820363_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

s 11 Hy -.,I I W f)L>
Type of Visit: GrCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ► U
Arrival Timer Departure Time. jv County:
Region/ 5
Farm Name:
"�� Owner Email:
Owner Name: t�D 1j ,t,� G t`aC �'wt-S Phone:
Mailing Address:
Physical Address:
Facility Contact: ([.w 1 N 4- �IOtJI � Title: Phone:
Onsite Representative: l Integrator: •�-
Certified Operator: �( Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Cnrrent Design Current
Pop: Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
If
Layer
Dairy Cow
Wean to Feeder
JNon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
J 4-Z
1&3 7
Design Current
Dr. Po_nl Ca sci P,o P.
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other°.
Turkeys
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ei "" ❑ NA ❑ NE
❑ Yes [:)No P. -*A ❑ NE
❑ Yes ❑ No LJ_NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No Cj�`IGA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes O No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Jity Number: _ Date of Inspection:
k
,Vaste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D-fro_
❑ NA
❑ NE
. a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3 ""
❑ 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
El 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
2 1Vo
❑ 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
E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FL-4,<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U3-*No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EE1110
❑ NA
❑ NE
maintenance or improvement?
l 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑lA7pplication Outside of Approved Area
12. Crop Type(s): mac!` V
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [b]Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 2No
❑ Yes Q"No
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5:�4o
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E 'J o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
t
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection:
24 •Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
2s Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3<o ❑ 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 D-1go ❑ 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
I �'J "'a
❑ 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
BIX/o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
G2 o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ql o
❑ NA
❑ NE
-At( b &q7'�j
7
Reviewer/Inspector Name:
C
Reviewer/inspector Signature:
Page 3 of 3
C2 - q 6 f ) -, Q. / 7
Phone:
Date:kw-q,( I b
2141YO15
3

F�eili Number � - � � Division of So ltand esources
I
ty Water Conservation
0. Other Age,�cy
type of visit: C1ommpliance Inspection Operation Rekiew 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: r} Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7 (O Departure Time: County:tsAyg Region:
Farm Name: ���'�; �" (p Owner Email:
Owner Name: IW-yr `Z.'�"� P Phone:
Mailing Address:
Physical Address:
Facility Contact: cuu`Ft S acc/li Cle4l Title:
Onsite Representative: l r
Certified Operator:
Sack -up Operator:
Location of Farm:
IC
Latitude:
Phone:
integrator:
Certification Number: /97ef 7
Certification Number:
Longitude -
Design Current
Design Current•
{�. k' " '� Design Current
Swine
-Capacity Pvp.
Wet"Poultry Capacity Pop.Cattle
Capacity Pop.
*.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
_:'
a
DairyHe
Farrow to Wean
Z J L
a'Design Current} :
D Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
DPoultr,
Layers
Non -Layers
1pullets
Turkeys
6Caa rtva=Po
-Dairy
Beef Stocker
rTBeef Feeder
Beef Brood Cow
Other
Other
Turkey Poults
Other
may,*J
Dischartres 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 Q,-vV-- ❑ NA ❑ NE
[:]Yes
[:]No
0'i`TA
❑ NE
❑ Yes
[:]No
[]rNA
❑ NE
❑ Yes [—]No
❑ Yes [?fNo
[:]Yes dNo
dNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 2/412015 Continued

Facile Number: tr Date of Inspection: .4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fg-Nor—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[ A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P-N-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
❑1qo
❑ 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
Eno
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2'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
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EffNo
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�r`No [DNA ❑ 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): 2t T& u
13. Soil Type(s): _ _ tj!�.l _
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 [�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? TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[j'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 6o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection: v
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 1314o ❑ NA ❑ NE
❑ Yes CyNo ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
❑ Yes [2�<o ❑ NA ❑ NE
❑ Yes �lVo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes e o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the saute agency? ❑ Yes WNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5� !a-a36- rf,K P-s.
GHQ;
Reviewer/Inspector Name: L
Phone:
r
ReviewerAnspector Signature:4;�[ Date:
Page 3 of 3 21412015

Iiype or visit: tot-:ompttance inspection V uperation xeview V btructure r vatuation V i ecnnicai Assistance
Reason for Visit: (Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ry r-r
Farm Name: �, � q F J v-j Z_ Owner Email:
Owner Name: �=o �[�`' "[-Ctr!'k s Phone:
Mailing Address:
Physical Address:
Facility Contact: C Q �w ` Title:
Onsite Representative: t(
Certified Operator: I [
Region_
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Cnrrento
Design Current
Design Current
Swine Capacity -Pop. ,,
Wet Pouliry Capaci#y `Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
- " " : :. I
Feeder to Finish
Dairy Heifer
Farrow to Wean 7-
Design Current,
".::. ' ' 10 � 10W Ca aci Po
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
lBeefStocker
Gilts
Non -Layers
lBeefFeeder
Boars
Pullets
lBeefBroodCow
Turkeys
Uther
IT e Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [}-KG ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes ❑ No
[-]Yes [:]No
❑ Yes 12-No
[-]Yes [:�No
[D-NA ❑ NE
�A ❑ NE
3'�iA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 _ 21412014 Continued

Facility Number: -3 jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El-bta— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No QJN-A 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes EZ�No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ca 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
0No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2'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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t�N'�� O
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ❑'hlo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []�<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes [] No
[—]Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
[2No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 214/2014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes-[�'hio ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0�N_o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes UD�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes EJ PW
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
JEJ-ido
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ,Efj"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 [Z 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 ENo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
❑ Yes Ej No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency`?
[:]Yes ENo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES. answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situatzons'(nse additional pages as necessary):
C6�' C(D
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: T� 3
Date: 1
lk2-
21412014

1
J
n t..1
type of visit: %4 j Compliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: (Y4outine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: QQ Departure Time: Oi CountyVA—Itt
Farm Name: C. fo Owner Email:
Owner Name: (� . I! '�r.,tlwf Phone:
b �P�/'ttG
Mailing Address:
Physical Address:
RegiogE�
Facility Contact: 6 `R r &-W 4ntle: Phone:
Onsite Representative: ( Integrator: ! y-r- jI`GQ
Certified Operator: � Certification Number:
/d R 7
Back-up Operator:
Location of Farm:
Latitude:
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?
Certification Number:
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?
Longitude:
[]Yes o❑l o ❑ NA ❑ NE
[3 Yes [:]No ENA ❑ NE
❑ Yes [] No ffNA ❑ NE
[:]Yes [:]No
❑ Yes Cf No
❑ Yes f:�fNo
[ErNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q.?K- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? C] Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes [!3-� ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[g-Na--
❑ 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
[3-3d's
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[r.. -NW-
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EA-N°
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[?4u,
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Q.,Ki ❑ 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 Approved Area
12. Crop Type(s): 2 �yylLt.�i( S V 0
13. Soil Type(s): U"p—,w,
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes [f'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®-Mm ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �, ❑ 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 DITo [DNA ❑ NE
❑ Yes E. f'o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ET —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
[Dlo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall D 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
UNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑i No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: J�L- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes
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:
0 o ❑ NA ❑ NE
0-M-6— ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? [ ] Yes ,E]' Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ED44tf ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2 j"' ❑ 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
[ ,Nl r ❑ 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
Q�N ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]�l o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
l.J l"' ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes
[].?io ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comineats.
Use;drawings'of facility to.better=explain situations (use additional pages as necessary).
Reviewer/Inspector Name: P U [t4
Reviewer/Inspector Signature:
`.
Page 3 of 3
Phone:
Date: _
21412011

I
Type of Visit: ®'Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access �y�
Date of Visit: Arrival Time: [ (� Departure Time: County: c ct Ln= Regi4. t
Farm Name: S Owner Email:
Owner Name: Gt tl `( Phone:
Mailing Address:
Physical Address:
Facility Contact: C� u� S I_Jaht3&Y' Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
I O `
Certification Number:
Longitude:
DesignX Current
Design Ciirrent :
Design Current
Swine Ca aci Po
P.. P-
fi7
Wet Poul Ca ac` Po
h`
Cattle Ca aci Po
P ty P•
.P _
�P
Wean to Finish
Layer
Dairy Cow
Dairy Calf .
Wean to Feeder
Feeder to Finish
I INon-Layer I
S. ',_ b
I
Dairy Heifer
Farrow to Wean
7
$DesignCurrent
- ``
Cow
Farrow to Feeder
D . P,pult , °Ca�aci"rl'ok
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other �*
Turkey Poults
Other I
FTOther
Discharges and Stream Imancts
1. Is any discharge observed from any part of the operation?
❑ Yes
D lqo
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
OX°
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
g- o
❑ 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
Io
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�1Vo
[]m
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Jfe—❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in), -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Ck o ❑ NA ❑ NE
P'No ❑ NA [] NE
Structure 6
❑ Yes M NNo ❑ NA ❑ NE
❑ Yes [Er -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
T Do any of the structures need maintenance or improvement?
❑ Yes E!rNo
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [TNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes E'No
❑ NA
❑ NE
maintenance or improvement?
Waste ApplicatiGn
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [a<
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Q 5o
❑ 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): 1) of A4A, / 5 60
13. Soil Type(s): CA�'a
14. Do the receiving crops differ front those designated in the CAWMP?
[-]Yes
[G,'fvo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D'�o
❑ NA
❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable
❑ Yes
gjNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Rl o
0 NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[j>o
❑ NA
0 NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z j Ko
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes
[g-Ko
❑ 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
[;I,1Nr
❑ 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
�lo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [D4o ❑ 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 [41-No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [3 110
the appropriate boz(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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[5,16'
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
h o
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EZ>o, ❑ 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 EZ>d- [DNA ❑ 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 0 Yes 0>6 ❑ 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 C3,M ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes []'1Go ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Eg o. ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 61No ❑ NA ❑ NE
Comments (refer4to question #): Explain any YES answers.. and/or any additional recommendations=or ny other"comments.
Use. drawings„of (aclltty�fo better explain situations (use additional pages as necessary).
� y
0((f
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412011

•L
a ypn U1 visit; %ff-% ompuance inspecnon v uperatnon xeview U niructure r.vamanon V t ecnnecai Assistance I
Reason for Visit: GH routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: p County: wy 2L__ —
_
� '
Farm Name: f ,ZZG L — Owner Email: �
Owner Name:17 Phone:
Mailing Address:
Physical Address:
Region: F7A a
Facility Contact: Title: Phone:
Onsite Representative: Integrator: /'x-
Certified Operator: ¢� Certification Number: /571i7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
-Design Current
Wet Poultry Capacity Pap.
La er
MINN&Design Current
Cattle Gapacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
" `i"
Design Current
D . P.ou1 Ca aci P,o P.
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
a
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
La ers
Non -Layers
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Turkey Poulis
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes U&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
[--]Yes [:]No
❑ Yes LaNo
[:]Yes E�J-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: gf2= - 4,3 jDate of Inspection: --/�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes QffNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 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 [S No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): UO, /
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
0 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
[ja No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eq 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
IQ 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. 0 Yes fo 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 CgNo
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

1.
Facifi Number: jDate of Inspection: 0-13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes 2 No ❑ 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J4 No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes 5g No ❑ NA ❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[—]Yes
® No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
Comments (refer to�gtiestion #): Explain any YES answers and/or any additional recommendations.or.any other. 6rnments ' *§
Use drawings.oi facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 33 Ck=b
Date: r-10 —1;;0/3
21412011

type or visit: w uompuance inspection U Vperation Review U Structure Evaluation U technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: '—-� Arrival Time: ! Departure Time:County:�2
Farm Name: A & JrAft M L L- r Owner Email:
Owner Name:
Mailing Address:
Phone:
Region: IeD
Physical Address:
Facility Contact: +s.c, ����rcj( Title: Phone:
Onsite Representative: Integrator: PR�fi�c g
Certified Operator: Lig4-TS 8 A f K Lax,e K Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current• Design Current Design Current
Swine 'et Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish IN jLayeT Dairy Cow
Wean to Feeder
Non -La er I Dairy Calf
Dairy Heifer
rent DDry Cow
Feeder to Finish
Farrow to Wean 7 a&aLo
Farrow to Feeder
Dry P,oultr. Ca a -1 Po Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
I Beef Feeder
Boars
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
JEFFOther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes [D'No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
(UNA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes 0 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 I of 3 21412011 Continued

. i
Facility_Number: JDate of Inspection: y
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 G3/No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): lei
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EZNo ❑ 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 [2rNo ❑ 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 gNo ❑ NA ONE
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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [� No ❑ NA 0 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): 6 C R M V lJ4 A zf. f. 0.
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ff 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?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ 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 CAWMP readily available? If yes, check ❑ Yes D No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [jNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �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 ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ 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
0 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
[4 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
d No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Gj No
❑ NA
❑ NE
Reviewer/Inspector Signature:
� ya
21412011
Page 3 of 3

nvc? &113 / / 1
Type of Visit: (E'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: GHG"utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / vU Departure Time: (} County: gor,, Region:F2
Farm Name:d-+q�/�o� 5 LLO — L CP Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: � 5 &-4mG!- Title:
Onsite Representative:
Certified Operator: ar7 S .73=r_ ,I
Back-up Operator:
Phone:
Phone:
Integrator: A1110 C.00
Certification Number: zz
Certification Number:
Location of Farm: Latitude: Longitude:
h ll'j
""
Design Current.
r rrent
r : - D sign Cu
Design Cnrrent
Swine Capacity Pop.
Wet�Poultry Pop.
Cattle Capacity Pop.
tCapactty
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
*`'' Design Current
Dry Cow
Farrow to FeederD
,Pohl Capacity Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Beef Brood Cow
_ ...
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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?
Page I of 3
❑ Yes Io ❑ NA ❑ NE
[—]Yes ❑ No
[:]Yes ❑ No
E3-<A ❑ NE
©<A [] NE
❑ Yes ❑ No [tiKA ❑ NE
❑ Yes El<o ❑ NA ❑ NE
❑ Yes L g4o ❑ NA ❑ NE
21412011 Continued

[Facility Number: Date of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q*&A ❑ 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 E3 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 e 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 Ej"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �n o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes O 'Ko
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes FO-<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): y.t
13. Soil Type(s): L�C,Cv-G
14. Do the receiving crops differ from those designated in the CAW -MP?
❑ Yes
2 1'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
&Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
Epolgo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ild40
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
to
❑ NA
❑ NE
Required Records & Documents
19. Did
<
NE
the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA ❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
12 iro
❑ 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
FL: <o
NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
#o
❑ NANE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
B❑
P, A ❑ 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 U?❑ NA ❑ NE
D
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check D Yes -3Qo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[-]Yes 2-ITo ❑ NA ❑ NE
[:]Yes g-IGo [DNA ❑ NE
[:]Yes ga<o ❑ NA ❑ NE
❑ Yes rL-;l�o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes EjNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes F��o❑ NA ❑ NE
Comments (refer to question #): Explain any_YES'answers and/or any additional recommendations or: any other comic fifl
'
Use drawingsvof facility to better explain situations (use additional pages as necessary)..'
OL-5 0,EJ .
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: / 1U ` V-3 ? 7 U�y
r
Date:
4/1011

r
R191S 1- 7-2.- Zbi 0
i ype or visit (-Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 011 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9:30 4 .,r 1 Departure Time: County: Sa sz;�-1 Region:
Farm Name: C r & Owner Email:
Owner Name: dD t a. �1 C_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Ct4LYT"[~S barValc_V_
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: -7��^ SC'r— —* Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [71 0 0 ` Longitude: El ° 0 ' 0 u
Design Current Design
Swine Capacity Population Wet Poultry Capacity
Current
Population
Cattle
Design Current
Capacity Population
❑ Wean to Finish
1
10
I IE]Non-Layer
Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Dairy Calf
❑ Feeder to Finish 1
❑ Farrow to Wean 872- 1 !1 d S Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts Non -La ers
u
❑ Boars ❑Pullets
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures
Discharges & Stream Imusets
I . Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
D NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
El No
E NSA
❑ 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
/
9 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,No/No
L7No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 6Z 3b3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No NA [-INE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes L<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ElYes a< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 o ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside/of Area
12.
Croptype(s) ��'c.tt,`� �Gra Z� S (G C Q. S J
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ffNo ❑ 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
E No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
L71:1 NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? El Yes
E, ❑ NA
❑ NE
Comments (refer to question #): Explain any YES°answers and/or any recommendations or any oth en' omments
Use drawings of faciliiy to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name �� R�QJS Phone: 9/0. q33, 3360
Reviewer/inspector Signature: Date:
.1 212/U4 uonunuea

Facility Number: SZ —03 Date of Inspection J -ZI -zo10
Required Records & Documents �,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
,/❑
L"J No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
DNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej1N_'o
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
�B
ff No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3110
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�/
L� No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
,�
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
I� 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
L►,�,�"No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA ❑ NE
12128104

KAS /0-06-2009
(division of Water Quality
Facility Number Z 31v3 O Division of Soil and Water Conservation
0 Other Agency
Type of Visit er'Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Arrival Time: �, �Z Departure Time: /%, County: Sit-+ Region: F12a
Farm Name: 0-6 Owner Email: —
Owner Name: _ lD 6 ✓� t- Phone:
Mailing Address:
Physical Address: C
ty C `-S 4.i C r
Facility Contact: +.t �' Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = Longitude: = o =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean f(] L j$f'L
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
1 ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Strucrure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ' Current'.:
Capacity, Population:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry 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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ff rNA ❑ NE
❑ Yes
❑ No NA ❑ NE
❑ No ErNA ❑ NE
❑ Yes
❑ Yes
No ❑ NA ❑ NE
❑ Yes
No ❑ NA ❑ NE
12128104 Continued

` Facility Number: gZ — 63
9 -/0 -- 0 1
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
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes NA El NE
El Yes�N�o[0:1 NA ❑ NE
Structure 5 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 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes f1fro ❑ 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 7No�
NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Dyes n No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 5 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ ApplicationOutsideO'utside of Area
12. Crop type(s) jojayoov � ��� C �"1 � I .�o�—��. 4 45 � -"' C` O' .S-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
l6. 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
to
❑ NA
❑ NE
Reviewer/Inspector Name �Y Phone: 9/a, 11, , �J3gy
Reviewer/Inspector Signature: Date: 91-le •— Zd0
Page 2 of 3 12128104 Continued

9-/o 4 0�
Facility Number: 9'Z -30 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes L] tvo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [1120 Minute Inspections ❑ Monthly and V
Rain Inspections E] Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IT No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
ErNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D* iqo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,0�
LSNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
ElNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[J[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?
ElCJ 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
r
u tvo
❑ 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
o❑
NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,B
LTNffo ❑ NA
❑ NE
Comments and/or Drawings:
12128104

j3 FfJ(S 9-0y-406 R-w-
DtvIs' of Water Quality
Fac�lity.Number# �� f 3'63 O. Dtvision of Sail and i'Vatcr Conservation
Q OtherAgency
Type of Visit (Q'LCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (3 rtoutine 0 Complaint 0 Follow up 0 Referral () Emergency 0 Other ❑ Denied Access
pate of Visit: /j g Arrival Time: gl4rf ., Departure Time: �'•'�O .� County: �� Region: 11*20
Farm Name: _ C: O�� j' �� r�'�' S �� �p _ Owner Email:
_ J
Owner Name: f'� �— �•' Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu►� S r+�r'��C _ Title: /� S_ ,_ Phone No:
Onsite Representative: _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 F--I Longitude: 0 0 = f =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
S
9 a
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Dischar� & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef StockeE
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation"
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
L:J NA
❑ NE
❑ Yes
❑ No
OINA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
12128104 Continued

i
Facility Number:
Date of Inspection $ 1 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA [INE
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): _ Si t
LI No ❑ NA
No ❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
through a waste management or closure plan?
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L�J N El 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 ZNo ❑ 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 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEl Evidence of Wind Drift [IApplication Outside of Area
12. Crop type(s) Ee*wadv,/(s Gw vz_) t!Q,51 )
13. Soil type(s) ba / /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
WEf N ❑ NA El NE
WI"" 7❑ NA El NE
NA ❑ NE
XNo
NA El NE
❑ NA ❑ NE
Reviewer/ins ector Name t .333©
p e�i�- Phone, !�� 5�3.3,
Reviewer/inspector Signature: Date: F —//— Zd og
rage z of .i 1l/L&U4 uonnnuea

• L
Facility Number: F'Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ko ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 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 L' I No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L/J N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7X-0
❑ NA
[INE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
U No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N ❑ NA LiNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 7No
❑ NA [I 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 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�NXEINA
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NE
33. Does facility require a follow-up visit by same agency?
[I Yes;No
❑ NA
❑ NE
Additional -Comments and/or Drawings 7_
Page 3 of 3 12128104

t
9-/S-2007 eA-
Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -13 `0 % 1 Arrival Time: Departure Time: �Q'!i(O County: Q4U sd Region:
Farm Name: C ~ Co Owner Email:
Owner Name: b &a �GQ
�1rA4 Phone:
Mailing Address:
Physical Address: /��
Facility Contact: C 11 .3 y c� t2 k- -_ Title: Phone No:
Onsite Representative: Integrator: , tom% +�% L .1q !_ruts
Certified Operator:
Back-up Operator:
Location of farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 =' u Longitude: 000' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
❑ D Cow
El Non -Dar
El Beef Stocker
❑ fF d
Bee Feeder
Beef Brood -Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: SZ —3(p Date of Inspection 19 -/ —0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes IF] No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�9 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA ❑ NE
maintenance/improvement?
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 I0 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) a W� .ti_ G� �c ��' �%✓ C D U
J
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
W No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
rO 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 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):
AL
Reviewer/Inspector Name Phone: �3.)'�7c
Reviewer/inspector Signature: Date: 9 /ilp -- Z00%
I2/28VO4 Conhnued

Facility Number: SZ -3631 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes TfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [gNo ❑ 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 Q3No ❑ NA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�B No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:Arrival Time: : 30 act Departure Time: County: _E4 A 4oe SaA/ Region: 1-5A2V
Farm Name: "G r..h - Owner Email:
Owner Name: _ C r, Layi t'_ S i-f ►- w. Phone:
Mailing Address:
Physical Address:
Facility Contact: C Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: O el t
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Longitude: = o = , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La yer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
7 2-
$#S
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures: r 11
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 M No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
IU No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
El Yes
No
El NA
El NE
12128104 Continued

Facility Number: $'z-3rv3 Date of Inspection
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? El Yes No ❑ NA ❑ NE
,,Structure0 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway? -
n
Designed Freeboard (in): j g
Observed Freeboard (in): 5 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[YNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[X 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
[XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EM 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 El Yes
[ No
El NA El NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
Q. Crop type(s) S{ t'+til .� �� C G r�� G S`stG Cf �9►-c� n! (C� i/ ev ste_e�
1
J
13. Soil type(s) %JQ yG
e -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[V 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 determinations
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[!9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
n;sihiati0ti5`� (use'add
Reviewer/Inspector Name j c Rev �• S Yyt,� x .� M:.�� _ 4z Phone: 91OW06 -15W
Reviewer/InspectorSignature: Date: _Z5--;Z00
121.28/04 Continued

Facility Number: TZ —3i(o j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWNW readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El maps El other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
ENNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
20 No
❑ NA
❑ NE
A;ddtttoal Coninteents nd/or;Drav�uigs�'A'
x
12128104

t
�S
Type of Visit 49 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 Visil: 0 Arrival Time: Departure Time: County: Sa Region: PAS a
Farm Name: Cp%Tp-its �a�m 41-- _� Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address: _ AG _Y_�G rJ o,✓_ X.1te .'
Ale -
Facility Contact:
Title:
Onsite Representative: _��� f%.i r A. rw i e-�
Certified Operator: Cu r41w_s I?a c-
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: .0 tS347
Back-up Certification Number:
Latitude: =o =, = Longitude: ==4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La et
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
j $ 72
1"
❑ Farrow to Feeder
❑ Farrow to Finish
® Gilts
® Boars
/3
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: DO Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.:
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daiiy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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 ol' 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?
M
Yes ❑ No ❑ NA ❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
ZI No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: 9.2 —3G Date of Inspection z /Sfc•r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ff; a? 01'
Observed Freeboard (in): 9 a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tF No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[� No
El NA El 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
` j No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EP 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
P 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/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside
of Area
12. Crop type(s) ,(JlCr�rcdQ b s
13. Soil type(s) �d4rdis.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Op 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 acre determination` ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R3 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA ❑ NE
Comments {refer�ta question # E plate ady YESFansvrers4and/oi~, _ay rccommenda ans or any other�comuEertts.
Use drawtixgs ottfac�ty.to better eaplain�sitdattons.<;(ase add�tso�al4pages as necessary,).���
0sp,1 If �,.-s �1W1. +�,� p°x� �G 1y fo to fs
L2 ►7 � �, b K T Q � r'! C G� P Yl S 1 �G. r ��i ► INS �ij� / !r'c rr ri 1 �Cil � � YY� P �G✓ i C. 1 �•" YJ G K dG �Lc.-f
Reviewer/Inspector Name �. _ : Phone:
Reviewer/Inspector Signature: Date: '-7//spar
12/2&04 Continued

Facility Number: p -3` 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [5 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El 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? ❑ Yes [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PZ] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[54 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C� No
[:1 NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff] 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
[X No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[?No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
tLddiaonal"C6intnents and/or Diuwin s tea t
12128104

Facility Number Uate of Visit: 3 �L O� Tune: �.• Sd
0 Not Operational O Below Threshold
permitted 19'Certified © Conditional] Certified 0 Registered Date Last Operated or Above Threshold: .-..------ ---.._...--
Farm Name: .....[.�i l•, r sc c __ ..� .._.. County: _ Qnt� v kL .......
....... r .......................
Owner Name:......! fl,�1w'S Phone No: ] ga �1 ..__.-_--
Mailing Address:.. 00 '-0r5*_�{,....... Jed .. . m _.� - — - - ''�iw'�lrcr. ""le-
.
--... - - • -_. .�-........... .. .
Facilitv Contact: ..... ........Title:Phone No:
Onsite Representative:.._ tf"�� �ut iCA .... Integrator:
Certified Operator: ............... Operator Certification Number:
Location of Farm:
fflso'wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude �• �4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EPW_
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes LJMO-
Waste Collection & Treatment ^ '
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes L9'46
Structure 1 Structure 2 Stricture 3 Structure 4 Structure 5 Structure 6
Identifier: ..._ ..... ........................ .............
Freeboard (inches):
12112103 Continued

Facility Number: $.2 - Date of Inspection 3 r2 L O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes U.P-o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 9.NO--
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) �✓
7. Do any of the structures need maintenance/improvement? [IL
Yes eo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes L NC
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ YesO
elevation markings?
Waste Application �-
I0. Are there any buffers that need maintenancelimprovement? ❑ Yes ��Vo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Ld�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 84,sgad
13. Do the receiving crops differ with tho designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes LSO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes t
b) Does the facility need a wettable acre determination? ❑ Yes QN
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odar Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Deo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.

• Facility Number: — Date of inspection (�
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes D.No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? _ -
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yesvo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
UC
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
QNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
�^
(iel discharge, freeboard problems, over application)
❑ Yes
B-90o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
a, or
28. Does facility require a follow-up visit by same agency?
❑ Yes
Now
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
aKo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ Aie—�
3I_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

1 - 1
Facility Number
(late of Visit: ® Time:
� j
NoE erational Below Threshold
Permitted ©Certified E] Conditionally Certified ©Registered Date Last Operated or Above Threshold:
r
Farm Name: � '1 +� Gr�`M2 S County:
Owner Name: 1�;tlt'gf 9Phone No:
Mailing Address: �O ��• f/7c__ �!� _ 293
Facilih• Contact: �� ►rTitle: Phone No:
OnsiteRepresentative* C u rV' S integrator: C0A4r.le X,-*Is'
Certified Operator: CK r P f 5 1. r+y IC _ Operator Certification Number: O 3
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 o " Longitude 0
Number: of Lalr goons �� ❑ Subsurface Drains Present ❑ L oon Area ❑ Spray Field Area
s'Holdtng Pools !.Solid Traps ❑ No Li uid Waste Mana emeni Svstemw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DW'Q)
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 CpOtcfion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 structure 5
Identifier:
Freeboard (inches):
❑ Yes )�(No
❑ Yes
❑ Yes
❑ Yes
o
❑ Yes
❑ Yes
l TO
YXNo
El Yes�
Structure 6
05103101 Continued

a
Facility Number:w — 63
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; notif}- DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste -Application
10- Are there any buffers that need maintenance/improvement?
11. Is there evidence of-Dver application? ❑ Excessive
12. Crop type
13. Do the receiving crops differ with those designated in the0erti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
❑ PAN ❑ hydraulic
Waste Management Plan (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ UP, checklists, d r, as, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24- Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes k No
❑ Yes KNO
❑ Yes AO
❑ Yes XNo
❑ Yes ANO
❑ Yes gNo
❑ Yes $No
❑ Yes PKNo
❑ Yes ONo
❑ Yes ANo
❑ Yes X0
❑ Yes No
❑ Yes No
❑ Yes Q<No
❑ Yes �QNo
❑ Yes �91-1 o
❑ Yes WNo
o
Yes
❑ Yes o
❑ Yes t o
❑ Yes P(No
❑ Yes WO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
::. :.
Coini is (refer i'4 uestion i# E; lain an YE5 sttswers and/or an re ommesdatwns or aav,other comments: m - .
Use drawin s of facil "to betterez lain srtnabons: (nse at[ditwnal g rty p pages:as tteeess$rv) Field Copv ❑ Final Notes
w- --
Reviewer/Inspector Name q
Revievr-er/Inspector Signature: Date: — Z
05193101
U
ri
Continued

Facility Number: 2 — Date of lnspectiun
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ ' ere any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s). inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover?
❑ Yes vo
El Yes Flo
❑ Yes , NO
El Yes Mo
❑ Yes Flo
❑ Yes .o
❑ Yes
:2►dditionalGontmentsandlar-Draw•ings:.-.
O5103101

a
Type of Visit ® 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
Facility Number L Date of Visit: l� �� Time:
Not O erationa! 0 Below Threshold
® Permitted N Certified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: .t County:—
Owner Name: _ ,/%1i/O'GfC Phone No:
Mailing Address: _ 1Ga 4 �/ _rCri � ����/ _ Az C— '-O'x-4f_
Facility Contact: fL�6_�li�/�, Title: Phone No:
OnsiteRepresentative: �//���,�+l�c/C Integrator:
Certified Operator: �u.G�fs 17'4 Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 Du Longitude 0' ° 0"
Design -u rren# "D`esrgri Curreaf"'.i Design 'Current
Swine � Ca acrty Eo ulahont.: lou _, tr Ca acrtyPo ulahon Cattle Ca acrty Popntatian
❑ Wean to Feeder ❑ Layer
❑ Feeder to Finish Non -Layer - ❑
Farrow to Wean % 7Z Non -La
❑ Farrow to Feeder
- Other
Farrow
a,
❑ Farrow to Finish :a T t I Design Capacity
El Gilts �w
El TOtS%. SSLR'
i
Number of Lagoons ❑ Subsurface Drains Present JFEI Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System IN
■ 1.
--
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Tratment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
r
Freeboard (inches):
❑ Yes O�No
❑ Yes oNo
❑ Yes )n No
❑ Yes *o
❑ Yes P No
❑ Yes [ANo
❑ Yes / fl�No
Structure 6 rr�/ �-
05103101
Continued

Facility Number L —,_�
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADolication
❑ Yes Wo
❑ Yes 2�TTo
❑ Yes MNo
❑ Yes EdNo
❑ Yes 9U No
10, Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
0 No
b) Does the facility need a wettable acre determination?
❑ Yes
'0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
A No
15. Does the receiving crop need improvement?
❑ Yes
.®-No
16. Is there a lack of adequate waste application equipment?
❑ Yes
4 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes &allo
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 E'No
19. Does record keeping need improvement? (iel 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 UNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes IgNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5�No
23. Did Reviewerfinspector fail to discuss review/inspection with on -site representative? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 5�No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Commence „refer to question #) Explain an YES answers andlor"an recommendations or an other comments.
iio Y _ N y y
Use drawings of facilitydta better explain'sitoations. (use adillt�ianal'pages as aecessary) ❑ Field Copy El Final Notes
Reviewer/inspector Name
Reviewerllnspector Signature: Date:
05103101 Continued

Facility Number: Date of Inspection
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
'Yes ❑ No
❑ Yes 112'No
❑ Yes �9No
❑ Yes JqNo
❑ Yes M"No
❑ Yes J;a"No
kYes ❑ No
05103101

i
!Type of Visit ®Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit ® Routine O Complaint, O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 Time: d t�
O Not Operational O Below Threshold
Permitted © Certified[3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
FarmName: ......... if=..trr../ ......................... ... County:....... ... -SO•��
OwnerName:...... . . .............................. ................. Phone No............
Facility Contact:Title: Phone No:
-� ......... ..�_.._
Math Address: ..................jJj.. ........ U........ ........... / ............. J,t....
Onsite Representative:.. �-K -� (�i9ie°AAiC.G
1
................................................................. Integrator: ................
............_......._......................._...__...........
Certified Operator:.__r4,� s......80ewa � .. Operator Certification Number:..........
Location of Farm:
❑ Swine []'Poultry ❑ Cattle ❑ Horse Latitude • ° ref{ Longitude • 9 0"
Desi Current Casa Po ulaha
z n 1 ;: - Destgin . I
ie
Ca ci Po Wation, Poultry: n Caide Ca' "' po
Wean to Feeder
Feeder to Finish
Farrow to Wean
J 7z-
/ ?Z
Farrow to Feeder
Farrow to Finish
Gilts
Boars
❑ Layer F
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity'
:. TotaUSSLW
Nwnber of i.agoous ".': � �❑ Subsurface Drains Present 110 Lagoon Area J0 Spray Field Area
Holdtiug Ponds / Solid Traps'lj No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes XNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes N No
c. If discharge is observed, what is the estimated flow in gaVinin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes (KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 " Structure 4
Identifier. ....... _?9 /�,
❑ Yes RNo
Structure 5 Structure b
Freeboard (inches):
5100
Continued on hack

Facility Number: z— Date of inspection C�
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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop typee�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP checklists, desi�maps,
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
gs.et defcjepc{es mere ppted during Ois:visiti • Yoo vi#i•teeeive 0o ruttitee
6ri•esi) ndence: about: this visit. ::::::............................. .
❑ Yes IN No
❑ Yes W No
❑ Yes ;TNo
❑ Yes ,NfNo
❑ Yes gNo
❑ Yes ®'No
❑ Yes )K No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes JjNo
❑ Yes ;4 No
❑ Yes [RNo
❑ Yes M No
❑ Yes ANo
❑ Yes )X No
❑ Yes J No
❑ Yes PrNo
❑ Yes )�CNo
❑ Yes gNo
❑ Yes XNo
❑ Yes 12fNo
❑ Yes KNo
A,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
a/ SM0

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

E . ;
® Division of Water Quality
O Division of Soil and, Water Coiisevation
_- -- 0 Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other Q Denied Access
Facility Number
Date of Visit: �UX7 't'iine: Z _ c�C-3 Printed on. 7/21/2000
3
Q "Not Operational Q Below Threshold
® Permitted ® Certified [] Conditionally Certified 13 Registered Date Last Operated or Above Threshold: •........................
Farm Name :c��r/r�....�4�-�......-.. Count►:.................................................................
.... ...........................
Owner Name: �' �&..... {,1�.. .......... Phone No:...�10 Sf�.Z, �/z
....................l. .... `/r..... .......... `........................................ ............ ....... ..............................
Facility Contact:�r 1,��¢�LviG.� Title: Phone No :...................................................
........ ........
:Mailing Address: ��. t'`� ..¢.0 .� ... c? S': C.:'r..''r` i1 ./�G:..".r 00 � ......."""."................. ..........................
.. , ... ... / �/.." "..
Onsite Representative: ............................................................... �� Integrator:
....................................... "."""""...
Certified Operator: ,,u��/-f ,�s��.�<aC...__ """_" , Operator Certification Number. :.................................................... ........................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude • Longitude •
Design Current
Swine Canacitv Pnnnlatinn
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
12&7Z
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-wn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made''
h. If discharge is observed, did it reach Water of the State`! (If yes, notify DWQ)
c. II discharge is Observed. what is the estimated flow in gal/min''
d. Does discharge hypass a lagoon system'' (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate`? El Spillway
Structure I Structure 2 Structure + Structure 4 SLrUClure 5
IdcniiGrr. gip%
❑ Yes � No
❑ Yes N No
❑ Yes ,8 No
❑ Yes X No
❑ Yes Q9 No
❑ Yes J@ No
❑ Yes �No
Structure 6
Freeboard (iiiehes):
5100 Continued on back

f
� L
Facitity Number: — hate of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes /'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P"No
.11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes KNo
12. Crop type �j C,Y.t� c, Jq.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14_ a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?-
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP.checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, free foard, waste anay is & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
vio[afijris:odi:iiYh vegfciendieg Weeh6ted• dirtig thsystoVll•reeefib fukth&.
correspondence.about thiis visit_ . . . . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes No
❑ Yes No
❑ Yes P�No
❑ Yes F No
❑ Yes rN
o
ElYeso
❑ Yes �kNo
❑ Yes XNo
❑ Yes P'No
❑ Yes �(No
❑ Yes %No
❑ Yes No
❑ Yes N No
❑ Yes 04 No
❑ Yes IXNo
A.
lI
Reviewer/Inspector Name
Reviewer/Inspector Signature: .�u%«�rr � Date: 5/00

Facility Number: E7=Date of luspection Printed on: 7/21/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes evNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )'No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes NNo
Additional'Cornmentsan or rawtngs: ... �.._:.
J
5100

U Division oi.,oll anc[' Water: t-onservation Upertion ]Kevlew
(3 Division of Soil and WaterConservaaoa Compliance Insspectron i
'�` rvision of Water ality = Clian
ampee inspectio QuD
F Other Agency Operation=Review
T
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Z 363 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [] Certified © Conditionally Certified [3 Registered © Not O erationaE Date Last Operated:
..........................
FarmName: .ort�....J................................................................ County:....... _.... .....................
OwnerName:...... ... .............. I c I & ................................ Phone No:...----......._..._...........~-'_............zrl Z.Z...
FacilityContact: ............................................................ . Title Phone No ................. ........ . ...................................................
MailingAddressi �©� Gt_/25� P� t.�t.--Ata............................Z�3z�r
.......................................�..............................._.........................cc. �..�.
Onsite Representative: /�}/`�-�i8r Integrator: .... �.�..........................................
5 :�..................................................... ........
Certified Operator:... •�;c,;r _I �5'.... .....�o�tci.. G� Operator Certification Number. .....
.......................................................... A
Location of Farm:
....................................................................................._............................................................. _.-_.._..................................................--•-'----.---.---.----........................................ 1W
Latitude ' 6 •4 Longitude 0 ° �6
Design Current Design ° -Current Design Current
Number oflagoons
HoldRns_'Poiids / Solid Tra
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -^
[] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon [I Spray Field
❑ Other
a. if discharge is observed, was the conveyance than -made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system"? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 10
Freeboard(inches): .................................................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
El Yes XNo
❑ Yes J�rNo
❑ Yes KNo
❑ Yes 4�No
[]Yes kNo
❑ Yes A,No
❑ Yes ,1No
Structure 6 \\
❑ Yes 0No
Continued on back

f
Facility Number: Z Dale of Inspection
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
gNo
S. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
kNo
\\
Waste Al2plicalion
10. Are there any buffers that need maintenance/improvement?
[]Yes
k1No
11. Is there evidence of over application? P Excessive Ponding ❑ PAN
❑ Yes
00
12. Crop type
13. Do the receiving crops differ with thos designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
A
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
I 1ANo
b) Does the facility need a wettable acre determination?
❑ Yes
allo
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
❑ Yes
RNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes] No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes t)qNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 0 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes W1 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes 14 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes qNo
o yi. Midiis:oi- deficiencies •were noted• d0itng this:visit; • Y64 :WH1-febdW Iio further
;core- s� 6iideizee: abou this visit :.:.:.:. :
Comments.(refer toAqueshon #) Expla�h;any.YE.S answers'atid/or any recommendatrons Oran other comments._ —
_ y
Use drawings of facility to betteeexplai situations {t>9i dtlibonal pages as niecessary)` ­ —
w
,� i� SP�� '�l has Ierh s�1f�c a 4' 5��.� �e �a� ✓er�11, A.
ca dr- ldS 166K �aocl
mCj rCC.:,,d6.
-
Reviewer/Inspector Name I f = �, .— =K
Reviewer/Inspector Signature: Date: --Z— q 9
3/23/99

r
r
Facility Number: plate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes P No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes RNo
31 _ Do the animals feed storage bins fail to have appropriate cover? El[ Yes __ ``k'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
itional -omments an r. orawm -:
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Date of Inspection /a `/
Facility Number Z 3 Time of Inspection � 24 hr. (hh:mm)
13 Registered ® Certified
0 Applied for Permit a Permitted E3 Not Operational Date Last Operated:
Farm Name: ............o../.-.?.............r...................................................................................
County:........qA...±�2^1.............................................
OwnerName: ....... Gr_4.^ reA.... 2e'iko f....................... .......... Phone No:...... (I..B..............................................................
/ 7
Facility Contact: .... t c .. ' ......N. q�w!.a.............. Title:................................................................ Phone No:...................................................
Mailing Address:
OnsiteRepresentative: ........rC..4!r .t�✓........... .................................... .................................... Integrator:....( _...`A.h' !t .......................
Certified Operator :......... G .N 2.... f...... ..... /i .................................. Operator Certification Number:..... /EU2 .............
Location of Farm:
..............._................................................................................_............................................................_._I....._...
_..... f ......z I.�.%................................................................................................................. ....................... .
Latitude ='=1 =1
1 Longitude =• 0' ="
,! Design Currenftiu Design ::CurrentCuYcent-
q
Somme", Capacity PopulaUonw Capacity Population
s. Poukry;�, m ,Ca pacity;.Populahon :'Cattle ,
❑ Wean to Feeder" ❑Layer El Dairy
❑ Feeder to Finish 7f7Z AP? 2 ILI Non -Layer <n ❑Non -Dairy
-
Farrow to Wean
❑Other
❑ Farrow to Feeder
,
-, gn Capacity
❑ Farrow
❑ Gilts
�
'
Total SSLW
Number of Lagoons'
HoldingTi no ds ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
'LPN
4
�..L
t9gFs+ a `ap^.easw ak A
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes Eno
2. Is any discharge observed from any part of the operation? ❑ Yes 19 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IQNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes CTNo
c. If discharge is observed, what is the estimated Flow in gal/min? A-11A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes '07No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes UNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes UNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
mai ntenancelimpro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes R No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Zf No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures CLagoons,lolding Ponds,jElush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes Pq No
❑ Yes E) No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
Identifier:
Freeboard (ft): ..._.. ......
10. Is seepage observed from any of the structures? ❑ Yes JB No
I I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes VNo
12. Do any of the structures need maintenance/improvement? ❑ Yes V No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Anolication
❑ Yes Q No
14. Is there physical evidence of over application? ❑ Yes O&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typet�1.........................................................---......__........................._.................................................._._
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Q No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewhrispection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No:violations_or. defteiertcie's'were:iioted-during this:visit.- You:will recei-Ve,ito.ftirther ::
coerespoli&an a about this:visit:•"
❑ Yes W No
❑ Yes Q No
❑ Yes A'No
❑ Yes WNo
❑ Yes 4 No
❑ Yes gNo
❑ Yes R No
❑ Yes (iNo
❑ Yes JM No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
A4& Date: 2 0

t
.. _A-..
❑ Division of Soil and Water Conservation ❑ other Agency
Division of Water Quality
lla Routine 0 Complaint O Follow-up of DWO inspection 0 follow-uo of DS%VC review 0 Other l
Facility Number Date of Inspection
Time of Inspection 1� 24 hr. (hh:mm)
(3 Registered 13 Certified [3 Applied for Permit Permitted 3 Not Operational Date Last Operated
Farm Name: > /fi ....ii tz........ Gr... ............................ County:...........S�.SDi✓.....................................
Owner Name: Phone No ......4!O ....s.7L . .!/.Z. ...............
............L?.... r'��:....��� .../�....................... .�
FacilityContact: .......... .... Title Phone No: ......................... ............................................................................................................
Mailing Address: ....... �t.40 !✓ ravr�� 1�,C'�...( . `P^ fr .... 8 ....... .................... ..............
Onsite Representative: .... 1�.`'r ./f.144.4 .eZ4ntegrator:....._�:4 tC....../5'i�............
Certified Operator;........./ ......... Operator Certification Numberc..1 .... ...............
Location of Farm:
Latitude Q• =' « Longitude 0• ' "
r:F
Current DesrgnCnrrent Desip
>r:Deseggt�
Swine g Capacrtr Popiilateon Poultry Capacity Po ulation Cattle C ri } Po nlattan
R
❑ Wean to Feeder
.
�
f ❑ Layer ❑ Dairy
�: ❑ Feeder to Finish
❑ Non -Layer ' ❑ Non -Dairy
Farrow to Wean J 8 72 Z& 7 Z
❑ Farrow to Feeder
❑Other¢
❑ Farrow to Finish
Destg`
kTotal n;Capadty,
❑ Gilts
;
�x
❑Boars
m Total SSLW�
_. _.... _.. ...... ............ ... ...-.._-....
_..ao-.,.py,F F.:..r'•`�� u�as+,-L,� "_.a��Nv�_..��r�..a :,L7aa '"��rk"'.`
&
Nnmber ofaI.agoons.l�Holdutg Ponds / ❑ Subsurface Drains Present ❑Lagoon Area Spray Freld Ares 1
4��.......... .
3 w°�
"W "�� , ; ❑ No Liquid Waste Management System
q g Y
..�
�.,,,•
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at; [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4: Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes eMNo
❑ Yes to No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes R No
❑ Yes PfNo
❑ Yes Pa No
❑ Yes r q No
Continued or: back

, 4 A
Facility Number: ,?Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (ft) 2 y i1 1........................................................................
10. Is seepage observed from any of the structures? ❑ Yes UNo
H. is erosion, or any other threats to the integrity of any of the structures observed? El Yes 6a"No
12. Do any of the structures need maintenancelimprovement? ❑ Yes [�(No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes VNo
Waste.Application
14. Is there physical evidence of over application? "Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... ��..�............."......................................................................................................._............................................................_. .................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes KNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
�o
18.
Does the receiving crop need improvement?
❑ Yes
[(No
19.
Is there a lack of available waste application equipment?
❑ Yes`'
o
20.
Does facility require a follow-up visit by same agency?
❑ Yes
WO
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ANo
22.
Does record keeping need improvement?
❑ Yes
Wo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
gNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JVNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
)UNo
0. No:violatioitsor deFciencies: were noted,during this;visit., You , will. receive.no ftirther
;:•correspolidenceab;outtbis:visit:-;•:�:�::•�•.• -.-.:: � :�•.:::"..�: ::...:.:. : ;.:..:.
,s � +�j is ti jH,p,�•✓ /�!�{! IQit/ /t.c eo el," e /��4.5 AVEX
tea® �/• �'� 4.K.EL1r G/ �^'`N'� OGGu�R4�� �s �¢ ��J
7/25/97
� „ _ :x .'""'"'"`CA•"'�'r�;-l*a>,:. 4c" �r R`t ...Y.^s. :o�+.C'y�a '�° .b"�°F ^€
Reviewer/Inspector Name
Reviewer/Inspector Signature:/ ,�`� Pale:

0 Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Facility Number Date of Inspection $ 9
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 3 -�
'Certified ❑ Permitted I or Inspection includes travel and rocessin
❑ Not Operational Date Last Operated:
Farm Name:. .......... ......... ..._ ... _ .... . _ ..... County:
Land Owner Name:M..o. ` r L ............... Phone No: ...__.iga,�- 2
Facility Conctact:&"t'-�k S .. ar c''. c Title:— _. _ _ .. Phone No:
Mailing Address:
Onsite Representative:....1-e1F Integrator:ti ......_ .... W _ _ .
Certified Operator: .. ,� Operator Certification Number:.. .
Location of Farm:
Latitude ��0 C K Longitude ' 1 0 u
Type of Operation and Design Capacity
e4�- nCeec -s ;+yaw., 5"*,0.� A",°°°�•ree ,�-,.-,�
nDESIgl1 Current' `;„4 ^,aiDEStgn' x n' �� a iI)eS gn C`URCnt
Current K M4�
' z� :.� � :5' �H�e�' �3 ;dam
€: xa:, Ca aci Pa ulation ;r rw 7';. Ca aci P.o ulatvonk:` ,M«.tCa aci "' Po nlahon
Wean to Feeder ❑ �` ❑ D
❑Feeder to Finish Nan -La er ID Non-
Farrow to Wean3 ��-
Farrow to Feeder � Total',Design Capaa -N
Farrow to Finish
Fa
_ Total SSLWr �; f
❑Other
._. :xs•:--,r. "TM�w4a3'"'-; .... .. :� �.r�i� �a 1r- � � e.-„',k,s�`w .. x .'c,TM�'*.�:',�..«4a,� ,�.: �u�
� Number ,of Lagoons HohlQPondsffi i' � Subsurface Drains Present
❑Lagoon Area Spray Field Areaq
n ral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4_ Were there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes &No
❑ Yes ONo
❑ Yes 10 No
❑ Yes ® No
❑ Yes
I No
❑ Yes
® No
❑ Yes
No
❑ Yes
❑ No
Continued
on back

Facility Number:.,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding PQdsl
9. Is storage capacity (freeboard plus stone storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes A No
❑ Yes Q!No
❑ Yes 9 No
❑ Yes ,M No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
I3. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ft 1Ar..CV­......... _ .... ..... __................. _ ... _.... —_... ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes PYNo
❑ Yes No
❑ Yes 8 No
❑ Yes ig No
❑ Yes ® No
❑ Yes G'NO
❑ Yes Jj No
18. Does the receiving crop need improvement?
❑ Yes
[R No
19. Is there a lack of available waste application equipment?
❑ Yes
0 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
For -Certified Fac'Iiti ,s Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
Vf"No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�] No
24. Does record keeping need improvement?
❑ Yes
{j No
Comrnents,.(refer tb"*'strou'# Ezplairi any YES answers an or, recommendations'or any other comments r� .,
Use drawings;of facility to:better ex plain situations: (use,add�honal pages as necessary) '..: M fi` '
C'6 w"`-
�c> oa, c-o � ti r- � lc►��p p � t
s C_ T I c4 r ec e-- C-1 C. l e- , I \,e-
Nk
.,,5�ii,Fr5
Reviewer/Inspector Name ,:n,,_� fix. ` y0 :.W1k . he�
Reviewer/Inspector Signature:% - Date: 9
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number:=Z
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date
Time: 11;r. .
gene llnformation:
Farm Name- — Connty: s0
Owner Name: tin I� �.s M-, _ - - - Phone No: M i o) a _1 i a a
On Site Representative:_ % i� �, �`�f s Integ�atas: ��,� 1 srY►,.�
Mailing Address: 3 eC ► 12,1
-
�f fa. I, (- .2 S-&z �W
Latitude• 3 V l S 3 /_ &f
L Longitude; i
Q%eration Description: (based on design ebaracterisdm)
? e of Swine No. a f Animah 0 e of Poultry No. of AnimaLt Dairy
of Ca trk No. of Animals
$$ _.._ Lyn
Q Nmer O Nan -Layer Oef Be
Q Feeder
O*erType of livestock Number of Animals:
Number of Lagoons: / (include in tine Drawings and Observations the freeboard of each lagoon)
Facility ns ect' •
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hoar storm storage?: Yes 0 Nth
Is seepage observed from the lagoon?: - Yes 0 NoJIL
Is erosion observed?: Yes 0 Now
Is any discharge observed? Yes 0 Nol-
❑ Man -wade 0 Not Man -nude
Cover Crop
Does the facility need more acreage for spraying?: Yes 0 NoM
Does the cover crop need improvement?: Yes Cl NoI&
{ Lisr the craps which 7rIP
'rovement)
Crop type: �s Acreage:
Setback Criteria -
Is a dwelling located within 200 feet of waste application? Yes 0 No;
Is a well located within 100 feet of waste application? Yes 0 -NoR
Is animal waste stockpiled within 100 feu of USGS Blue Line Stream? = Yes ❑ No53
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Strearn? Yes 0 Now
AOL -- January 17J 996

---Maintenance
Does the facility maintenance need improvement? Yes ❑ No f3
h there evidence of past discharge from any part of the operation? Yes ❑ No jq
Does record keeping need improvement? Yes ❑ NoM
Did the facility fait to have a copy of the Animal Waste Management Plan on site? Yes O Nod°
Explain any Yes answm;
Si atiue: 6 31-4k�-� Dane:'
cc Facility Assessment Un t . Use Atwchmmu jFNee&d
Drawinp—or_ Observations:
l
AQI — January 17.1996 i

Site Requires Immediate Attention:.A✓d
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: JJ A o , 1995
Time: 10. 3 S
Farm Name/Owner: C C3 " a r- j e r V L- (d
Mailing Address: 12, C) 13v )-c- �[_ U o C / ; n tj�2 , (, . (, a ; 3 2,f- .
County:_ J C, S o
Integrator: C On Site Representative:tt
Physical Address/Location:_
_ rnone: r 0
k Phone:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' �" Longitude:, ° "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) &or No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the la oon(s)? Yes or(& Was any erosion observed? Yes or No
Is adequate land available for spray? re or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _ C p, c,,s±s, (_ _ _ r ct�o 2 CA C'= - - — -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? fPe or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ME)
Is animal waste discharged into water of the state by man-made ditch, flushing system,_ or other
similar man-made devices? Yes or 31�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments:
Inspector NaAe
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator: Phone:
On Site Representative: dF Phone:
Physical Address/Location:..
Type of Operation: Swine Poultry Cattle
Design Capacity: 3:L4!rd !t! Number of Animals on Site: _ A37Z_ S&e
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon h e sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �e or No 6cwal Freeboard: Ft. & Inches
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized:_ 6ft*
Does the facility meet SCS minimum
s)? Yes or as any erosion observed? Yes or No
r No Is the cover crop adequate? Yes or No
setback criteria? 200 Feet from Dwellin l or No
100 Feet from Wells. Y�'eo 0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or D
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(No)1If Yes, Please Explain.
Does the facility maintain adequate waste management reco0s..(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ve r No
Additional Comments:
1,61.
Inspector Name"' 0
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Deoartmenz of Environment., health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then chis form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. ?lease print clearly.
Farm Name:_ �y�a �.'� F ,,,, 5 Ah 6-6
- -
Mailing Address:
0
Z-p
County: S; ....osc. Phone No. -ii_x.1-
Owner (s) Name: D.). �i�,�� lof'), l�. 4'el _ rV r.s
Manager (s) Name: . 4, ,-t- 74--, .
Lessee Name: fl Pr
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.)2e( 6se
h
A�
Latitude/Longitude if known:
Desian capacity of anima} waste management system (Number and type
cf confined anima_ (s)) Id7a sew Rn-aw 4, i-In;. ;2,y
Average animal population on the farm (Number and type of animal (s)
-raised) /P _ _S�f VC40 ,e% '
Year Production Began:_ /fg3 ASCS Tract No.: 146cl
Type of Waste Management System Used:,
Acres Available for Land AanlicatiAn/Fif Waste: &O
Owner (s) Signature (s) :

_ _ �
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