310791_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental qua

Type of Visit: ®'7outine
nee Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: If a Integrator:
Certified Operator: Certification Number: 4f
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Resign
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Ca�pac`ity
Pop.
Cattle 111110�ty Pop.
Y
GliRa
�iSY
S}}u
11A16IIiW� i
Wean to Finish
La er
Dairy Cow
W n to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Desigu
Current
Dry Cow
Farrow to Feeder
'o .
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
.wYlP9t�v�'zat€UeWbMpSNf IveA%vt�+uwwnnlwms€°€cta.ve€Yivltatf€
fs�ly1M17wvaay€Yes11�!'ti
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes [ o 0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
' d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes LA-wo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [J"'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: N - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2-Mo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `Z 9
5. Are there any immediate threats totheintegrity of any of the structures observed? ❑ Yes Q'Rio ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No [] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [2'�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Vo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No 0 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rN ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfer ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N 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 Ins ection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. lathe 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 D 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
Q 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
Of 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
NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
�No[o:]
31. Do subsurface the 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
NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes/
NA
Rofoo
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA
❑ NE
Comments. referfto uesteon;# :i.Ex lain an ,,YE janswers and/or-an�1'additianal recommendations orl.an otlwer;eantments E'!{ili;1¢y€°!'tl�i: ll'°in{'
( S. crl. €!°: " € r v' A <f ' � € P;€: �� ±iii fi 4 y1#I ip .o5r.§I t !• - �:BEI!li€ °i :'.tit. .a.§.1 3 3 . r€' '€.I € I."' 7f€ F ! 1:1 r,... SR 1!.._} 3.4 t•3. i._1�..1 �'�� . "..5! i '! ,4>", '.fi >il .. 5, <<19� '��>.
�IJ{1;3 4 r1Fr.. .,.°land,. tli.., , Isla t ..i_.1;!tilt .°y . �i..11 . „i:l, IS„l., .f. IS . i 1.!�t.f31.1,€:,
Use drawings;of &61ity. to better expiam.situatJ1W(ase add:tional..ages as, necessary) ' 1 t.; , ,,,, i..
Reviewer/Inspector Name: 9 09 �P `! Phone: 7% 7-*39 y
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

M
Visit:Com fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z ( Arrival Time: Departure County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �c{ Integrator:
Certified Operator: Certification Number: i -
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
C►urrent
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Design
Drr P,oultr, Ca acit
Layers
Current
P,a P.
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. 1s 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 fNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑Yes rNo
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: ItCtllb
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: f_ 'k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). "G I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El
Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2fNo ❑ NA ❑ NE
t n n0
mam ena ce or improveme
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes V] o ❑ NA ❑ NE
❑ Yes7No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
0V❑NA ❑NE
No ❑ NA ❑ NE
VV❑NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Lns ection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
C—,f l'— ({ Ln'd f 1 a -a k ? ` 0
Reviewer/Inspcetor Name: Vu V ' � 0, '_.4h"
Reviewer/lnspector Signature:
Page 3 of 3
❑ Yes
ZNo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
[:]Yes
No ❑ NA
❑ NE
[:]Yes
No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
C
VN
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412014

ivi"siNEW f iW,ater Resources
Facility Number - ? 0 Division of Sail and Water Conservation
� Other Agency
Type of Visit: Compliance Inspection n Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ('Routine O Complaint O Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: I
( 2- Arrival Time: `I Departure Time: i �} County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �` t �y �J _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Certification Number:
n
Certification Number:
Latitude: Longitude:
Finish
!W�ean
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
C►►opacity
Current
Pop.
C*attle
airy Cow
Design
Capacity
Current
Pop.
Feeder
Non -La er
airy Calf
o Finish
c(yip2ZOO
Dairy Heifer
Farrow to Wean
Design
I Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,oultr, Ca aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E;-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EErNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: "J - q IDate of Inspection: !( tY f
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: i^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i9
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ff�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [j No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E'I<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):
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 [fNo ❑ 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?
Required Records & Documents
❑ Yes E3"No
❑ Yes ENo
❑ NA ❑ NE
❑NA ❑NE
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
EJ'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ ] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[j o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

F eili Number: . j Date of Inspection: it 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L_.I " ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I 110 ❑ 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 ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 the 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 6No
❑ Yes Ej"'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes o
❑ Yes No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
--- � - ----- - ----- r --- i.
QReviewer/Inspector Signature: 1 Date: 12- (
IV
Page 3 of 3 2141201S

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,3 / Arrival Time: Departure Time: County: Region: �'nL
Farm Name: G rG _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: -P5'
Certification Number:
Certification Number:
Longitude:
Wean to Finish
esign CurrentSwine Cacity Pop. Wet Poultry Capacity Pop.
t
La er
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr. P,uultr. Ca aeit Po
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;2'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes A�fNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes Pro
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes J ' o
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Dumber: 37- Date of Inspection: 42
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PJ"N0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E3"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
'Pl4o
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
',RNo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes o
❑ NA
❑ NE
8. Do any of the structures tack adequate markers as required by the permit?
ElYes rdno
❑ 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
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
7No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etcF"N-o
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
OfNo❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ 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 [ rio
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4NO
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 31-7 Date of Inspection; 2_
i � Y
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [;30No
25. Is A facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J:3-No
the appropriate box(es) below.
❑ NA
❑i NE,
❑ NA
❑ NE
❑ 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 ;2No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes ;No -
❑ 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 dNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations a required by the
❑ Yes J�fNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) j
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 2 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 4-No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes &o
❑ NA ❑ NE
34:yDo S the facility require a'follow-up visit by the same agency?
❑Yes . Ea/No`
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.othercomments:
Use drawings of facility to better explain situations (use additional pages as necessary).'
j G -1 y 1, 5V
1.73
{r6�
1, S- J J(-.;, Z
�ar� dad s err
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: ' Date: �Z Z� �✓
Page 3 of 3 21412 14

Type of Visit: JKCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: VRoutine Q Complaint 0 Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: =�--� Arrival Time: I I V toll Departure Time: 1= 5 County: Region: W R a
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: jW
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
4MID
Design C►urgent
Dr, PTu'ltP.
La ers
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
r
Turke s
�OurrkeyFoults
ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes Y No
[:]Yes Z"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 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 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes [—]No ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No ❑ 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 KNo ❑ 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 dj 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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box, below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V7No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes j(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes X 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?
Reuuired Records & Documents
❑ Yes rX T No I —] NA❑ NE
❑ Yes �JrNo ❑ NA ❑ NE
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 o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �TNo ❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ 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)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Z No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes [XNo ❑ NA [] NE
❑ Yes VfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone:
++ D—Ul—Ma
Date: 1lf�' 13
21412011

• f ivi`sion of Water Quality
`Facility Number' 1-31 1 - wo
ivision Water C
of Soiland onservationther Age,_cy
Type of visit: ompliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: �' Arrival Time:® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: E (fQ rR-AC>
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integratostion
p
r: /�
ertifi Number: 6 Li
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle C*apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Design C►►urrent Dry Cow
Dr, P.oultr. Ca acit P,o Non-Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imaacts
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 10 No ❑ NA ❑ NE
[]Yes [:]No
[:)Yes [:]No
❑ Yes ❑ No
❑ Yes No
[]Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,) (� 61
Spillway?:
Designed Freeboard (in): 9.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes PNo ❑ 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 j 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? S�
Waste Application
W. 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 JCE(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 1.4k 1(1 \u)L-LE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
io No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
TNo
❑ NA
❑ NE
Required Records & Documents 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.
QWUP ❑Checklists [3 Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
R Waste Application Q Weekly Freeboard 0 Waste Analysis [] Soil Analysis ❑ iste Tra sfers
FIRainfall ❑Stocking ❑ Crop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: ­4� 1 - -�:tq / I I Date of Inspection: 'R!3 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yeso ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
0
❑ 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 O[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
4
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 66 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes GNo
❑ NA
❑ NE
Reviewer/Inspector Name: Mlor/r o'4 Phone: q a - T !tG -T
Reviewer/Inspector Signature: Date: 13 /Q
Page 3 of 3 21412011

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?
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� te, 6eAu
Certified Operator: G�.�- Ul (S CA QLl
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certi IIcatio n Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity
Pop.
Wet Poultry.
Capacity
Pop.
Cattle C*apaclty Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Ll
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VkNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes q No
❑ Yes Vf
No
❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No [DNA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6aolu
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes X No
❑ Yes t4 No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1,6 � 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 "0 No ❑ NA ❑ NE
maintenance or improvement? 777T"'
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, et .)
❑ 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes I
No ❑ NA ❑ NE
QWUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No ❑ NA ❑ NE
Q Waste Application ❑ Weekly Freeboard 0 Waste Analysis Q Soil Analysis []Waste Transfers 0 Weather Code
❑ Rainfall [3Stocking ❑ Crop Yield [] 120 Minute Inspections Q Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - a I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: .
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
17�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IM No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 5❑ NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessarvl.a.t�
tft�RA7/a� ��-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (go p ' ??'P
Date:rJ
21412011

Type of Visit JaCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit x Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: \D �D Arrival Time:
© Departure Time: County: L I N Region:
Farm Name: J L LA 0--) Owner Email:
Owner Name:
Mailing Addre
Physical Address:
Facility Contact: Title:
Onsite Representative: 6
Certified Operator: r C - C,
Back-up Operator:
Location of Farm:
Phone No:
Integr. or: Q 1
Operator Certification Number:
Back-up Certification Number:
Latitude: [�:] c =' = Longitude: = c =' =
Design Current Design Current
Design
Current
Swine Capacity Population Wet Poultry Capacity Population
Catt[e Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
60d
❑ DairyPfeifer
Farrow to Wean pry Poultry
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish ❑ Layers
El Beef Stocker
❑Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
[I Beer Brood Cow
El Turkeys
Other ❑ -Turkey Poults
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 L No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes X..o ❑ NA ❑ NE
❑ � Yes No ❑ NA ❑ NE
12128104 Continued

Fpcility lNumber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into,the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [ No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA [INE
maintenance or improvement? 0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 0
11. Is there evidence of incorrect application? 1f yes, check the appropriate box below. ❑ Yes )kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable, Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S is 6l;o&
13. Soil type(s)
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
9No
❑ NA
❑ NE
❑ NA
❑ NE
lNo
No
❑ NA
❑ NE
No
❑ NA
❑ NE
NNo
❑ NA
❑ NE
-„ - ,., .,..: -..: a I.,•�re ,; r �,',.i y.., r.:r �: =i7 '-- Y �-:�e+f a-f�r�� {$<. � tt tss �1 a;:
Comments{refer to question #) Explain; any YES answers'4nd/or any m recomendations or ariy,other ctommuentsf
Use:'drawmgs of facility to better explain`situati66 (use addrhanal pagesias necessary) �
Reviewer/inspector Name l � �'� � � � � � �'e�� �� � AMN Phone: '_T% __430�3
Reviewer/Inspector Signature: Date:�Q
Page 2 of 3 12128104 Continued

�acility Number: j — Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WDP ❑ Checklists ❑ Design 0 Maps El Other
❑ Yes No ElNA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Y(aste Transfers ❑ �rtinual Certification
0 Rainfall 0 Stocking ElC/op Yield 0 120 Minute Inspections [I Monthly and 1" Rain Inspections /0 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?
Cl Yes
4No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes d 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 [INE
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 [INA ElNE
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 ,3dNo ❑ NA ❑ NE
Additional Comments;:andlorDrawings
CA uaa.a 1 lone bIAC- QoIG
Page 3 of 3 12128104

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ��r-^ Arrival Time: Departure Time: County: u Region:
Farm Name: 1� • fin` �S, N Owner Email: p
Owner Name: �E K. �(-'"'�` LA, - - Phone: 1 �"/&S24- 99
Mailing Address: �S eoucr-��1/CGIS V_d Mo�TC tour Nc La�(.S
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: % ��E
Back-up Certification Number:
Latitude: 0 0 0 6=15 Longitude: = c❑, 0 1l
Design
C*urrent
Design Current Design
C+urrent
Swine
Capacity
Population
Wet Pouitry C**opacity Population C•attie Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
Feeder to Finish
C>
❑ Dairy Heifer
Dry Poultry ❑ D Cow
Farrow to Wean
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La ers ❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑Turke Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
tWNo
❑ NA
❑ NE
❑ Yes J� No
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 — l Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )�No
[INA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ❑No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
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
6No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No [:3 NA ❑ NE
Pq
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
K] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
I
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [IEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) 3�s:s� 2r_AL_L?�
13. Soil type(s)
.3
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
[INA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Else drawings of facility to better explain situations. (use additional pages as necessary):
AS
Reviewer/Inspector Name ;T "�> rs'�';'
�.' . S , . s.�F.a` �d _.,�. .� r.�.�����. Phone: (//>- G
Reviewer/Inspector Signature: Date: 2Las �
Page 2 of 3 12128104 Continued

facility Number: �j f �91' Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,Xy No
❑ NA
❑ NE
the appropirate box. El WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
A No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ ste Transfers ❑/nnual Certification
E] Rainfall ❑ Stocking ❑ CXop Yield 0 120 Minute Inspections ElMonthly and 1"
stain Inspections ❑
Weather Code
22.
Did the facility fail to install and/maintain a rain gauge?
❑ Yes
No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El
No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
[J NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ 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
[:j 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/] n spector fail to discuss review/inspection with an on -site representative?
❑ Yes
100
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility. Number 3 I 0`Division of,Soil and Water Conservation
Other Agency,,
Type of Visit Acompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit o Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 17319T�2 Arrival Time: I!� Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: / Integrator:
Certified Operator: �� `� Operator Certification Number: ) Sa y
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ c ❑ 1 0 Longitude: = ° = 1 = "
Design Current
ign Current 'Design`, Curr
Capacity Population. Wet Poultry Capacity: Population Cattle Capacity Pb
❑ Layer
❑ Non -Layer
Dry Poultry
ElLayers
ElNon-Layers
❑ Pullets
❑ Turkeys
El Turke Poults
❑ Other
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures
Discharses & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes [--]No
❑ Yes ,k-No
El NA
❑ NE
❑Yes 14No
❑NA
El NE
12128104 Continued

Facil1.ity Number: j Date of Inspection —�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
6 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?:
n
Designed Freeboard (in):
L�J/
Observed Freeboard (in): '7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
((No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ 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 b(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ` dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 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):
T
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Fhcility Number: 3 1 — j Date of Inspection
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available?% El Yes VNa ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ❑ NE
the appropriate box. ElWUP ElChecklists ElDesign ❑Maps El Other to
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 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 ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Fj No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes DNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes _RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [*No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes (ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
ElNE
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 Z5 'No
❑ NA
El 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 A 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 XNo
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number Q 1
dDivision of Water Quality
0 Division of Soil and :Water Conservation
0 Other Agency
Type of Visit (0 Co Hance 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: /6 Arrival Time: I /a c70 1 Departure Time: County: w Region:
Farm Name: I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: IkX'� 64An�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 i Longitude: = ° 0 1 = Ii
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: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Currerrt
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes L3 No ❑ NA ❑ NE
12128104 Continued

Facility Number:3 I—
Date of Inspection 110A,427
I
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: L4�/�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�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 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes [4 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes/
o
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O� NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
[I'No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name A I J I Phone
Reviewer/Inspector Signature: Date: p
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2/1 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
Ll No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
❑ NA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�J/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
,�,/
C3 o [INA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Lf 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
0 No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
fo
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
Vy❑ NA
❑ NE
Comments and/or Drawings:
12128104

E
ivision of Water Qualitycility Number ?j Irf O Division of Soil and Water Conservation
_. -.
O Other Agency
Type of Visit Corgpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: �lt12 LSRfi.�+�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° = 1 = "
Design Current - . Design Current,Destgu` Current`s _
Swine Capacity Population -Wet Poultry Capacity Population Cattle . Capacity Populate n.
❑91,
Wean to Finish ❑ Layer i ❑ Dairy Cow
❑ Wean to Feeder ILI Non -Layer i ❑ Dai Calf
® Feeder to Finish 1qq1J I vro ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry El Dry Cow
� - r-"_. _ .
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
L{ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures r
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E2/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
❑ NE
❑ Yes
Ell Yes
V ❑ NA
❑ NE
❑ Yes
L No ❑ NA
❑ NE
12128104 Continuer)

Facility Number: — 1 Date of Inspection �F
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: JA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): YS'
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 ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes 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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElLI✓ Yes
��
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2�0 ❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) Q L6- O
13. Soil type(s) AYJ6,1,76
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
�No
43 N,9 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑Yes
Er o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
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):
�) L ?TArE Chi Yob . (8� SUA-C- fa- JP 7JA1, ALL,/ 1. PACAA, z
Reviewer/Inspector Name _ f to yQ46J Phone: A 7 G
Reviewer/inspector Signature: Date: ZI 14.4
Page 2 of 3 ' 12128104 Continued

Facility Number: — Date of Inspection 3
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes
;Z0
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee y Freeboard ❑ Waste Analysis ❑ Soil A ysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ I20 Minute Inspections Monthly and I"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
21/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
L(lNNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LK
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑�o
❑ NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,//��
1 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LTNo
❑ 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
Er/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3 Vo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

L
Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ArrivalTime; 3: $0 Departure Time: County:P-4mm-ALRegion:
Farm Name: Owner Email:
Owner Name: i� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
l
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o = 6 = is Longitude: 0 ° = 4 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
T _ I ❑ Non-Layet
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: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
[I
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: E— ]
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 P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 10No ❑ NA El NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number. — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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: 162�f
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in): s ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes A 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 )Z 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZfNo ❑ 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�4"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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
,, El Evidence of Winndv Drifl ❑ Application Outside of Area
12. Crop type(s) `� 09a)gD,fi` 1�9,4LCJ , ��U-. �f��rQ$E�\ _•,• ._
13.
!
Soil type(s) u
J
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination, ❑ Yes
�No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
iLl No
❑ NA
❑ NE
Comments (refer ta; question #) Exp.lain gny YE5 answers andlor-anyrecommeridahons`or any othercomments
' .t`
Use drarvEngs�offaci{sty= to better efplain situ ahons (use addihonal'pag s as ne�cessaryk i. "k ``��YYi �» 4s .
Reviewer/inspector Name Phone�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropiate box.
❑ WUP ❑Checklists 0 Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WrNo ❑ 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? ❑ Yes VfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
1No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
'VNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA�NE
❑ Yes to No ❑ NA ❑ NE
❑ Yes ' VNo ❑ NA ❑ NE
❑ Yes
'VNo
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes )!fNo ❑ NA ❑ NE
❑Yes JdNo El NA El NE
)) 04V'� 4"'Y'wc ��s� �� w'Ek-Ly Avo ';51V'rr04y_ 1AC?s2
71 " 44o J,
!yo?fl' � �dF. ,� /�c �AR n'i �PP,E�fi� � .� �%Gc �� G��/�i,�.�✓�;4.
y
12128104

Mi
of Visit O Compliance Inspection O Operation Review O lagoon Evaluation
IReason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Num r �I Date of Visit: i 1 Time: r- f "
10'Not Operational 0 Below Threshold
rmitted Certified ©Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Naive: County: ..... ..... ........».».....»
Owner Name:
Mailing Address: .... ............. .....................................
.....»._....»._._........ ».......... _...
Facility Contact: ___._ .... _..» . »_ __._ » . ». _» » Title:..-
_ ,
Onsite
Certified
Location of Farm:
Phone No:..
Phone No:
Integrator: r r-C S7,1,+& t;„_»
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 (14
.Des
ean to Feeder
❑Layer
;
❑ Dairy
eerier to Finish
q y I o
S�
❑Non -Layer
n
?
❑Non -Dairy
Farrow to Wean
j
TOE DeSIgII` �iEl �iSClty
k i
4 'x ,Totsi'SSLW,s
Farrow to Feeder
Farrow to Finish
Gilts
El Boars
a_..
s..
Discharses - Stream Irtr�aCts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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? ElYes No .
xo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�W
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
,
Freeboard (inches): y.3
12112103 Continued

Facility Number: 3' Date of Inspection ; o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or j] Yes 0 No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) --!!
7. Do any of the structures need maintenance/improvement? ❑ Yes 011 0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [314o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ffNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes iJ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type W-4L41 LXR Ce") &O
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?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
��.� VPUr+TC S�at.K-xt.lts �,R.nn
]C('"1`C r'_ t ' f" k4A_ t_ L.
❑ Yes
❑ Yes
0 tvo
%
�No
El Yes
❑ Yes
J
❑ Yes
❑ Yes
10
No
❑ Yes erNo
❑ Yes 014o
❑ Yes 40
❑ Yes To
Field Copy ❑ Final Notes
�L• CSC' t�?Y �� R.�N;J ;� �=�RTr��c:r��`?�J �rt_.M �°�`- 1Z.c:c,�t<_�s.
IF-J)r c l�" f �j 6""'-u 5 H pj Pf- ,
Reviewer/Inspector NameW
Reviewedlnspector Signature:
Date: D-7
12112103
Continued

0
Fadility Number: 31 —10111 Date of Inspections
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M 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 [�NNoo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1 �IN0
❑ 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 Na
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑'<o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E31�o
28. Does facility require a follow-up visit by same agency? ❑ Yes Eriz,
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes two
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No .
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ yes IdN o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes O No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 00
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Bi o
35. Does ord keeping for NPDES required forms need impro ement? If yes, check the appropriate box below. [ Yes ❑ No
Stocking Form ❑ Crop Yield,Form ❑ Rainfall nspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit ,Z Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit j2rRoutine O Complaint 0 Follow up Q Emergency Notification O Other ❑ Denied Access
Fucilitv Number Date of Visit; I 7 S Time. I q ' 50
10 Not Operational 0 Below Threshold
O Permitted ©Certified M Conditionally Certified 0 Reggiistered Date Last Operated or Above Threshold:
Farm Name: � E. 9rad� - �D ,�G�//O t �Y/� 1� ��' y County: cti 11�%i
Owner Name: _ 6 Y'" r �'�""� / Phone No:
Mailing Address:
Facility Contact: -� Title: Phone No:
Onsite Representative: C ! e rr U x • (< Y'a 4 Integrator: Pre S�c,c�e
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JFEI La non Area ❑ Spray Field Area
tlolding,Ponds 1 Solid Traps . Q ❑ No Liquid Waste Management System
Dischartzes &c Stream I.nivacts
1. Is any discharge observed from any part of the operation? ❑ Yes J;2*No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes IzNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Statc other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
Freeboard (inches): 36
05103101 Continued

Facility Number: T Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Warute_Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type b^'' e r ,--, vd A ;'c s-�v ire
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspcctor 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 'ZNo
❑ Yes ZNo
Yes ❑ No
. ❑ Yes �TNo
❑ Yes ffNo
❑ Yes 2No
❑ Yes �2No
❑ Yes ZNo
❑ Yes '�?No
❑ Yes 2No
❑ Yes J'No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes 4--oNo
❑ Yes ONO
❑ Yes PTNo
❑ Yes JZ No
❑ Yes J?j No
❑ Yes .2 No
❑ Yes j"No
❑ Yes �ZNo
❑ Yes _PfNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ciririnments' refer,%` 'des on``#) `.€ Ez" Isiri?'aa`{" YES' answeirs!aad/or, aii 7u" re conni�ie %�Istion�:or"a�` atherle,cornments:
i �, 6. { � E �> .g / _..p j., 1'�..-: i . Ii Oil E. 4., € { -(� € .P<E. �i K i ' �•it�4... '.li'.•i•1.f. t6;k r �i. �.lf lfa.{.li��•n i�.Mii.€..-
y ��
se
Udrawtnps of factltty to better ex latn'situations.; (use adiiltaonal pages as necegstiry) i , Conv ❑Final Notes €
€�4 '
c4,°�,a€i.,} ��i€::,[ d, : •,fi S€,. �� ;h� a;❑Field ��
i�. t,v;% send a�iar.✓�✓ A heL.1cy ' Ce or; GI-�c or' C ve✓�__ge 17
ra P-i 4 44 e A ✓ --N >"F Z lz,v ve 44-ZY i a v4.1"1t 0e,
/ q. r v � -Z oil
�s��,
4sa,�e�
�lc��c�rd book�lrG1-%Zdy
nd �, e
4
Sa ys �� his-��,ese r0GofdS b v 4Zle7 a,�e cv✓►��-JI elscw1,e -e
1%s� ZAS �d✓ be ;•,.� � n� �Yo9e�-�. �)1 awa�t�c �h ��, c �'�l?�Z� S ,�o►� (r>o�
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: S�'L
05103101 Continued

Facility Number: 3 — Q Date of Inspection l
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. 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?
,Additional Comments,and/or,Drawings:
JZYes ❑ No
❑ Yes ONO
❑ Yes ONO
❑ Yes JZINo
❑ Yes �No
❑ Yes 'P�'qo
❑ Yes ❑ No
-fke 1a106h 4AS crodeol arr�GS
f S, lei r • l'►-�d .ra �1 e Gtics ,/'Psl.� a�a a d 44,'r q.
e'at-p%e of ir►;es, '
4nd secde�l ��. T�}}er'e ir'r �} heed -�a1 ,�csl��� ��•'�
�jee;,,. rlF7Lr 1'PS��fr��, 6rivtg 1%I �ap,�Dfl�or'%akKiG
M a 1yelr And r e s e ed �� �e � 4o gel 9 ro s1 Gave✓r
E° s-�a b l,s�,ed ¢a �rcve� -� Gan �, n vAh� ¢✓'•s�'�h ,
fe ber,�1.vdg ,r-��rvt� a+�,° Q1;-•z.'�-aa'e
�DhbGY►"'L✓�h `raSSe3 eAl 4t' pV1l .57 ctnd p, �J W r v)( (7�
yt�r, �ro�d � �a1�hJ �6 s�r'a� ��C �'s gsea Iy�'�� l�eyb► �.►�[e
a Pr DM. o� G�tsah1 �f �'o�Zr ,
Overall) - h r Ate -h-47 i*-< Vey i„el t main ��i�1ed .
di)
nvd Ae w-w17 vier y 5aod
bae>^rh v da . ✓✓I-eGOrA$ ipre bvel j kefk,
05103101

Divisility on of Water Qua
a !.
f° Ez' O. i6igion a Soil and Water Conservation r
! •F, 1 n4�. •' a ` '� ' Q'Oth&r Agency.. ' .�"' •�" i ,.h
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit _' Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 2 �� 'rime: ® Printed on. 7/21/2000
J 10 Not Operational Q Below Threshold
0 Permitted ❑ Certified [3Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ...............
Farm Name: Gd ...z.-p?.5.... County: vf..'.'.....................................................
r e: `' " '^�dPhone No:
Owner Nam .............................�..............................................................
............... ..........
FacilityContact: .............................................................................. Title:..................................................... Phone No:
MailingAddress ... ..................................................................................................................,........................................... ..........................
Aye
Onsite Representative:...... ,.?�^,`.�....:G.Y C4.................................................... Integrator:....'..,....'".... �/...... .........................................
Certified Operator: ................................................... ................................... .................. Operator Certification Number:
Location 'of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • 6 iG
Design
Current Design Current Design Current
c
tCttleCa
Plation PoulCa ci
`Po ulation
" Wean to Feeder
,
❑ Layer ❑ Dairy
eeder to Finish (j
❑Non -Layer L❑ Non -Dairy
Farrow to Wean
6-0;' Farrow to Feeder
❑ Other
aU
E Farrow to Finish
Total Design Capacity
Gilts
AUN Boars
e` �
Total SSLW
S iw i IY }I C IIN.,a9fi Y k .',
'Numiser of Lagoains
/ ❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
�Hdltlin8 Ponds /,Sohd`Ttraps:
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �To
Discharge originated at: ❑ Lagoon [I Spray Field El Other
/
a. If discharge is observed, was the conveyance man-made? ❑ Yes X01,10
b. If discharge is observed, did it reach Water of the State`? (lf yes, notify DWQ) ❑ YesNo
c. li' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes )ZNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yesoo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ I ..................... ............................. ....... ................................... ....................................
Freeboard (inches):
5100 1 Continued on back

1♦acility;lumber: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes,,KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes 'O'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 ONu
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 21"No
9, Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Ye�,dNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ YesXNo
12. Crop type eemt14 Pefsjure, 5-r''tu , Grnt in 4 eo rr e SQ o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Pan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes"ONo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ YesNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes o
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? 1
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes XT,
a
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 11,1�0
�'!14'YiQ� �FQ 9,0�': d� c}encies ry re rioed. c 0hig Ns.Visit! - Yoo .WiiloboiVC 06 futth�f :: :
co r'resporideit& ahoiif this visit . .... • • • • • • • . • • • • • • • • • • • • •
'ers and/or any recom
I w a
rtzeCtiMdn oY b,,ve e ^ectS ter,91' C.
,) eG e. % �5. _7`_�ere o od f.�� d � �s-Fa � ffn 1pt.a s-� tK -F; elf 6�f �, d � k le,
be#er e a�1•sh 46e bef'")d� oo f u
141. go,,Ve. 14 /c-�-�' ovle years Woar f1, of 1�'�a�;oh re.coi'df a✓a; k61a
J-6r ;nsr64ler) "%rGp &iL1 /cGbr�Jtam �e�f.s . —
Reviewer/Inspector Name� "
uvJ�A A'i 1AA. s., iA
Reviewer/Inspector Signature: Date: Z Q % 5100

Facility Number: F Date of Inspection a I Printed on: 7/21/2000
Nor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes --QiQo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes L]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—'[:�40
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__Ej'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional„Comments an or Drawrngs "
A6t
5100

Q,D1ViSE011 bf SOiI and,Water,COnserva40n`;-:.t7peration R&"ii ijai4 i� "i„t4'y4e4 ti?i" t' yid$' j) y1 3 t 3 3��
isi � �.-e,r SE i , -.t �€ F `., , i �, 1 9;
+ } O DiAsion of Soil,a11d Water.Conserva4on = CoEn Rance Tns ecUoo h "
� w., s.� � p
a ;r.,ra� ';!+i,:,' =t` €'y.; 1v1sEOri Of'yWater�Quallty ;'Compliance Inspecgon
t ,Other,Agencyr-Operahori!RevieW� ..< ., a�-iE13 ,€�i€,��_?,��? 5
b. s . , , •� - — - r • , �, rs4.L _, s,<., x �. � ..ui.4 V : - 4:h �. �� , &dif ..
Routine 0 Complaint Q Follow-up of DWq inspection Q FollOW-Up of DSWC review Q Other
Facility Number Date of Inspection �p
Time of Inspection E� 24 hr. (hh:mm}
XPermitted [Certifie
d 13 Conditionally Certified [3Registered 113 Not O erational Date Last Operated: ...,...,, ,
Farm Name: I.* ..i(. C.r Ji?Y1 �.. County: ............��_. 1L. .1 a.k ...........
OwnerName : ................................................... ........................................................................ Phone No:...................................
FacilityContact: ... Title: ................................................................ Phone No:...................................................
Mailing Address: ................................... ............ . ...
integrator: Onsite Representative:......... t„S,_,•,,,,,, �.,r,,,,,,,,,,,,,,,,,,,,
.......... .........
Certified Operator: .................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
r
.. . .. .... ......... ..... ..
Latitude 0=,0" Longitude =•=1 11
Dest n rrent" ." De`slgn ` Current
Swine �Ca ac t Po elation Poultry Ca�acgitPo elation Cattle . Ca acl ,"Po' elation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
:-''[]'Farrow to Wean t ,
❑ Farrow to Feeder ❑Other "
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars Total `SSL' w 4
Number of;Lagooris ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area s
Holding Ponds I!Solld,Traps ❑ No Liquid Waste Management System "�
Discharges & Stream Imtlacts
I. Is any discharge observed from any part of the operation? ❑ Yes )No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? � A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
tructure I S tEA re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r� �dP�s,�F(aV-,rs
Freeboard (inches): ........... [J
.......................... .................9.0.... .......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNO
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection J Printed on: 7/21/2000
5: Are there any immediate threats to the integrity of any of the structures obser ed? (ie/ trees, severe erosion, 0 Yes dv­` 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 KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes SINo
11. Is there evidence of /over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes VNo
12. Crop type �j/' �,
13. Do the receiving crops differ ith those design ed in the eertified Animal Waste Management Plan (CAWMP)? ❑ Yes 5lo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes Eg�No
b) Does the facility need a wettable acre determination? ❑ Yes 2<40
c) This facility is pended for a wettable acre determination? ❑ Yes &�No
15. Does the receiving crop need improvement? ❑ Yes Glo
16. Is there a lack of adequate waste application equipment? ❑ Yes EfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes VNo
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 LPo
Ooes record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) WYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes H�Sp.
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N:No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Kilo
24. Does facility require a follow-up visit by same agency? ❑ Yes $6No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes O'No
�'�iQ yiQl >�iQltls ;off dgf ciencies v re IQt;e� d4rg s: visitf - Yoo will •tea0iye fid ru>j't�tgr.
ctir'res}�oridence. abotit this .visit.. • . . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ri v ; koC. S ° `�'�''' t►r- D "`� S 1. �0'� a�'v`` "�-�
-1-}-�-1.� u vc.Ct.a-,� a s -�V - vV h e v
a.w�l
Reviewer/Inspector Name re e .4-7
Reviewer/Inspector Signature: Date:
I IV
yid 3� s 3gaa
_/ewo zzaei> 5100 ZLS

Facility Number: — ncj Date of Inspection a

Facility Number: - 7/, Date of luspection T%� 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 :it/or below ❑ Yes 0 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ YesNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes '�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JNo
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 Q,0Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑files 1<40
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ko
e�
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5100
"VI

iy [3 Division of Soil and Water Conservation Operation Reveew " t
P 3 i k jF 4i - i° i :�
4' i '0 Division of Soil and Water Coiiser*atlon Compli�ance h15peCtlDn �t�i 3` s ` " E5€a�ir� �,i i�,1E
91'_Division of Water Quattty Compliance Inspection
i Y 'SB t M1� 3k 38 SP Sl ,p PI 1 3 i�S P�YPo 'hYE
t H s' � [)Other Agency = Operatton�Revyew � t ' � f � �
Routine Q Complaint O Follow-up of DWQ ins ection Q Follow -tip of DSWC review O Other
Facility Number
Date of Inspection /
Time of Inspection /S Q 24 hr. (hh:mm)
IN Permitted © Certified r] Conditionally Certified [3 Registered 0 Not Operational Date Last Operated:
Farm Name: �✓7 County:... L,LLI
v/ C�/tGIG�..JO!'L�C ............................................................
j
OwnerName: ............../ P...... �?."`ZPs.............................................................. Phone No:............................................................................,..........
Facility Contact:..........................................•....................................Title:.................. .. Phone No:
MailingAddress: ...••...•.......•.......•.......•....................................................................................................................................•.. ..........................
........... �."e.......... � qd ��...s� e
Onsite Representative: ................'r�..... ....�............ Integrator: ..... e„ a.
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A AL
.. ...............
Latitude = Longitude C�• ��«
Design Current. Design Current • Design Current
5wme "Capacity Population •• „ Poultry'.., .. Capacity Population, „,.Cattle ,: Capacity Population ,".
❑ Wean to Feeder ❑ Layer ❑ Dairy
ff
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean �•3.7.
❑ Farrow to Feeder ❑ Other Pz
❑ Farrow to Finish
" Total Design Capacity
s ❑ :
Gilts a, •P- iti , .,,, sR`
❑Boars ° Tota1.SSLW
''i' Num ber'of Lagoons Subsurface Drains Present ❑ Lagoon Area Spray Field Arca
r.
0
Holding Ponds`/ Solid Traps ❑ No Liquid Waste Management System "
0
Discharges & Strearn Impacts
1. Is any discharge observed from any part of the operation? [:]Yes 2 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes 0 No
b. If discharge is observed, did it reach Water or the State? (If yes, notify DWQ) ❑ Yes I? No.
c. Ii'discharge is observed. what is the estimated flow in gal/min? h q
d, Does discharge bypass a lagoon system? (II'yes, notify DWQ) ❑ Yes JRNo
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 ff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;3 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Freeboard (inches): .......... ;;;�7Saa
.l................................................................................................................... ..................................... I....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 2§No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3/ — % Date of inspection !tf
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 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? JC Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes 14No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes .,'M No
Waste Application
10, Are there any buffers that need maintenancelimprovement? J9 Yes ❑ No
1. ' Is there evidence of over application? []Excessive Ponding ❑] PAN �-- ❑ Yes (Z No
12. Crop type _13e e-t t d ri r G s v re) -S-4-01 6rel t ri) t-oPrt�_f'11, � As, 641,001 iT b,.Cea
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;KNO
14. a) Does the facility lack adequate acreage for land application`? ❑ Yes .9 No
b) Does the facility need a wettable acre determination? ❑ Yes OgNo
c) This facility is pended for a wettable acre determination? ❑ Yes V No
15.
Does the receiving crop need improvement?
VYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
A No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IN No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
1E No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JgNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Jff No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
X No
yiolatitjris.or• d0ficieh.... r... pQee�1 dv<tring his'visit: A00.will tree lye o i'u thgr
correspondence, about. this visit. • • • • • • • • • • • • • • •
1 1 11 E li.. 1<. . '-, . � 1 i 3
Comments (refer tn.question #) Explarn any YES answers andlor any'recommem atioEns EorianyEother3comments.
Use!drawtngs of facihtyto°liett°er!explatn situatto s (use"addtt<onal=pages as necessary „€.., . tf. ti.n• �� "„ �, t? . )�,.,�1 : �'E'
'i. &re arfe45 AM4 ef0442d gr'eas On lCL900"n wge'l sl�oc�lar be •
e pa of v,%.4 I-Vive -ro-,N" 19e r)ee.r' vege-�o4► vt e54•a
!�. ,�oDl'�c( q�Cas atRauK� t tra�e✓Geerfie, Ga►,t�.�� -ceaAt VrL t ya1,+0
4;1e i vt C-alxs-1 ) -Ct t (d 51•w44.10( be re R;,-Q of ytd 6t ve
ve yr.•}z4#' ee GAves e54,t,4 jjskec. L.°ows kAay 'lee -�o
At qrrA
1 tart-�� n c era,- s 4d e0etb i sk cezv n l be femvd.. q o-1 e,7� .'ee4 y 0- r;el4 ,
Reviewer/Inspector Name,_,,.
Reviewer/Inspector Signature:
2'`03
Date:
3123/99

Facility Number: 3l - r Date of Inspection
Odor. M-ucs
2&
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
V Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
i iona ommen an or raw�nggs 9
j
I e-r,cr-rhot,.ld /7csuw►e, kE`ri'"j wQek/4 r ePbd,,,4 lev'elS'.
W A S+e- sa rt. r l e-S a e e S 04 -Ae r 6 4 d 4 y -s Le. Ao ee q n di et4e r
fhe- Am4e Opt, 4hr, gnatysfs, -pq� spr�a �e�o��s sl-�pJ'tq
be, kef
Y
3/23/99

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
[G Routine O Complaint O Follow-up of DWO inspection O Hollow -up of DSWC review O Other
Facility Number
D Registered ©Certified (3 Applied for Permit KPermitted
Farm Name:.. ...-r .. SG .....................
OwnerName:... ....G!rv`............................... I ..................... I
Date of Inspection
Time of Inspection I 1001u__j24hr.(hh:mm)
0 Not O erationa] Date Last Operated :..........................
............ County:.............�...............................................
............ Phone No: , ) ft_. Q.... b.g...........................
Facility Contact: .............................................................................. Title:................. ... Phone No:
s^7 L �Q [ �^+4� x`
Mailing Address:...�...L..,7.....Q.............. ... ....1�!Gcs................:xV 4.`.�,..................... 31�........................... ..........................
`�-�
Onsite Representative:.. `........ ... �.v ................... Integrator.... Y �.:.1.. "ti! ...............................
Certified Operator;.............................................................................................................. Operator Certification Number,.................. .......................
Location of arm:
e. ... .. 5....G.tr+......... .................................................................................................................................................................I...................
Latitude 0 6 46 Longitude • 6 66
General
1. Are there any buffers that need maintenance/improvement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes 1ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes MNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes t4 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P9 No
7/25/97

Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding -fonds. Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft).........�J.t..:..4..................
................................. ................................... .............................
.
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was. answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes 4No
❑ Yes CirNo
Structure 5 Structure 6
............... I ... .............................................
❑ Yes JANo
0 Yes ❑ No
i4 Yes ❑ No
❑ Yes bd No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 0 No
(If in excess of WMP or runoff entering waters of the State, notify DWQ)
15. Crop type .... .... .....
.......{...P..4...-........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? XYes Jallo ft—
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 Reviewerllnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
O No.violations-o' ddiciencies:were-nated•during this:visit. .064ill receive n6-fturther,
:: • corresp��deince atiout this: visa:::: :.:. � .. - . , :. - ..:::.. :: ....:. :: • . : ::.
❑ Yes VNo
,Yes ❑ No
❑ Yes CXNo
❑ Yes is No
❑ Yes Dd No
XYes ❑ No
❑ Yes 'VNo
❑ Yes 0 No
Yes ❑ No
1) �+�•�e t�-� e. --c, e^,�,-��- 6 N, Lv1 �k� A-., w��d p��-�� t- �,E�. '`
�I�I�i S„eye c� n - 'ti4 e•—.�,_� „��`�,-��e e+.�sl�
.�� V4 I I ►-,.cam t, l
Xr heQd
wc� � r, G I•-�.,�- c� i��-d t �-. -1� 1•,-� bti 1�? �� +.-;t�..� � p�-� I
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 'Z , G _ Date:

rheility Number.S.) ..... Date of Inspection: h t
Additional Comments and/or Draw- ings'
__y vi�l L,)VQ�l vzl--)ktv
4AA V-,�-�y -\,P �e—
�.�.- �S -ems �-�d -� �� ��4 � ��
Ile-
, IZ3
NzyVI
kv-eSs 17
se-
w\ AA,
ZA-
4/30/97

w=&❑DSWC Animal Feedlot Operation Reviewv
�, <: ::
3' R DWO Animal Feedlot Operation Site Inspectio
0. Routine O.Coinclaint 0 Folltnv-u of DW ins action 0 Fallow-u of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection ^ 24 hr. (hh:mm)
13 Registered [3 Certified 0 Applied for Permit Permitted JE3 Not Operational I Date Last Operated: ..........................
Farm Name:.iTr. .-... i............ ..�Q...SA.."A.... County:..... ?.Q.L.i.,r-..................................
.,u�,ls.. ......
Owner Name: .................... Phone No: L t..�t.....~..b g..?rE�.......................
Facility Cantact: Title:
.......................................................................................... I ............... . Phone No:............................................,.,....
IN-lailing Address: ......5..1.. ........,.......1 st- .........0..LV .,.......................,. g.�..(Z. ..
Onsite Representative: ....... .Grp+-s r1........ ............................................ I ...... ......... I... Integrator:.... .x .rS..,.............................................
Certified Operator................................................................................................................ Operator Certification Number,........ .........
Location of Farm:
.b.....s.a.V................s..........,a.......5.......4.3.4..�...,.....�.�,.ra�,t.artc!� ....?.:..............r�.►.1 �.....s......a .,.i.�.>.....
s..�..a.,•�......uu.i..i`..... ,.. I...1.., ...............................
Latitude R 1 46 Longitude • 4 46
Design Current DesignCurrent Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity, Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish JE1 Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds. 10 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/inip rove ment? ❑ Yes KNo
2. Is any discharge observed from any part of the operation'? ❑ Yes ® No
Dkeharwc 4iginated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CRNo
b. if discharge is observed, dial it reach Surface Water" (If yeti, notify DWQ) ❑ Yes RNo
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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes %No
4. Were there any adverse impacts to the waters of the State other than from a discharge`? ❑ Yes 21 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 19 Yes ❑ No
maintenance/improvement'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9[ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ®-No
7/25/97 Continued on back

Facility Number: — T
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes SNo
Structures La dons Moldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ........s....•......................•.....................................•.......•.•.......•..................•........•........•.•.........................•.•.............................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12,
Do any of the structures need maintenance/improvement?
QYes
❑ 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
C[No
Waste Application
14.
Is there physical evidence of over application`?
❑ Yes
M No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15,
Crop type b. ^^'�v..[ a...... ....................... .
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
49No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
9LNo
18,
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
91 No
20.
Does facility require a follow-up visit by same agency?
2LYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
22.
Does record keeping need improvement?
❑ Yes
DkNo
For Certified or Permitted Facilities Only
23,
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
9 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
No.violations•or. deficiencies were- noted- during this. visit. -.You,will receive•no further
correspondence about this visit:
efer.to.question #): Explain any -YES
Qf facility,t6 better explain situation,
:ad
any
er comments.
SGOSr �t/4'[. Ak
0
00, .�t. �.v-o S o •► Ld 6.e". {� l U- 4- t 'I-n. J44 1 w, w X4_yL
1$ . t� a "r X- 0 r• C a r r�- c i t� R n-d 3 i vc si r t L. �� W y D
*-N-S o- d�- e A -Y 4 w i ft-,
L1�� lid o i4�. LJ
0,1 o �-` cx �� c. i 4-VL `7 W i 1 l 10-L 4ems, �t �o �r e,,,-y S ; o �•a �o Le.+.r+ a t o �gg dd v�
1 P s 74X/ 7
Reviewer/Inspector Name t Reviewer/Inspector Signature: �a ��a ,,, i Date: 16 1 q-