820279_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua!

Type of Visit: 1D-Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: GYAoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /— Arrival Time: OE> Departure Time: ,' County: -- Region:
Farm Name:✓� 7����CSt� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: XD,zree-Tr, -_4 J5, -- Title: :2U,'n f" Phone:
Onsite Representative: � �_ Integrator: � _
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Curren#
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Ca#t!e
Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oul
Ca aci
P,a ,
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
Yes Q No
[:]Yes. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ 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
eNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D<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
Ej No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[21 to
❑ 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
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,-�
E-,
i
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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): &-riss ce JGe l 5911,f -3 /C D /' A / Gvh / �k-,' 3C%�`� 14., —
13. Soil Type(s): g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes u 'Vo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
O-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E314o
❑ 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 [3'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

7
.11 lFacitity Number:°L;( j j Date of Inspection:
'E 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6-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 [3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3No ❑ 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 [ h 0 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:]Yes PrNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Z No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 VNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EKO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments
Use drawn s of faci[i to betfer explain sittations (use. additional pagesi;as necessary,) „� ns or any other comments.
1; efe . to qttoa # Eaplam any YES aaswers.andlor<anytaddtteoaal recommendat�o
Reviewer/Inspector Name: s�u� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

(Type of Visit: Q-Comp'ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:.,( / 7 Arrival Time: , 3 f) Departure Time: County: �iiiy�r��Region: �7
Farm Name: /5T-- .. Owner Email:
Owner Name: , Fro,rrS T-- Phone:
Mailing Address:
Physical Address:�}-
Facility Contact: g"j CiT rJr 5cr - Title: 42e_�K 7"'r Phone:
Onsite Representative: Integrator:
Certified Operator: 4 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number.
Longitude:
rrent
DesigNF
Design
Current
Design Current
Swine
�
op. Wet Poul#ry
Capacity
Prop.
Cattle Capacity Pop.
can to Finish
La er
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
',Current''
"
Dry Cow
Farrow to Feeder
D ;_Fault . Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
?Other
' 'F
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ®No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
[:]NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[g No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
B-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 9 2- Date of lns ection:
— /
i, Waste Collection & Treatment
.� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[C No
❑ NA
D 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): (I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J],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
[Z 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
_H 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
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2LNo
❑ 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): �SYYJet /y - * o r r._ (��t-,.jf
la !r I' +^-
13. Soil Type(s): %UO /f
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FZLNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ 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
FINE
❑ 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 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F';LNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Ds ection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [Z No
IF 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®- No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 U3�,No ❑ NA ❑ NE
[-]Yes [2 No ❑ NA ❑ NE
0 Yes B No ❑ NA ❑ NE
El Yes ®No [:INA []NE
❑ Yes ® No
❑ Yes No
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
= menendatioos or any oilier comments:'' =z.
Used rwin �of fac Lue to�bette �_ Liin aoy YES answers aod/or any addition ' I reco
F_
l ty P ah situnfidhs- (wz addrttanal°pages as.gecessary)- ' !i;.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2ZL33 3—015 i
Date: SS—
2141201 S

1 \s a-g �M � t)i_�)
(Type of Visit: O Co
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I V76ZIAArrival Time: << Departure Time: County: Region
Farm Name: V 1 efr'-r 43— Owner Email:
Owner Name: G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: t(
Back-up Operator:
Location of Farm:
r*'�' Title: Phone:
Latitude:
Integrator:, '�-r-i 4W
Certification Number: 7�T
Certification Number:
Longitude:
Design,Current
Design
Cnrreat
Design Current
Swine Capacty Pop.
Wet Panl#r3'
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder I
INon-Layer
I
i Calf
Feeder to Finish
airy Heifer
Farrow to Wean Design Current_
Cow
Farrow to Feeder
D , P,oultr
Ca aci
Pop.
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other F
Turkeys
Turkey Poults
Other
Other
Discharees and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ETNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[fNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
ff'RA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
6NA
❑ 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
�' o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

l`
Facility Number: - Date of Inspection: dj IDC—(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VEr]�❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
d'No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 'es io ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [!fNo ❑ 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 (EfNo ❑ NA ❑ NE
maintenance or improvement?
s.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E!f No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Win-dowa ❑[EEvidence of Wind Drift ❑ Application Outside of Approved Area
J 12. Crop Type(s): �J�J[ i� 6 b C &.-J -1'/' �A 9 c�^ s 'tom,
v
13. Soil Type(s): �p C4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E:fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo D 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?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
[:]Yes
fNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [l�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E!T'�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 dNo
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Erl
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 21412015 Continued

Facility Nainber: - Date of Inspection- CET
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cq 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 [fNo [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Ej 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
0 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
E� No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[!(No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
eNo
❑ NA
❑ NE
Reviewer/Inspector Signatur
Page 3 of 3
21412015

I
. 1 /
t ype of visa: %_x<ompuance inspection V uperation xeveew u structure Evaivanon V recnntcat Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — —%S Arrival Time: ; O Departure Time: 'tJ0 County:''p -- Region: {�
Farm Name:Owner Email:
Owner Name: Ti/ �► yr--ids [t'—�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �...�� - Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current:
Design
Current.
Design Current
Swine
Capty' Popes' Wet=Poultry
CapacityPoF.
C*stile Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
1 INon-Layer
I
Dai Cow
alf
Feeder to Finish
Farrow to Wean
=
T :
Design
"'
Current
Da Heifer
Dry Cow
Farrow to Feeder
D . tPou!
Ca aci l ol`
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
_ - -
_1
Turke Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ WE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
fallo
❑ NA
❑ WE
Page 1 of 3 2/4/2014 Continued

I
' Facility Number: - Z jDate of Inspection:—,R_-3jEt
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes [Z No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: o,
Designed Freeboard (in): _ l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes to No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [gNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [?!,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®. No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 ❑ Eviiden/ce of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): �//7T O�'Jf7v � 'Yra� LG8 AV&'.4
e
13. Soil Type(s):�/ (,(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tZ] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW -MP 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 [aNo ❑ NA ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes © No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

` Facility Number: -"ZZ jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo
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 M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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 [8 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [j3,No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes No
[—]Yes [ No
❑ Yes [gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to question # Ex larn.an YES answers andlor�an additional recommendations"o`y y ts.-
�� q P . Y Yran ,other co>nmen
Use drawings of (cihty`.to better explain situations (use addit<oa pages as necessary):
Reviewer/Inspector Name: �� ��'��Phone:/jt'-33 as
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

ivision of Water Resources
Facility Number ®- ® OO Division of Soil and Water Conservation
QQ Other Agency
Type of Visit: ompliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: : 071 Departure Time: ; e'Y] County: v Region:
Farm Name: �i~'��'-,3 %—' Owner Email:
Owner Name: 1/ V y `%'( ��rS Z), Phone:
Mailing Address:
Physical Address:
Facility Contact:ry� Title: Phone:
Onsite Representative: ��_-�--�— Integrator:
Certified Operator:
0-4—
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Design Current
rGa!tfle Capacity Pop.
inish
Dairy Cow
eeder
Non -La er
Dairy Calf
Finish
Wean
p
Design Current
D . I',oul Ca aci P,o
Dairy Heifer
Cow
Feeder
NFarrow
-Non-Dairy
Beef Stocker
Beef Feeder
Finish
La ers
Non -La ers
Ocher _
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[:]Yes C&No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes [:]No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]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 observable adverse impacts or potential adverse impacts to the waters ❑ Yes D,No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of inspection: /
J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): CY
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
gE�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
[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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
J&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[XNo
❑ 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
Cj� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &a 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): f i[ / 16P �'� �2vhi jJ� AS
13. Soil Type(s): D .7f— /
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 (2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [B No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes R No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [!�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes C4No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: J
l ' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo
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 JRNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes RNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[0 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
5jNo
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
S No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E? No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawings of faci>, to Better a lain situations use additiona! a es -a anal recommendations br�any otfierzcoaments:�` � Comments (refer to question;#) Explain any YES.arnswers and/or, any ad
g ity ap ( p g necessary). V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

r
Type of Visit: (Dr —Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: !%> Departure Time: 'v c7 CountyRegion: /
Farm Name !/ �' �ri�/js --•_ �ilylpt Owner Email:
Owner Name: y c�. ��rs �.-�� Phone:
Mailing Address:
Physical Address:
Facility Contact: f�j gsy � 431— Title:
T �
Onsite Representative: �� t
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1170*dr
Certification Number:
Longitude:
Current '
Design�Current
Design Current
Swine
FDgn
city
PoM.p i
Wet Poultry
Cap c ty _Pop.
Cattle Gagacity
Wean to Finish
La er
airy Caw
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
ffD
' `
DairyHeifer
Farrow to Wean
Design..Curre..nt
D Cow
Farrow to Feeder
Dr P,ault .
Ca aci " ` Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes [a 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 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
No
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

A
Facility Number: / Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to 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 0 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 Cj� No D NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 ,a No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of ❑ Application Outside of Approved Area
/Wind Drift
12. Crop Type(s)
13. Soil Type(s): Alojef1 r
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes }Q,,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes o No ❑ NA ❑ NE
❑ Yes Ug-No ❑ NA ❑ NE
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes EjNo
❑ 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 ❑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 jo No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes fZ No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

r
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 10 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes Q�[No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes to 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 CD No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes gj No ❑ NA ❑ NE
[:]Yes E] No
❑ Yes [Z No
❑ Yes R[ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments :�,�,g�� .
Use,drawings of facility to better explain situations (use additional pages as necessary).=
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone:/D�y3��j7
Date: �3
21412011

f Type of Visit: O'Ciance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ?�j�t-1 Arrival Time: r Departure Time: ; fl County: _5f--,w_4 r --- Region:
Farm Name:aV Owner Email:
Owner Name: _��y f [ jar-��� ire--� Phone:
Mailing Address:
Physical Address:
Facility Contact:��.j�.----�_ _ _ Title:
Phone:
Onsite Representative: �l"�.c,- Integrator: /'z-
Certified Operator: S` Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine Capacity PetPoiiltry
1111 Design Cu;f5ayer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Dai Cow
ean to Feeder
n-La er
Design Current
D . P,oul Ca aei l;o
La ers
DairyCalf
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other 11
10ther
Turke s
keyPoults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El 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
[ ] Yes [:]No
C] Yes [:]No
Yes 2.No
Yes [n No
NA NE
NA [] NE
NA [] NE
NA NE
�NA NE
Page 1 of 3 21412011 Continued

Faciliq Number: - Date of Inspection: f
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:
�No ❑NA ❑NE
No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 K 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 E4 No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes RLNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes � No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes EgNo
❑ 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):' D tA
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 [g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes S 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 M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:)Yes E&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Z No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[gNo
❑ 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
IM No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[& No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[7Yes
❑ 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
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JNo
❑ NA
❑ NE
Comments (refer to question l Explain any YES answers and/or any additional recoritmenddtions or any other c�bi mentg_ '
Use drawings of facility to befter explain situations (use additional pages as necessary): �•_,_., __x,A�.,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:oo
Date:
21412011

Date of Visit: Arrival Time: r a Departure Time: County- Region: - yc:���]
Farm Name:
Owner Name: r� , }�r•js� w
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Phone:
Onsite Representative: l�� Integrator:
Certified Operator: : �a�; Certification Number: /Z'22&
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current _ - Design
Ca aci Po Wet oult Ca aci
P h' P• p. ty
Current
Po P•
Design
Cattle Ca aci
P
Current
Po p-
Wean to Finish La er
DairyCow
Wean to Feeder
Layer
DairyCalf
Feeder to Finish
`- =
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design
DryAPoult a .aci
Current
Pao ,
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Beef Brood Cow
Pullets
Turkeys
Other
Other
-
TU rkey Poults
Other
Discharizes 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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
CK No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):L
Observed Freeboard (in): 3_�C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 INo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CKNo ❑ 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 FZ71 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes Cff�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 E] Application Outside of Approved Area
12. Crop Type(s): %GvAn
13. Soil Type(s): ALA Ar
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ED No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
fa No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ 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 I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EgNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes & No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[jj 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
RNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® 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
0 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
(P No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L4 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r,Lio
❑ NA ❑ NE
( 9 P Y Y
1U§e ervl mendahons or as otber`co nmen#s.
dranwinEs of facility to better explainituabo s (use additional pages astneces
My_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Ag" 1 -2p2aj l
21412011

Type of Visit U;Cb—mpliance Inspection Q Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit &, outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t7� Departure Time: :3Q County: Region:
Farm Name: per..17 a� Owner Email:
Owner Name: �e EP 7-c- rS Dr - Phone:
Mailing Address:
Physical Address: I
Facility Contact: '��yss�..I /� .t t� Title: OQ/fit Yv-- Phone No:
Onsite Representative: Integrator: ter'
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� e [=
=" Longitude: = ° = A = is
�Design Cnrrent
OaKcity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other -
i
Design 1.0
urrent
Wet Poultry Capacity pulation
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPouets
❑ 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 Curren#
Cattle Capacity Popu�4
❑ DairyCow
❑ Dai Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: & — Date of Inspection
Waste Collection & Treatment
• 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SZ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (gNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes EgNo ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19 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 5LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13,
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P.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
0 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
'Comments (refer to uestion;# Ex lain an YES:answers and/or an recommendateons ar an other+COrnments. --
.t .fib P Y Y Y
[1se'draNings"of facility to better egplai4 situations: {use addihoual pages as necessary):
^€.
Reviewer/Inspector Name L� `� 1� O Phone: �J°10� y33 33�
Reviewer/inspector Signature: Date: Z _.— —�fT1
Page 2 of 3 1 Zl.Z5/U4 Lonanuea

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

Type of Visit (Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑Denied Access
Date of visit: Arrival Time: / O O Departure Time: County: Zr Region: /_1', 0
Farm Name: ;T_ iy { K r �� `� er.3 r, -- Owner Email:
Or
Owner Name: _T7✓-r_r! 1 C F)t�gcT' Phone:
ff
Mailing Address:
Physical Address:
Facility Contact: i['/sow-- Title:
Onsite Representative: %—
Certified Operator: Ir
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6 = « Longitude: = ° = , 0 ,A
Swine
Design Current
Capacity Population Wet Panitry
Design
Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Laver
❑ DairyCow
❑ Non -Layer
❑ Da' Calf
Feeder to Finish
1} 0
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ell
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Other
❑ Other
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PBoars
Discharges &Stream Imnacts
] . Is any discharge observed from any part of the operation?
❑Yes
®No
❑ NA
❑ NE
Discharge originated at: [I Structure ❑Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[I 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)
[I Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
®No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
� No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number:ge —
Date of Inspection — D4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No ❑ NA
❑ NE
a, if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Stricture 2 Structure 3 Structure 4
Structure
; Structure 6
Identifier:
Spillway?.
Designed Freeboard (in): / g
Observed Freeboard (in). Vq
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[KNo ❑ 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
(K No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El 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
XNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
[jlo ❑ 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 ❑ Evidenceof Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3�No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
QR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[)? No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: — C7a
Reviewer/InspectorSignature; Date:
12128104 Continued

Facility Number: — 2 Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ 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 ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
['No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[gNo
❑ 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
CH 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
O 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
[Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
['No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[$ No
❑ NA
❑ NE
12128104

9•
1
Type of VisitC,.om�pliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Koutine 0 Complaint o Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �3� Departure Time: Q: 3 a County: Vrp ' Region:
Farm Name: U % �< �pei C✓-�a��l'Owner Email:
Owner Name: ✓'G y { ` T ���dSfl~� Phone:
Mailing Address:
Physical Address: /J
Facility Contact: ��f �� Title: Phone No:
Onsite Representative: /"r _.. __ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =' E--]" Longitude: = o = I = "
Design
Ciurrent
Desrgnt Current
DesigPCurrent
Stivine Capacity
Population
Wet Pouiltry Caty Population
Cattle CapacPopulation
❑ Wean to Finish
❑ L�e_r
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
ceder to Finish
�"
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
Dry P,vu1t
ry
❑ Farrow to Feeder
,- - °';
❑ La ers
❑ N Nets ers
El Pullets
❑ Turkeys
El Non -Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑Beef Brood Co
❑ Boars
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ 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
J,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
S&No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

4
Z Facility Number: — Date of Inspection r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PSNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
;-No ❑ NA ❑ NE
(iel 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? 0-yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[9 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
[9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
allo ❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
ts.
Comments (refer toquesteon#)Ezplaa�an} YES answers and/or any, recommendations or any other commenRICO '11111111111��Iigl
Use draw* situations. (use additional+pages as necessary).
a
l sT
G19/1n (y]Pt joctj er a mac - 3rw
ufe 73•s�� � �y3
Reviewer/inspector Name d Phone:
Reviewer/Inspector Signature: Date: �l7
Page 2 of 3 " ' 12128104 Continued

r,
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JR No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ 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
0,No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
16No
❑ 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
C,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F�LNo
❑ NA
❑ NE
�►ddtttonaLComments°and/or Draw tngs �„ ,I �L ;_�t�. 3� f
Page 3 of 3 12128104

O Division of Water Quality
I MFacility Number 0 Division of Soil and Water Conservation
_.... 0 Other Agency
Type of VisitCommpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Ql outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit. I js j� 'jj191 Arrival Time: ,' / Departure Time: � ii County: Region:
Farm Name: ±�� G+r 8' Ctr'rs— Owner Email:
Owner Name: r �� 1B''ti-' / Phone:
Mailing Address:. ��7 a W� i �rg,,� 141� ut ^� /" C.
Physical Address:,-�--
Facility Contact: �n.�C.sY �t�/��SA�-�-Title: Phone No:
Onsite Representative: Integrator: sL-
Certified Operator: _� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1:1 o 1--] ` 1:1 " Longitude: 0 0 = g = YY
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry.. Capacity Population
_ ❑ La er
_ I _ i ILI Non -Layer
1
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke 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 C
Cattle Capacity Pbj
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in) -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JgNo
❑ NA
❑ NE
(ic/ 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
JO No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
12 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
(RNo
❑ 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/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 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] yes
NJ No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
V1 No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
KNo
❑ 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: _}j0!'33 310D
Reviewer/Inspector Signature: Date:
li'/ir V/VT a....... I.-

+ Facility Number: ig— Date of Inspection ®7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rvo ❑ 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 JENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LkNo
❑ NA
❑ NE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P9 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
(RNo
❑ 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
OfNo
❑ 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
0 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
KNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I
Type of Visit f&Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit &k0l'utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Db Departure Time: County Region:
Farm Name: Owner Email:
Owner Name: ���� �.5/�� Phone:
Mailing Address: /_ leT Gt axi' _ cc/,.`
Physical Address: ..��-
Facility Contact: Xonga �G /�t-5 V Title:
Onsite Representative:
Certified Operator:
Phone No -
Integrator:
�
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� O 0 I F-T Longitude: = o = j 0
Design Current
JillDesign Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer 1
❑ Dairy Cow
❑ Wean to Feeder I
1
110 Non -La er I
1
❑ Dairy Calf
Feeder to Finish
Re,6V Illao
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other _
❑ Other
F-1 Turkey Pouets
ElOther
I
Number of"Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
KNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
allo
❑ 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
RNo
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: $" — 9 1 Date of Inspection �b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JR No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
5Z No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
1 denti fi er:
Spillway?:
Designed Freeboard (in): 91
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
D4 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?
J Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
ruxLc�k
El NA
El 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[SNo
❑ NA
❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 Driifl El Application Outside of Area
12. Crop type(s),r'Iyll(�!�- �/fi-� G �S/h�.�P (�/`ci; ►L �SY�-'�zr
13. Soil type(s) j[%p
+14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes D4 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 54 No ❑ NA ❑ NE
18. Is there azz lack of properly operating waste application equipment? ❑ Yes MNo ❑ NA ❑ NE
l/
Reviewer/Ins ector Name r u'n�rf., Phone: 33 33
P C/Y f� e F
Reviewertlnspector Signature: Date:
12128104 Continued

Facility Number: — 7 Date of Inspection �afv
r 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 ;SNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZLNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JKNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
13 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
25,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours andlor document
❑ Yes
KNo
❑ 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
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
J�jNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RTo
❑ NA
❑ NE
T''
Additional Coments and/or m:Drawings: ,ME
Page 3 of 3 11118104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I/= GS Departure Time: County: $ ar•+ Ag" Region: Qa
Farm Name: -r K. Owner Email:
Owner Name: �f CN �t r.foaJ Phone:
Mailing Address: i a �+ A/6
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: IldrQti A PC }CVJ o M Intebrator: Rt-
Certified Operator: 13 ay. CAA Operator Certification Number:
Back-up Operator: xG_ r re de-!'-JoL2 Back-up Certification Number:
Location of Farm: Latitude: = e = I 0 11
Longitude: EJ ° ❑ t = µ
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
eder ❑ Non -Layer
❑ Wean to Finish
El Wean to Fe
Feeder to Finisht,214,kV
/ S'ao
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design —Current;
_..7 1
Cattle Capacity Population,
El Dairy Cow
❑ DairyCalf
ElDairy Heifer t`
❑ Dry Cow
U Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures: L[
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?
J
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[Z No
❑ NA
❑ NE
[:1 Yes
[4No
❑NA
El NE
12128104 Continued

Facility Number: r'L — 21
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): r a y of L l t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes QI No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ® 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) UCtm..oPa. /..QX / idS % — a.5
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, D Yes [ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes §0 No ❑ NA ❑ NE
Comments {refer taquestton #) �Egplamany YESanswers ar atiy��ommendatsons ar any other comments.
essary):
Use drawings ofafactl t3 oto+betteraegp. misituattons.F(use additional pageps� as necVT
A /Vv
Reviewer/inspector Name aY�c Phone:
Reviewer/inspector Signature:
Date:
12128104 Continued

Facility Number: x — �7q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [%No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [?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?
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 ® No ❑ NA ❑ NE
El Yes
®No
❑NA
❑NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
gNE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes Q9 No ❑ NA ❑ NE
[]Yes 5 No ❑ NA ❑ NE
❑ Yes
Q9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Ad�hon loCommenVand/or:Df`dWIRgS
12128104

4
Type of Visit 0 Compliance Inspection 0 Operation Review' O Lagoon Evaluation
Reason for Visit S Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: � 7 � O Time:
Facility- Number
�,,� Not D erational Below Threshold
E Ye' rmitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name; — 1t eA _P>PdP,'_sa,n, F3�►i County:
Owner Name: __ k"e I Pe'rer„Phone No: `gIQ- 5-22 �r7
Mailing Address: I W. /n . ���a C Rdad C/,`hly„ A/C ,k3
p rres���
Facility Contact: I ` e�e 1*aca _ Title: Phone No- ' Sell
Onsite Representative: Raaalz / elers134 Integrator: _ �,slp�t _
Certified Operator: Jje
_ !1 n loe/'1'rSos'1 Operator Certification Number:
Location of Farm:
924wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 04 0- Longitude 0a I
Design Current
Swine rnnaritr Pnnnlntinn
❑ Wean to Feeder
eeder to Finish
?
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acitti Po ulation Cattle Ca ackv Population
❑ Laver I I ❑ Dairy
❑ Non -Lave; I I ILI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons „R I ❑ Subsurface Drains Present J❑ Laeoon Area j❑ Spr v Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge oriainated 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, notifi! DWQ)
c. If discharee is observed. what is the estimated flow in sallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
?. Is there e-,idence 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? ❑ Spillwav
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier_
Freeboard (inches);
❑ Yes io
❑ Yes al
❑ Yes 3-go
❑ Yes B'No
❑ Yes [-No
❑ Yes �10
❑ Yes L_T1vo
Structure 6
05/03101 Continued

Fa ity Number: J,�
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 maintenanceJimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �� Sfe�, %�i,w�rcCR . Sm../1 G-,�i.`r� O
❑ Yes 9-Ko—
❑ Yes EWo
❑ Yes EPeo
❑ Yes O-Ko
❑ Yes Q-96
❑ Yes ❑-Ncr
❑ Yes UM
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes am
14. a) Does the facility lack adequate acreage for land application? ❑ Yes B-No
b) Does the facility need a wettable acre determination? ❑ Yes O o
c) This facility is pended for a wettable acre determination? ❑ Yes [ +4D
15. Does the receiving crop need improvement? ❑ Yes [No
16. Is there a lack of adequate waste application equipment? ❑ Yes QNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes BNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O-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 Okla
Air Quality representative immediately.
=Commits (refer to question if) E�cpl im anYFS aaswEis andla nap recommeada6w or any offer comments.
`'-� x. x
`Use drawnrgs �' fanlrty to better eXplarn 5rtatataoas. {rise �dtteonal pages as neressnry} d Copy ❑ Ftnal Notes :
I A,
Soi! Sa�nP�PS u/'e ,of"nneLe
Re COreA5 a no/ Fir, ry)
_'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

)C'atility Number: — r7Date of inspection 7 D
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/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? yes, check the appropriate box below.
[I 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 AWMP?
NPDES 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 [9-No-
0 Yes D.AIo
❑ Yes [No
❑ Yes &No
❑ Yes D.NO
❑ Yes ( o
❑ Yes aNG
❑ Yes &NO
❑ Yes 0-irlo
❑ Yes Q_W
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Faciiiry Number (late of Visit: �-D Time: % 0 Q
Not Operational 0 Below Threshold
Permitted 0 certified [3 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name:—. fle kl pe ie rSOAI f7etr"g County:
Owner Name: ken Pei r_50 t" Phone No: W0 ' .0/oa - —319S 7
Mailing Address: 70� �'._/12/ • 6411ZAI A C-// rl 41G d-tP_3 a8
Facility Contact: f Q / Title:
Onsite Representative: PQt71 1C{ re//er5017 _..._.
Certified Operator: Let? � Ae 7` rsy J1
Location of Farm:
Phone No:
Integrator: 61-1!X4744e— _._..
Operator Certification Number: 788�
R Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • " Longitude a
Design Current
Swore _Cans�retiPnr.ntAtiiu
ff] Wean to Feeder
®'Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
._Current
❑ Other17
Total Design"Caacih,
Total SSLW
;Number of Lagoons __ ❑ Subsurface Drains Present ❑ La o0o Area ❑ S ray Field Area =:
:Holding Ponds/,5ohd Traps = H ❑ No Liquid Waste Management System t
_. �.
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lamon ❑ 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 ves, 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 l Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): as "
05103101
❑ Yes W No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 50 No
❑Yes 59No
Structure 6
Continued

Facility Number: g 2 — a7
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 anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Analication
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ®No
11. Is there evidence of over application? 1 ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes O No
12. Crop type Chi A& SoyD ellil S _
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 r%21 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes [0 No
16. Is there a lack of adequate waste application equipment? ❑ Yes W] No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EZ 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
6a No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergencv situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
M No
23_
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
6a 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 A Arw?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammer►ts {refer raayeommequesbon'#) E,anyYES answers Atiaas'ar anv aiher`coiaments --`=
�-
Use drawtags of fsrs3i#v to better ezplata sttnahons. (use addrtwnal pages as necessary) ❑ Field Conv ❑ Final Notec _
Reviewer/InspectorName himhiV. - - -
Reviewer/Inspector Signature: Date:
05103101 er Continued

Facifiry Number:-_,22.!�
GeneralInformation:
Farm
Owne
On Site
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
tT�p�
No: 592 - 305-7
Mailing Address: KA- 9 tK 3i 4 N
Physical Address/Location: i
Latitude:^..^ / Longitude:
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
❑ Nursery ❑ Non -Layer © Beef
❑ Feeder
Other -Type of •Livestock Number of Animals: 6Z
Number of Lagoons:, �_(include' the Drawings and Observations the freeboard of each lagoon)
l
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1.foot + 25 year 24 hour storm storage?: Yes 0
Is seepage observed from the. lagoon?: Yes ❑
Is erosion observed?: Yes ❑
Is any discharge observed?
O Man-made ❑ Not Man-made
Cover. Crop
Does the facility need snore acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which nAed improvement)
Crop type: Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well -located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray -irrigated within 25 feet.of-Blue.Line Stream?
AOI - January-17,1996
Yes ❑
No
No LY
No a--'
No
Yes ❑ No
Yes a No ❑,---
Yes ❑
No CYi
Yes ❑
'No ❑�! .
01Z
Yes ❑
No
Yes ❑
. No ❑

Maintenance
Does the facility maintenance need improvement? Yes ❑ No �`
Is there evidence of past discharge from any part of the operation? Yes ❑ No
Does record keeping need improvement? Yes C] No-
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No-4
Explain any Yes answers:
G� �/ ' ' Date: 2 z
Signature: -
cc. Facility Assessment Unit Use Attachments if Needed
Drawings or Observations:
AOI — January 17,1996