owner Email:
Owner Name: i�t�+Vp��rgrbjLh Phone:
Mailing Address:
Physical Address:
Facility Contact: C Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
,� J� Phone No:
Integrator: L."T� h
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= n = ❑ ,, Longitude: ❑ o = I ❑ u
rent
Design Current Design Curreniulation
Mcu—f
R.M
Wet Poultry C*ap�ac
tyPopulattan ,,r Cattle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er;
❑ Dairy Calf
Feeder to Finish
1900
13
`-'K
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
° r ;` El D Cow
El Farrow to Feeder„
-
❑Non-Dai
El to Finish
"' El Beef Stocker
Gilts
❑ Gilts
s El Beef Feeder
❑ Boars
El Beef Brood Coyj
-
❑ Other
^ " �3Nutnber of Structures:
El Lavers
❑ Non -Lavers
El Pullets
❑ Turlce s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[NNo
[I NA
El NE
Discharge originated at: El Structure ❑ Application Field El Other
a_ Was the conveyance man-made?
❑ Yes
El No
® NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
[0 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
El No
M NA
El NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[NNo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
'] No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 09-- $ 1 Date of Inspection
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? ❑ Yes W No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[1 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[jNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or i 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JP No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviiewerllnspector Name ffflReml-M 02", Phone: &) q 3�_3 300
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2128104 Continued

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 CA WMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
❑ Yes [�S No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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?
33. Does facility require a follow-up visit by same agency?
❑Yes
14No
❑NA
El NE
❑ Yes
ffj No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑Yes
KNo
El NA
El NE
❑ Yes
5� No
❑ NA
❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes QgNo ❑ NA ❑ NE
El Yes [�No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

,86/
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: '( Q Arrival Time: Z Departure Time: County: S Region: FAQ
Farm Name: G_.J- Owner Email:
Owner Name: 6xr. C it r5 �o S Phone: ``''
Mailing Address: PC K S� ��� f , it , l jC, 28 yS6
Physical Address:
Facility Contact: / //'�_� Title:
Onsite Representative: e'er (fare`
Certified Operator: , �+° /Y[G�3 rf_
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Ny t
Operator Certification Number:
Back-up Certification Number:
Latitude: E-1 O ❑ 1 0 Longitude: ❑ o = & ❑ «
Design ';Current Design Current Design Current.
Swine Capacity . Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Ff,—
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ 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 ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (if ves. 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?
:I
❑ Yes ,J=y,No ❑ NA ❑ NE
❑ Yes
❑ No
NA
ElNE
ElYes
ElNo
NA
❑ NE
&A
❑ NE
❑ Yes
❑ No
❑ Yes 0"No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
12128104 Continued

,Facility Number: e� — 38
Date of Inspection Eamg
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: J i
Spillway?: �Ly
Designed Freeboard (in): 4.
Observed Freeboard (in): 38 _
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes o RNA ❑ NE
Structure 5 Structure 6
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ANo ❑ 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 4No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) t
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1K No ❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) -A4 u icy - cz s _ c : ct:.ti * zi c� (or" -rcr �'a
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ElYes ',No ❑ NA
El 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, El Yes EQNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 4 No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes C&No ❑ NA
❑ NE
Comutents'(refer to.question #); 'Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situation's. (use additionaI pages as necessary): _
Reviewer/Inspector Name ( Phone: ���—C/rr-}+ f���
Reviewer inspector Signature: / Date: G
12128104 Continued

Facility Number: — Date of Inspection RT - ,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®No ❑ NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUK ❑ Checklists ❑ DesigR ❑ Maps- ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5�No ❑ NA ❑ NE
❑ Waste Application' ❑ Weekly Freeboard`" ❑ Waste Analysis✓ ❑ Soil Analysisr ❑ Waste Transfers ❑ Annual Certification'
❑ Rainfah' ❑ Stocking-'❑ Crop Yield!❑ 120 Minute Inspection`❑ Monthly and I" Rain Inspections❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ffNo
❑ 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
[SNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5Z No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
2&
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
ANo
❑ 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
qNo
❑ 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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[8 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KLNo
❑ NA
❑ NE
Addiitianid Comments and/or°Drawings: .
12128104

Type of Visit v Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number hate of Visit: % �0�0 Time: �v' c] a
ro Not Operational 0 Below Threshold
©'permitted [Certified © Conditionally Certified O Registered Date Last Operated or Above Threshold:
Farm Name: -- C `• m - County: 5 aw.,csse)IJ _ F;z7-->
Owner Name: 1'ylk U r P�. r G a w p Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: _ 61 . k�:_ _ /} 7v o r G Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Longitude '
Design Current` _ Design
Current Design _ . =Current
Swine
Ca acitr Po elation - _Paeh .V 'Ca acih
`Po elation Cattle ' Ga aciri . Pa als4on
❑ Wean to Feeder
_
❑ Laver
I
❑ Dairy I-_
® Feeder to Finish
G o 0 0
❑ Non -Laver
❑Non -Dairy
❑ Farrow to Wean
_ =
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
--
Total Design Capacity -
❑ Gilts
❑ Boars
Total:SSLW .,
Number of Lagoons ❑ Subsurface Drains Present JEEI La oon Area JOSprav Field Area ?:
Holding Pbnds'3 Solid Traps =: ❑ 1`o Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sorav Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
N'aste Collection &- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spilhvav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
y,a
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
N 14—
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes © No
❑ Yes 91 No
Structure 6
05103101 Continued

Facility Number: rid — 3 Date of Inspection
.f
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑Yes] No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
S. Does any part of the waste management system other than waste structures require maintenanceiimprovement? ❑ Yes ® No
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ID No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [19 No
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes In No
❑ Excessive Ponn�ding ❑ PAN [I Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
12. Crop type LJc�.•,��� gracx �dL / ;S. i7rnY� f Carn �ht� 1- / G -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes [9 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 F7 No
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [$No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ® No
Air Quality representative immediately.
:Comments,(refeir to'gteesLon #) 7Ex0lat6any YES aaswe s and/or airy recomni!RdationS 0r'any okleei "cacti ne_uts.
'Usei�ngsh' to better explain sttnatioas. {nseaddttzunal pages as necessary) ® Field Copy ❑ Fina] Notes
AL
+
be�M1,..v2� c�As haJ reaci"_to tho �
f Ihrti 1- bC 4�oirCSSCa[. �o �S 't'y�
t'SG'l-
't"�C proa�eh..,
Reviewer/inspector Name
ReviewerAnspector Signature:
Date:
� u
l LI1L/VJ l.uI"SIL"

Facility Number: Tg - -3 Sr Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WiJP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AAW?
NTPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[11 Yes ❑ No
❑ Yes [0 No
❑ Yes W No
❑ Yes m No
❑ Yes ® No
❑ Yes [$ No
12112103

Type of Visit �� Com nce Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 7 D� 'rime: Z—�
Facility Number
Not O erational 0 Below Threshold
erC� mitted Q Certifieed [] Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: it/!n r Countr,:
Owner Name:
Mailing Address:
Facility Contact: .,..,, J2 ' 0 ! t Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' Longitude '
Design Current Design Current Design Current '
Swine Capacity Population Poultry Capacity Po ulation Cattle Capacity ' Po ulation -
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish 1 10 Non -Layer I ILI Non - airy=_
❑ Farrow to Wean - -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure i
Identifier:
Freeboard (inches): f
05103101 Continued
No

Facility Number: '3zo7QIIJDate of Inspection UMM
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONoZ
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes o
Waste Application
10. Arc there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o
12. Crop hype rr7 "' rh 1 S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N
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? El Yes No
Required Records &Documents
17. Fail to have Certificate of Coverage R General Permit or other Permit readily available? El Yes;No
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.) El Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) El
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes Ng'
21. Did the facility fail to have a actively certified operator in charge? El Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes N
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N
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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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): [❑ Field Copy 6FmaiNotes
Reviewer/Inspector Name
Reviewerllnspector Signature: Date:
05103101 Continued

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: -- 1' � Time:
a
rO
Facility Number
Not 0iperational 0 Below Threshold
Permitted [3 Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: j County:
Owner Name: (In rr oIi is Phone No:
Mailing Address: j
Facility Contact: r }� 1ay e Iy�lt�I k6 P Title: Phone No:
Onsite Representative ^_ Z_C-�_ e) P. Int rator•
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 4 0"
Design Current
Design Current
Design . Current ...
Swine Capacity Population
Poultry Capacity Population Cattle
Capacity Population .
❑ Wean to Feeder
10 Layer I Dairy
r
Lgry Feeder to Finish L1,000
____d❑
10Non-Layer I I I El Non -Da
Farrow to Wean
- -
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
._ -
Total DesignCapacity..
El Gilts
❑ Boars
Total SSLW
_Number of Lagoons
❑ Subsurface Drains Present J10 La ooa Area 10 S ra • Field Area
Holding Ponds 1 Solid Traps
10 No Liquid Waste Management System
J•
Discharees & Stream Im a t
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laaoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes jKNo
❑ Yes No
❑ Yes No
❑ Yes tNo
o
El Yes
ElYeso
❑ Yes
Structure 6
Continued

Facility Number: 0 Z —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimproverrent?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Po9ding / ❑ PAN ❑ Hydraulic Overload
12. Crop type r
13. Do the receiving crops differ with those designat d in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Animal Waste Management Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Requirgg Records & Documents
IT Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes o
❑ Yes No
El Yes No
❑ Yes gNo
❑ Yes No
❑ Yes No
❑ Yes ONo
❑ Yes ESfNo
❑ Yes k3"No
❑ Yes 5jrNo
❑ Yes WNo
❑ Yes �o
❑ Yes PNo
❑ Yes No
❑ Yes o
❑ Yes fo
❑ Yes &No
El Yes 1No
❑ Yes No
❑ Yes No
El Yes
violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
( q only Erphnn any YES answers and/or any rec©mmendatzons or any other rnmments.
MOments refer to, uesti b r
"'Wall",
drawings ofifscdtty to,better` (use sddthonal pages as necessary,): ❑ Field Copy ❑ Final Notes
ern 49 WV 1� Al �c/
i
�LjQ
7.1
Reviewer/inspector Fame Fb '�
Reviewer/inspector Signature: Date: ` O—L�
0510.3101
Continued

Facility Number: — Date of Inspection=L�=
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?
Klyes
❑ No
❑Yes
o
❑ Yes
o
❑ Yes
V
El Yes
No
❑ Yes.
❑ Yes
❑ No
O5103101

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint. O Follow up ® Emergency Notification O Other ❑ Denied Aocess
Facility Number Z Date of Visit: !,Z
/ C Time: -' d'g
Q Not Operational O Below Threshold
Permitted 0 Certified U CConditionAy Certified 0 Registered Date Last Operated or Above Threshold: ... ._
Farm Name: .................5....F.(!................................................................................ County: ........
5
.5FNPr.........._......... ........ ........., ... .
Owner Name: .......... ✓.e�p.`...1.�1!Cf�iWl�!a
,� 1 ...................................................... Phone No:
Contact: ....... 14 :... - j ,..d4 .............. Title:..............`.................................p.................. Phone No:......... -......... __ ..
Mailing Address: ...... a -fix... y� �re g� /V
,.._... f............. --- ................. -
Onsite Representative: ... Integrator: cc -
Certified Operator: .................... .......................................................... ...................... Operator Certification Number:........
Location of Farm:
❑ Swine © Poultry © Cattle ❑ Horse Latitude • 4 44 Longitude
Design , Current - Design Current Desk Gitrrestt
Swine° ci Po nlation Poultry Cs ci Po ula#ion C1e`
Wean to Feeder ❑ Layer ❑Dairy -
Feeder to Finish ❑ Non -Layer 10 Non -Dairy
Farrow to Wean -
❑ Other "-
Farrow to Feeder'
Farrow to Finish Total Design CapaCity .
❑ Gilts
Boars Total SSLW
Numbcx_of i;iiigoons1 l ❑ Subsurface Drains Present ❑Lagoon Area Spray Field Area
Holdwg Pdbds/.Solid-Traps.= ❑ No Liquid Waste Management System
Discharges & Stream Imoacts
1. is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field )N'Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) H 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} R'Yes ❑ No
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? 91 Yes []-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....... :(......... C_f.................................... ......................................... ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: tF2 — Date of Inspection C�
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
Q] No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
10 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
s�
J&No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
J9 No
Waste Application
10, Are there any buffers that need maintenancelimprovement?
❑ Yes
EP No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
RNo
12. Crop type 6� . Sfr-1 c,��.d.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
[IYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
gj No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
UNo
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
MYes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
-yiQla>kignjs;or d0ficiei�dH iWL— ingtet d><tring t tis:visit! Yoh wiii sti eceiye o fug tMgr"
cotTesporidence abouti this :visit ::..::.::::.....:::......::::.... .
df,��jo�sce�.,g,�� Cc�prq .� o•� �,� `�2/�/d1J ,�iv�,.,,,,� ,per A�
toJ+i'P6lis ' oi%��� �i+ �K ,�/EL'!✓.J. �;0.✓.v/� ��ld���is�-�c� f��
��/Ax- 7 '�0 /%�! ���� sc�®'.✓/s�rs�i%�1.Pc��d��/.�l�`��O�,�iI7 /��ls..Co'/S�rrirf�
i7C'iL / 4t/r � Lri .Lr.9i� 'r-� ,L�-- �o/c- " � c�.,/���.✓ J
Reviewer/Inspector Name ,
5/00
Reviewer/Inspector Signature: ,�_,� Date: lZ G/

r �
Facility Number. -_7dO Date of Inspection
Odor Lssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
, -omments an or; Drawings: -' m
a "_ � .. — -
5100

t
of Vislt @Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit O Routine O Complaint. 0 Follow up O Emergency Notification O Other I ❑ Denied Access
Date of Visit: Time: !z 1 6 / me: = L9
Facility Number 2 3
Q Not Operational 0 Below Threshold
® Permitted ® Certified 113 Conditionally Certified 13 Registered Date Last Operated or AboveThreshold:ov
FarmName: .. ....... drs................................................................................ .. County:........ S ......................
q'>
Owner Name: .....
c.e�..�i.2�1,�set�.................................................. .... Phone No:
FacilityContact: .....�.�:Cfr+'r.................n'�................. Title: ................................................................ Phone No:...................................................
Mailing Address:
Onsite Representative:.... . ! �L ... dL).........._. Integrator:
Certified Operator:......,,_„ ............................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 6 Du
De4gn . Current ` Design - Current Carresrt
.::DesrKn
CrPo ulatiou Poultry Ca ci Po nistiari Cattle _
Svi*lne Po ` dots
Ej Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish &4z w Geevo❑Non-Layer ❑ Non-D!jqLL
Farrow to Wean
Farrow to Feeder Other '
Farrow to Finish TOW Desilp. Ca aCi
p tar
Gilts
10 Boars TOW. SSLw
IYtsmher of Lagoons ' ! ..::. ❑Subsurface Drains Present Lagoon Area ❑Spray Field Area
Holduig Ponds / SoLd_Traps ... ; ❑ No Liquid Waste Management System
Discharxes & Stream Impacts
1. Is any discharge observed from any part of the operation? Myes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field N3 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) IN Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min? 4.14
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? ES Yes []-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpilIway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................
Freeboard (inches):
5100 Continued on hack

Facility Number: d,- — 3 P Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
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?
Re uired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Y: N-q-yi0 a(idAs;or d�fckndOO *'re 00W d(Wing �his:visitf - Yoa will-t�eceiye do fu4 th
- • t406-isi)6 ideQce abouf this visit:.....:: ::::::.......:.....::...:: :
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Wo
❑ Yes JK(No
❑ Yes KNo
❑ Yes Slo
se`
w gs'o , ty to .. tter egp tna ons. uise; _ , tide `Pages
r/� - ` ' o.✓ ��s' � G�.�i� �.f�.aJ- � f�i�G �
eX �"
, /lip,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
7.7
Date: /2_/2/!/ 5100

Facility Number: Date of Inspection IOZIZlcl
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional -Comments an or= ravnngs;: z
,.,� �.r� lurE.�i� Coi�� Sly''"' �/a'r'� T�'� /!%y ��✓ �/l�.�L ` .._. ��� �r � S �
44
• jam. � �oe��.✓��
5100

of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit O Routine O Complaint. ® Follow up O Emergency Notification O Other I ❑ Denied Access
Facility Number Date of Visit: Time: =cfr'D
Q Not O rational Q Below Threshold
® Permitted -0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _
FarrisName : ............L.................................................. ........................... County: ...... !`??•q.................. ...,
Owner Name:....... �j -.., d�?/r'�t' ......................................................... Phone No:.... �/C+ .... �C. ...... -
Facility Contact: ....., eP�.�e ...., r7.SXi!! .................. Tit ....
tlle:................................................................ Phone No:........................W .. M .... .
Mailing Address: ............ / .... :....t1�r....7...J....`..L'P1,rFf.Cc...,c.................. ..........
Onsite Represent ative:....... ,,,��/,r� ?r�N ............................... Integrator:...0
Certified Operator:._ ...................•...... .. Operator Certification Number•
Location of Farm:
❑ Shrine ❑ Poultry ❑ Cattte ❑ Horse Latitude • A °t Longitude • �OK
Design Current =- Design Current - ; ::._ Design .,.
Swine
_.. .._
Capacity Po nlatiori I'oWtry Ca aci Po elation Cattle Ca
Wean to Feeder
Feeder to Finish
Koco
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEI
❑ Boars
❑ Layer ❑ Dairy4-4
❑ Non -Layer I Non -Dairy
Other -
Total'Design Capacity
Total SSLW
-� Number of i.agoans ❑ Subsurface Drains Present Lagoon Ares ❑ Spray Field Area
_ -
Holdi>,g Ponds'/ Sohd'Traps.; No Liquid Waste Management System j
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes JW 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 P9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes U9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Qs No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: .................................................................................................................................................................... ..................................................
.
Freeboard (inches):
5100 Continued on back

Facilliy Number: � — J? Date of Inspection
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ 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 ADDllcation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �'�o �yi+�atiggs:e�- d�fic�e�tci�s �vt�re ppte� d�rttg tt; • Yoh wi.� .�eiye do fph�r . : •
corresootidence: ahir6i this visit`
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
;e%71,xGr%�C� w, ---
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: / 5100

Facility Number: Date of Inspection 1 21201
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
:._.._ tio_:omments an or, rawings:
/ A 104eL
J
5/00

(Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation I
Rmoon for Visit d§ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit:
`7 df Time: d "
Facility Number
Q Not Operational Q Below Threshold
.Permitted 13 Certded 13 Conditionally Certified p Registered
Date Last Operated or Above Threshold:
Farm Name: M
_ County: A klf...-•..................... /=fib
OwnerName: ......... C.W. ...........................................................................
Phone No: ....................... .................... ............. ......
FacilityContact: ....Dve..:.. j.0.................................. Title: ....................................................... ........ Phone No:............................. .......
Mailing Address:.....?......� �.. k
GrSav� All
Onsite Representative:....Cad......................................
Integrator: ...... ...._.........
Certified Operator: ............. JdLv.,................. .......Can neilY............. .....
Operator Certification Number:.... §57
Location of Farm:
[2Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` it Longitude • OK
Design Currient
Scene : _Capacity Population
El Wean to Feeder
Feeder to Finish
(,pp o
El Farrow to Wean
Farrow to Feeder
Farrow to Finish
El Gilts
Boars
Number of Lagoons
Design Current
Poultry Capacity-p Population 'Cattle.
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
FO Other
Total Design Capacity I
Total SSLW . I
❑ Subsurface Drains Present 10 Lagoon Area
Holding Poads / Solid Traps _ [] No Liquid Waste Max
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
C­
Ur
�. Popnl
© Spray Field Area "
a
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0 No
❑ Yes IT No
❑ Yes 0 No
❑ Yes
W No
❑ Yes
[P No
❑ Yes
P.L.N.
❑ Yes No
Structure G ,
Identifier: ....................................
Freeboard (inches): '43
5100
Continued on back

Facility Number: Q,Z - Date of Inspection "J 4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 01No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [VNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [ "o
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 J No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type EX'M h. r M xe . 5,/hu rn cam' r-3 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Owo
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
W-No
15.
Does the receiving crop need improvement?
❑ Yes
RNo
16.
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?
(ie/ V4tbffi� che4Kts, desifn, maIrs, etc.)
❑ Yes
[;*No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[>No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
C�(No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
0: -* aiiods •oi dtficiend * 'rb ppte4 iiurimg t is;visit; - You iyiii •i eei iye Rio fui-tbs . ;
cories deace abbiii this visit` ... . ... .. .
Comments (refer Lt► gaest,on #} Explaia any YES answers and/or anyr ommendstwns or any other comments.
Use dr"nngs of facthty to better,ezplain s tunt,ons. (use _ bonal:pages as necessary) -
--
/ - Cc),A:Atit we"I on bare... 519eAr, Qn /tyc oon d;Ae- - -
e - T.7 — t)ds 7f W IJ J, ! I��,dy y ray,j e n c c
CJ[a5 In}crc rv,{ Sse�
PI K 2rcd4d GtJru
Reviewer/Inspector Name , Sk-M,L,.t
Reviewer/Inspector Signature: Date:
S/00

Facility Number: $a — Date of Inspection 1 7 9 v
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IyNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [�No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 1VNo
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 [0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Wo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
5100

,P Dtvtsioi of Water.Qtiahty
> Diivtlsion of So>i! and Water -Co -rvat
� _Otheir Agency _ .`
n
Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit. 5 1 CD I Time: � Printed on: 7/21/2000
_
Not Operational C Below Threshold
Permitted [3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........................
Farm Name .........� County:......,-3.............................................
............... .............................................. ......................... n Q
Owner Name: ...,ut.Y.la.t...T?X.S..t�!%C.r................. Phone No: �l.1.Q ��.�...1:3_
.......................................... ....... ..... ................
Facility Contact: ..J1 7�{2 ..1 `!. {.....1.' �.......... ................ Title: .............................................. 1. ................ Phone No:...................................................
Mailing Address: ....................................................-
Onsite Representative:. {.►................ ............................................ integrator:
........... .................................................
Certified Operator: ...... Qr q,l(rl. Operator Certification Number:
.. .............I..............
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & « Longitude • 6 &S
ine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
sign, Current " Design Current Des : Current -
raci Po ulatioo Poultry Capacity Population Cattle - -Population
1 ❑ Layer ❑Dairy
❑ Non -Layer ❑Non -Dairy
10 Other
Total Design Capacity .
Total S LW :
❑ Subsurface Drains Present
No Liquid Waste Managen
Discharees & 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. slid it reach Water of the State'? (if yes, notify DWQ)
3 Spray Field Area
c. If discharge is observed. what is the estimated flow in galhnin'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes tfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Nlo
❑ Yes 5rNo
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes -ANo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................
Freeboard (inches): 34
5/00 Continued on back

Facility Number: Qd, — 3S Date of Inspection Printed on: 712112000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )allo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Wo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
r'U7. 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? Roes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes VrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? yQS s i ilo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type 0 60 c � f 17::P r Yv,d . A ti/ n rr+.70, si,' a) it n4q" < <-, t c% v 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j(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
❑ 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
P No
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
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
0 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ELNo
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 KNo
::Rio viol. wris:or• deficiencies •mere noted• diving this:visit' • Yop will•i-eeeiye Rio 1fufth
corraespoiidei ke: about this visit: . " ... '
Comments (refer toquestioa #): 'Explain any YES answers and/or any recoaunendatinns or any other comments
Use drawinigsof iaidtity to better explain sittatians. (use additional pages as necessary)^T
(�
7 � 6-v r.� � a
�° �" � ��.� v�zy ha 3 r-K��V i'C, 1Cs_n . ac.� 4j 11
010Un5 1 L P 1'e-'a a• GvQ a . 2y,_sj ,, _ ` `] r _-
IP&
t L,) + 'O vL.k 0.t'0-� �S QiX�S51v2 LJe-UV Z 1 rr�W�n [ )C]t�LR' rI�ti' tv1 +�CC]ZL75 ,
�
r21ds 1 a�-rV65GV-Qo,- � p vD� d I
nQad S tbL ' VQ
Fac 1 V tw 1 LI'i LM
Reviewer/Inspector Name ,, 0 vit
Reviewer/Inspector Signature: U — rDate: $/pp

Facility Number: — 31R Date of Inspection j a5 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation'?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MNo
2& 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONo
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 RfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PINo
32. Do the flush tanks lack a submerged fill pipe or a peT-manent/temparary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100

13 Division of Soil and',Water Consetiwahan - Operation RevEew _E
Y 4 Division of Soil and Water Conservation ;Co' -IPPhi ncekllnspechon
`x
y Division of Water Qual>Ity Compliance L� 4te tin
Other Agency Operation ' ' '
® Routine 0 Complaint Q Follow-up of DWQ inspection 0 Follow -tip of DSWC review Q Other
Facility Number a 3
Date of Inspection
-A lime of Inspection 3 24 hr. (hh:mm)
13 Permitted © Certified _r© Conditionally Certified [3 Registered 0 Not Operational Date Last Operated:
Farm Name: ...................... j.- . • ......................
Owner Name:...............l-arr� �f s �Js .�C .
I........... i `"` I�:....................................................... Phone No:................_................................................................
FacilitvContact: . _Title: ......... Phone No. _--_ ...............................................
Mailing Address
P 0 80;�. �� ............. 1 arS.R .q .......a.8..........
......................... nlC 3 `!S
Tr
Onsite Representative: ......:...... Vrr ,,,,,, Or •...!J .. Integrator:.........��R/%�l 5,�
//�� ..... rr
Certified Operator: „UA./� .. A . - ....ic � O erator Certification Number: ..........................................
p....: ............................... p
Location of Farm:
Latitude ' ° �4 Longitude • 4 64
= Design Current-' Design Current-- Design Current
Swine try
:. CatCapacity Population y, ua acity Po Mahon <'
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish 6 pco ❑Non -Layer ❑ Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity Ex3e�
❑ Gilts
❑ Boars Total SSL W
Number of.Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area -
-Bbldtng Ponds./,Solid Traps _ ❑ No Liquid Waste Management System---- -
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes WN0
Discharge originated at: ❑ Lagoon ❑ Spray Field [-]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
h. If discharge is observed, did it reach Water of the State-? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (I1" yes, notify DWQ) ❑ Yes 1ANo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9f,
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 [J No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......................... ......... ._......................... ................................... ...... I ......... ......... .................. ........................
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 onlack

Facility Number: t, _-?T Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes [XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
El Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
[` Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Wid level
elevation markings?
Yes No
LUL C
Waste Application 5- — ql ~ ��
13,ID —73 — !7
10. Are there any buffers that need maintenance/improvement? I% —
El Yes o
T
11. Is there evidence of over application? ❑ Excessive Ponding 4 PAN
Yes No
12. Crop type �� ' LiwU"'L al.OJ2 S/YYte 1 �tJi4i ,P%_ 01-e-r.. C2�
13. Do the receiving crops differ with those designated in the Certified Animal Was% Management Plan (CAWMP)"'t
❑ Yes
® No
T❑[
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
ONo
16. 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?
Yes
kNo
(ie/ WUP, checklists, design, maps, etc_)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
U(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
06 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
06 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? El 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? XYes ❑ No
yibiatigris;or defeiencie mere nQfecl dix`itpg �his:visit. . . . will receive Rio: #'urthe ;
comes ontieirce: aboU this visit::... • . ::... . : ; ; :..
Comments (refer`to :question #) ExplaRnyany YES awers and/or a ny reconnimendaiions o any other comments '
Use drawings of fac►lity to better explain situations (use,addrhonal=pages as -necessary) �=�
i
Reviewer/Inspector Name
ReviewerlInspector Signature: ��Date: - 9
3/23/99

`Facility Number: Dr� — 38' 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 es ❑ No
liquid level of lagoon or storage pond with no agitation? ky
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EP&o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [No
roads, building structure, and/or public property) �/
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 00
j
30. Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. ,Do the animals feed storage bins fail to have appropriate cover? ElYes INO
P/A ❑ Yes [-]No
32. Do the flush tanks lack a submerged fill pipe or a perinanent/temporary cover?
Additional : omments an of - - awings.
a�.
C41% �.
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
14A Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection�2��
Facility Number
Time of Inspection Q 24 hr. (hh:mm)
Registered © Certified 13 Applied for Permit XPermitted 10 Not Operational Date Last Operated:
r�
Farm Name:.... ..................1 .... .... /. .....
County:...........�'� I
S................
gg►►Owner Name:S..r !1C`!(`QI. d�1 ... ...... .. . Phone No 8�.....�.............
Fl.Facility Contact:.....Cll..... ['t v"` f�. .. Title:....r.....� Phone No:
.. .............. ... ........--.........
MailingAddress: ...................L/......._.................�..................................... ........... ..........a.5........�r... ...G.�
Onsite Representative:... ! C a�---C.7.. Integrator:......--•--..... I
_`...II _�"� �'. `""`�.....................................................G.............
Certified Operator-,...- ..Q.4� L.C� ...... .. Operator Certification Number.......:Z.O 7
p ��.!.. K ......_............. p f..
Location of Farm:
Latitude 0 A 0« Longitude =' 0' 0"
s
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Current Design Current
Population ' Poultry Capacity. Populattanm Cattle",`
❑ Layer
10 Dairy
❑Non -Layer°;
❑ Non-D;
:'„ ❑ Other
-
Total Design Capactl
r-:n
Totaf'snv
'.Capacity`4"P
Subsurface Drains Present 1E❑ Lagoon Area
No Liquid Waste
Ii13
Spray Field Area
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
)�`No
2.
Is any discharge observed from any part of the operation?
❑ Yes
00l0
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 Surface Water? (if yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
❑ No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
A No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ANo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
P(No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
b(No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25/97

Facility Number. Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holdine Ponds, Flush Pits. etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2 Structure 3 Structure 4
Identifier: C' ♦ w1S
Freeboard(ft):........................................................................................................................................
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering raters of the tale, notify DWQ)
.. 1/.
15. Crop type ......E.1!!!l.L.li.. ...5.1�?�. ._....V.�.�-.S,l �":........ ........ ...
❑ Yes k"No
❑ Yes 6-- No
Structure 5 Structure 6
16. Do the receiving crops differ with thosedesignated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewrrnspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violationsor deficiencies were noted during this.visit..y . U4 11 receive.no.ftirth:er
-:•correspQt�dettceab"outthis�visit::�,�: .. :� •:•:-;•::�.: : :-.• -.:�: :�. :. ...:.:...:.....:..:.
❑ Yes No
❑ Yes No
❑ Yes X No
❑ Yes �No
❑ Yes �No
❑ Yes O(No
❑ Yes P(No
XYes ❑ No
❑ Yes A No
❑ Yes KNo
❑ Yes )(No
❑ Yes XNNo
❑ Yes No
❑ Yes No
❑ YesNo
Ig. sow p.-�s pi���ed need Aer4l os— ) r, Pr: Cock � 44�jdy_ JJ
` L s eel /t1R B .S4.rC or Q06
r� w w {�erl�C �l N �o P�
ha.5 bae,� re_ce:aed i�. �1e.+.
L ra.— � S f 6ok m u,c.L be;4r_r �a,,_ i as� ' eo r s i &%speei o
WCO�IJer--q r�-S S �
J
7/25/97
Reviewer/Inspector Name --I
Reviewer/InspectorSignature: IAC— (I _ If/— Date: '7-2.f—I

Carroll's Foods, Inc.
c/o David Nordin
PO Box 856
Warsaw, NC 28398
SUBJECT: Operation Review
C&M I Farm
Facility No. 82-38
Sampson County
Dear Mr. Nordin,
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Notice of Referral
FAYETTEVILLE REGIONAL OFFICE
February 24, 1999
RIECEIVED
LIAR 7 - 2000
FAYETTEVILLE
PEG. OFFICE
On February 16, an Operation Review was conducted on C&M I Farm, facility no.
82-38. This Review, undertaken in accordance with G.S. 143-215.1 OD, is one of two
visits scheduled for all registered livestock operations during the 1999 calendar year. The
Division of Water Quality will conduct a second site inspection,
During the Review, it was noted that the bermuda and small grain had been over -
applied greater than 10% of the PAN recommendation for these crops. According to
Section 111.6.F. of the general permit issued by the Division of Water Quality, it states that
overappiying animal waste either in excess of the limits set out in the CAWMP or where
runoffff en eI rs surface waters should be reported to the Division of Water Quality. It was
also noted that the waste utilization plan for C&M I Farm and Pork Plus Farm were
combined but permitted separately. You need to contact your technical specialist for
these farm sites so that he can contact Division of Water Quality to have permits
combined into one permit.
You are strongly encouraged to contactour certified technical specialist for help.
You may also want to contact yourlocal Soil andyWater Conservation District Office since
they may be able to provide you with additional technical and/or financial assistance to
implement corrective best management practices.
Please remember that in order for your facility to be in compliance with
environmental regulations, animal waste cannot be discharged into the waters of the
State, and the animal waste collection, trey e t, storage and disposal systems must be
properly sized, maintained and operated under the responsible charge ofya certified
operator.
The Division of Soil and Water Conservation appreciatesyour cooperation with
this Operation Review. Please do not hesitate to call me at 9101486-1541 extension 292
if you have any questions, concerns or need additional information.
i cerely,
cat Faircloth
Environmental Specialist
cc: DWQ-Fayetteville Regional Office
DSWC Regional Files
Sampson County SWCD
328 GREEN STREET, SUITE 714, FAYETTEVILLE, NORTH CAROLINA 28301-5043
PHONE [phone] PAX 910-466-0707
AN EQUAL OPPORTUNITY/ A FFIRMATIvE ACTION EMPLOYER -50% RECYCLED/1 O% POST -CONSUMER PAPER

1 f:13
M 12outine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 82 38 Date of Inspection 2-16-99
Time of Inspection 9:15 24 hr. (hh:mm)
® Permitted ® Certified [3 Conditionally Certified [] Registered 113 Not O eratianal Date Last Operated:
Farm Name: C..&.M.1............................................................................ County: Sampsoxi........................................... FRO .............
OwnerName: ................................................... Carxali'S.?AdS.It1C.............................. Phone No: 9a.Q-2�.:.9�.9.......................................... .................
Facility Contact: IY.I.ichavI.Grit aaw......................................... 'Title: Employep ........................................... Phone No: 29.3-3.43.4................................
.
MailingAddress: P.Q.B.ox.816........................................................................................... Warsmy..PIC.......................................................... W9.8 ..............
OnsitcRepresentative: 1Ch�1�1.�rCaila...................................................................... Integrator: C, rlCsull'.Skucttl T[tc...............................................
Certified Operator: Ra,yid.A................................. Faku ............................................... Operator Certification Ntimber:2,01.93 .............................
Location of Farm:
.............................................................................................................................:.....
...................................................................................................................................................
Latitude • + 14 Longitude • k 44
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Topulation "
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish 6000
10 Non -Layer
ILI Non -Dairy
Farrow to Wean
Farrow to Feeder
JE1 Other
13 Farrow to F—ini-sTF
Total Design Capacity
6,000
Gilts
LJ Boars
Total SSLW •
810,000
Number'of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System P.
�;
Dischare s & 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. It'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? n/a
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 t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..............2.6.................................................................................................................. .
........................................... ..................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, C] Yes ® No
seepage, etc.)
1/6/99 Continued on back

aci14 Npmber: 82-38 Date of Inspection 2-1659
G. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ® Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application'? ❑ Excessive Ponding ® PAN ® Yes ❑ No
12. Crop type _.Coaslra1.BaanudA, (Qxaze)..,........S.tr II.Orain.Dverxrwad....................... Mi112t.(a=Qd.......... ..... .................................................... .......
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
15. Does the receiving crop need improvement? ❑ Yes ® No
16. 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?
- • N.o:violatious•or de:ficiencies:we're•noted during: this :visit: �You� will receive titi further � : � :
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
nitrogen on small grain; field #2 -73 lbs. of nitrogen on bermuda; and field #1 -77 lbs. nitrogen on bermuda.
(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
- • N.o:violatious•or de:ficiencies:we're•noted during: this :visit: �You� will receive titi further � : � :
correspondence about this'As, it:.'...'.;.:..:. ..... .
--� ._.' -' I �I 31 " ;'. �, !-. -. 1.1 '- "'""111'1 ' �'"E {iivE V i' F i.i"[s4"{'9lilltl. 3d:�t.;3'Si.=1i u. is€l E'F3Y-111.1.:"I111fh i. Irl 6!:111. 11171!1 �'1!�EIYtYJEll Elil"111 ' i IY' �� ' F f E it j
Co'mments€(refer tolquestion.#} Explain any!YESlanswerslandlor any,recommendations or anyfyotherclommentsli�i�iill���;`�`
i + , III Iql Ohl'.,,, i f 1 I!q7{ I'11I r.ff,
,<; uc! , s, k 1 {I pii , ('1;7liirll iE lI1 ,
Use drawings of facility, to better explain situations. (use additional pages as necessary).11F 11{] i I ` itE1C' ;Ili11i 1'' 11111111
�
�I
�k11`� 1iV1�tlll L)ri , q 1.Y �,IrGIa;IV1
According to the database, Start Date 01/01/76 Certification Date 04/13/95
+
8- Need to cover repaired discharge pipe on corner hog house with dirt and vegetation so discharge pipe is not hit by tractor or
mower.
11, 22- In cases where PAN has been over -applied greater than 10% of the PAN recommendation for that crop, stop irrigation,
notify DWQ, secure alternative sites, contact technical specialist. Notice of Referral Over -Applied Field #5 -48 lbs. of nitrogen on
bermuda and -63 lbs. nitrogen on small grain; field #6 over -applied -49 lbs.of nitrogen on bermuda; field #4 over -applied 24 lbs. of
nitrogen on small grain; field #2 -73 lbs. of nitrogen on bermuda; and field #1 -77 lbs. nitrogen on bermuda.
Note: C&M I and Pork Plus WUP combined, Permitted Separately. Contact technical specialist to combine permits with DWQ.
1W
.. .�... . _..<..�. �. . ! !7i 1 nl� I ..« t��ka5 li " 7 tP
7 i E -tlr_ .i� 11 1 44. d P I I1 -E IJ'.
ReviewerlInspector Name l�scott. it l h=1.1117:;fJl� ,Elle,€ I ISIi1�� rl€ did l pJ11�1N[!I, {�!1i�il� i
ReviewerfInspector Signature: Date:
116199