310806_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: C3 CCoiance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 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: ' T —�.7't 1 2
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 61'
Certification Number:
Longitude:
Design Current
Swine Capao"acity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
MDesign F Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Dr, P.oultr, Ca }acit
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
MUM
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes VN
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page 1 of 3 21412015 Continued

FacKity Number: K16 Date of inspection:
Waste Collection & Treatment
4. fs 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 frceboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier, L 6*0.1,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25.
3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes d No ❑ NA ❑ N E
(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 VNo ❑ NA ❑ N E
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen�Vb
threat, notify DWR
7. Do any of the structures need maintenance or improvement`? E] Yes ❑ 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 YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NI?
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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?
❑ es
No
❑ 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
VN
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
1 �fo
❑ NA
❑ NE
18. Is there a lack of properly'operating waste application equipment?
❑ Yes
777
El NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MA
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements I] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes YNo ❑ 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 ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [b E] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Yo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacHity Number: - Date of Inspection-,
24.•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZN
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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? ❑ YesVNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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
ffNo ❑ 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
I_J N" ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1V , ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;No❑ NA
❑ NE
Comments(refertoquestion #):xplamt:any.YlS answerskandlorany additional"recamrnendat�onsiorfany atherc�o+mments
Use drai0fib' fifacility.: to• better ;explain situattonsi(useiaddittonal pageslasmecessarx r . p
Reviewer/inspector Name:
Ts
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21412015

(Type of Visit: Q Corlfpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access li
Date of Visit: Arrival Time: Departure Time: County: QyPj2M Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �N ��a M Q—LEA_ Integrator:
Certified Operator:
Back-up Operator:
Location of farm:
Latitude:
Phone:
Certification Number: 22 _09' 7
Certification Number:
Longitude:
Deslgn Current
Swine Capacity Pop.
ean to Finish
Design Current
Wet Poultry Capacity Pop,
La er
Design C*urrent
Cattle Capacity Pop.
DairyCow
ean to Feeder
Non -La er
DairyCalf
!Boars
eeder to Finish
arrow to Wean
arrow to Feeder
arrow to Finish
Design Current
Dt. Pioultt. Ca aci P,o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
ilts
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
her
ther
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ YesjZ
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
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L /No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: �3
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: LAGmw I —L,- -3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C3 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
1 1. Is there evidence of incorrect land application? if yes, check the appropriate box below, ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑
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?
❑Yes
rNo ❑ 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
eNo ❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q NA❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
8�No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNNo ❑ NA
❑ NE
acres determination?
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
No ❑ NA
❑ NE
Required Records &_Docum_ents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ejl<o ❑ 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:
[:]Yes 10 ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
❑ Yes 4W1" ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2,Ko­ ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [g"d ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 6,Ko'/ ❑ NA ❑ NE
Vik'
°.;YES answers and/or:any additional recommendations or;an'y other commentsdra ,,. ... f .. �
wings of facility.ato; 6eft'er5exp,lain,sstuntibiist(gse�additionalpag"s neces_'sary) °. r . , C,
Reviewer/Inspector Name: �j�(�z�sC�,e, Phone( 3
Reviewer/Inspector Signature:
Page 3 of 3
Date: ihl it S
21412015

Type of Visit: (0 Co pliance Inspection U Operation Review U Structure Evaluation () Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner -Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: jo4AT Integrator:
Certified Operator: Certification Number: I I)
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
to Finish
Desirrent
Wet Poultr§!apacity&F op.
Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
UWean
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
'1,1Sn
Design Current
Dry P,ouItr Ca aci Po
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
row to Feeder
row to Finish
7Non-Layers
Beef Feeder
PGilts
ars
Pullets
Beef Brood Cow
her
her
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

acili Number; - Date of Inspection: .1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
E(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA 0 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 ❑ o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes %o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNNo ❑ NA ❑ NE
acres determination?
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 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faeilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 ❑NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes�Z�TN
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes No ❑ NA ❑ NE
❑ Yes Uf/No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ONE
NA ❑ NE
VN
❑ NA ❑ NE
Reviewer/Inspector Name: v /Jtp, P4l j �o(�-� Phone:N(�
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: Q rRoWne
liance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: l Arrival Time: / Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
ILayer
Design Current
Capacity Pap,
Cattle
Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
I
INon-Layer
I EE
Dairy Calf
Feeder to Finish Q
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P■oultr
Design Current
Ca aci P,o ,.
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
I
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State?,(If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes 2;o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: 1 r
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (, (�Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4 ice_ 1 4j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
167NO
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Z/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
reat, 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
L Io
❑ 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
__ /
1 ISO
-777
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [To ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 9Ao ❑ 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 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 ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E KNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes l=J No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;Y o ❑ NA ❑ NE
Required Records & Documents TT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Zo ❑ 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 Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: V1111 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 Eryes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
EIon-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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Wo ❑ NA ❑ NE
Other Issues ,--,�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2e o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ONo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KO ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to'better explain situations (use additional pages as necessary).
Lit c . �)E(Vw
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: lD 3
Date:
2/4/201

Type of Visit: tD Co pliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: WaLArrival Time: Um= Departure Time: L County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:�(A)d
LAW EOL-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 2
Certification Number:
Longitude:
Design Current
Swiue Ca acit—v= Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity P on.
I
Design Current
C►attle Capacity Pop.
airy Cow
Wean to Feeder
Non -La er
I
airy Calf
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
D . P,aultr
Layers
Design Current
Ca acit l;o P.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113cef Brood Cow
Other
Othert I
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier:�L�
77
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
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?
EZ/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No [] NA ❑ NE
❑ Yes WNo [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm2No
al threat, notify DWQ
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? ❑ Yes FZ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ 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?
s
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
g s
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
& o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE .
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ird No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;I/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 YNo ❑ 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 ' '� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ' Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes 0/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 1340 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C21No ❑ 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
EA
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El yes
N
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments , ,
Use drawings facility to' -better explain situations use. additionalpages'as'necessar
g ty P ( / y}�.
M660 �'V efO I*L) INV6
S7MO Jr-41 2613 ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t INA I /'U —
Date:

Type of Visit: 0 rRoutine
pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint O Follow-up O Referral C) Emergency O Other O Denied Access
Date of Visit: I �II�1IL I Arrival Time: Departure Time: County: DUi'tJO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J O M AIMAi 64 Z) ; [XiZ
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: ?.'Tz E2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr. P,oultr. Ca act l;o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impact
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 No [] NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Faciljty Number: 3 I - 964 JDate of Inspection: 112
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: u�r l ( / C."tj 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 y r _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., Iarge trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 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
❑
❑ NA
❑ NE
P5. Does the receiving crop and/or land application site need improvement?
❑Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
fN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FfN o
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
0 <No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
fo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
g/N
❑ NA
[3NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yeso
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: x✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes u 'V ❑ 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 NVN
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
EJ/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
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
Flo
❑ 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
Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rjt
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments'(refer to question #) Explain anyAYES3answersyand/or,any'addiutranal�\ ecornmendations�or`anyy'dtyher comments
Y -«' 9. ^ i , wr.i.-3 J V �, L' ab i '! `Y 'i, j-f¢ G -
Use drawings, of facility to.better explain situations°.(use additional page's asnecessary)� :� ,1; i, t
La CA-t( kM5% IJAAL+T-6US
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rip, 51,0nG-E Fl*l.
aoij PRN
Phonet? , IDi�—'-�3YV
Date:
2/4/2011

Type of Visit: Q 7Routine
pliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance "
Reason for Visit: O Complaint 0 Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /03 D County: IDWL4) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:y a NAT�lArI rn Cf K-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop:
Design Current
Wet Poultry Capacity Pop.
Layer
C►atile
airy Cow
Design Current
Capacity op.
Wean to Feeder
]Non -Layer
,airy Calf
Feeder to Finish
b
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , Pavult , Ca aci P,o ,
Layers
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
[:]Yes j/No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facgi Number: jDate of Inspection:
Waste Collection & Treatment
4'. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
LA L/ L LA6- W3
Observed Freeboard (in): ` q
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 No ❑ NA ❑ NE
❑ Yes CNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El
Yes gNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes [No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s):
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
❑ Yes [3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes UZo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �40 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie' Number: - Date of Inspection:
24.'Did the facility fail to calibrate waste application equipment as required by the perm t? ❑YesZjNo
2;. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail 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 YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ZNO
❑ Yes CZ/No
❑ Yes [�/No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Fo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recomi6endations or.any other comments i _ w"k
Use drawings of facility to better explain: situations (use additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 o'
Date: Ilgi /I
21412 II

Factlfty, Numb`erf$�
5
r Gtinservxtion:
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �,S` Departure Time: County: QQPL_'tk1Region:
Farm Name: Owner Emaii:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `� u�R Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ , = Longitude: ❑ o = , ❑
'i' a� �.•�frr :. ,'g;t a'.�s.:. . &"5� y_:F�y:,'3� t 'S •'k �1 .ha�3t,�.A��.� ; � l�'� � .'S; .d%S': �Y
Design Current, �.,Design�4 Current' ��,�,�e�` DesignCurrent
...`��� ��>,�, Al �::: a:,:�..f,� $�.��`��,.�_Popul„ bit>�,_:�.��:
Swine, t CapacytyatPopulat�orr Wet Poultry }.ation,
tCapacityCattle.4 } t+c,Cap�acaty�Papulatton�,
,,.
.,.
❑ Wean to Finish ❑ Layer )
❑ Wean to Feeder � ❑ Non -La er
�a ® Feeder to Finish
❑ Farrow t0 Wean i�
vUry�Poultry��'�
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Non -Layers
❑ Gilts
❑ Pullets
❑ Boars R
-Ti� S ut 8❑Turke 5x x v A
�g :
Other
�xzv .`, ?gt .iw >'�?. mb .?`i ❑ TurkeyPuults# 4�
❑ Other ❑Other Nu{m3be of Struc_ tures ; ? y
R „— ac .�2T7 ":x "1.-,. P i t. -74T
q
❑ Dairy Cow
5
r Gtinservxtion:
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �,S` Departure Time: County: QQPL_'tk1Region:
Farm Name: Owner Emaii:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `� u�R Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ , = Longitude: ❑ o = , ❑
'i' a� �.•�frr :. ,'g;t a'.�s.:. . &"5� y_:F�y:,'3� t 'S •'k �1 .ha�3t,�.A��.� ; � l�'� � .'S; .d%S': �Y
Design Current, �.,Design�4 Current' ��,�,�e�` DesignCurrent
...`��� ��>,�, Al �::: a:,:�..f,� $�.��`��,.�_Popul„ bit>�,_:�.��:
Swine, t CapacytyatPopulat�orr Wet Poultry }.ation,
tCapacityCattle.4 } t+c,Cap�acaty�Papulatton�,
,,.
.,.
❑ Wean to Finish ❑ Layer )
❑ Wean to Feeder � ❑ Non -La er
�a ® Feeder to Finish
❑ Farrow t0 Wean i�
vUry�Poultry��'�
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Non -Layers
❑ Gilts
❑ Pullets
❑ Boars R
-Ti� S ut 8❑Turke 5x x v A
�g :
Other
�xzv .`, ?gt .iw >'�?. mb .?`i ❑ TurkeyPuults# 4�
❑ Other ❑Other Nu{m3be of Struc_ tures ; ? y
R „— ac .�2T7 ":x "1.-,. P i t. -74T
q
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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?
Page I of 3
❑ Yes LLJ No ❑ NA ❑ NE
El Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
�o
❑NA
❑NE
❑ Yes
LJ No
❑ NA
❑ NE
12/28/04 Continued

Facili(y Number: — Date of Inspection 4 -�
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 Struuctu_re2 Structure 3 Structure 4
Identifier: i.A r� I LA&.aJ Z- LA froz9J 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G o S�
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 E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [; No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? U Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenanceli mprovement?
❑ Yes ZNO
❑ Yes ZNo
El NA El NE
El NA ❑NE
❑ Yes L/J No ❑ NA ❑ NE
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?
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
ZNNo ❑ NA ❑ NE
13"NNo ❑ NA ❑ NE
V)o ❑ NA ❑ NE
RI No❑ NA ❑ NE
o ❑ NA ❑ NE
i S-z� �6 y 'Jb '
G,om en s�(refer to�quegs#t�ton #) Explamiany .YES answ and/or'+any reco$mmendat ons,or.any.other: comments. f n,
iJse,dr8wing5.Uf`faClllty<tobetter explain s�tuations',(usetaddirional pages as pecessarFy t rev
�,�:.'�a��$'#b�.��.�'i�,� . ' i*_• a4 ,�!>&��, fit. _ �. ��a � , . ,�
'� � t.At'r�� � I-yt^�bs Wtit4tc� a G2.AS:S CovE(L,
�
Reviewer/Inspector Name ;( is , Phone: io WC
— 3
Reviewer/Inspector Signature: Date: r1' 74]b
Page 2 of 3 1 12128104 Continued

Facility Number: j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D N ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE.
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
QTo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain InspectioneNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Id No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Io.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[; N
El NA
EllNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'j
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
NoNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C31N'o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional'Comments and/or Drawings:
Page 3 of 3 12128104

3;- H 8a.
Type of Visit o Pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit7Roou�tine 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: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
�e�-
Onsite Representative: � T_
Certified Operator:
Phone No:
integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e =' = " Longitude: = ° ❑
Design
Current
Design Current
�__urrent
ity Poapacity
❑ Layer
opulation
❑ DairyCow
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish Q
to OA
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
El Layers
❑ Non -Layers
❑ Pullets
❑ Beef Stocker
❑ Beef Feeder
[[]Beef Brood Cow
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Points
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
nlNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
ElNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 31
Date of Inspection 4 a
,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: LA(�tJ i t-Acy 2i , t-i"t/&o&yJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 5
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 2(NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes KNZNo
❑ NA El NE
[I Yes ❑ 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 12No ❑ 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/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2/No ❑ NA ❑ NE
maintenance/improvement? ,,��,,//
11, is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes [2/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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Is lack
❑ Yes
[INA
❑ NE
18, there a of properly operating waste application equipment?
Yes
ElVNo
❑ NA
❑ NE
` .;3; t V� �;� tv ' ki`:� �� *,Vk� s� �'�� mk�kv
t tomments {refer to ueshon # Ex fern anlyYAESfanswerstandlor. an recommendations or an other comments.
TLy� q7p� Y�r�����aY.�'�� Y a
Use dnawmgsofsfaulitynto�better exptam .s�tuat�ons.g(useaddrtiunal pages as necessary.):
r►
Reviewer/ins ectorName - V - -- o - - �._� _ -
Phone:�?fZ� i96 -�]
P �J J 14 f
Reviewer/inspector Signature: Date: r5`j
AaruP 2 of 3 12128104 tonlinued

i
Facility Number: -g Date of Inspection `t G
'Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes L/ I No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
� o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
[INA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dN o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,�
2! 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
L!/ 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
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

11
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 'j p Arrival Time: /b O (] Departure Time: County: �4rh) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: So1441k.j Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o = = « Longitude: ❑ ° = 1 ❑ „
l
esi n spesagn. ). rre"'Des' 4:{ Cur`retny
t;,"DurrentC
Swine Capacity Populatton VVet Poultry Capiia PopUlation 6Y b Cattle , q w, +� Capacity P;opulatson� 3
:`❑ La er
3` h.
❑ Non -Layer
w•
44 i1Dr ,Poultry ,e�
�. }.
p' , �. #'1i,4: 'tti."a�44`° 6-� ''k i. � lit
�i4Other��:441"�S',:a s_s. `ems__. .`��i%'
❑Wean to FinishWean
to FeederFeeder
to Finish❑Farrow
to Wean❑Farrow
to FeederFarrow
toinish❑GiltsBoars
❑Laers
❑Non-Laers❑
Pullets❑
Turkes❑
TurePoults❑
Other
❑
DaiCow❑
DaiCalf
❑DaiHeifer
❑
DCowNon-Dai]EI
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharg& Stream Imacts
1. !s any discharge observed from anypartoftheoperation?❑YesNo
❑ NA
❑ NE
Dischargeoriginatedat:❑Structure❑ApplicationField❑Other
a.Wastheconveyanceman-made?❑Yes❑No❑NA❑
NE
b.DidthedischargereachwatersoftheState?(Ifyes,notifyDWQ)❑Yes❑No❑
NA
❑ NE
c.WhatistheestimatedvolumethatreachedwatersoftheState(gallons)?d.Doesdischargebypassthewastemanagementsystem?(Ifyes,notifyDWQ)
❑Yes❑No❑NA❑NE
2.Isthereevidenceofapastdischargefromanypartoftheoperation?❑Yes�❑NA❑NE
3.WerethereanyadverseimpactsorpotentialadverseimpactstotheWatersoftheState❑YesILINo❑NA❑NE
otherthanfromadischarge?
PageIof312/28/04Continued

Facility Number: 31 — 6G
Date of Inspection a d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo ❑ 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: LA CrobN L/16vzfr✓ L LA[,t,/ .2,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , $-� ��� 5T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[!fNo ❑ 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
E�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1
iNo ❑ 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
tNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[2(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
U No
❑ NA
❑ NE
Comments (refer to question #,}; Explain any 1'ES answers antl/pr any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}:
Reviewer/Inspector Name
Phone d R 3
Reviewer/inspector Signature: .h Date:
Pn 7 -r 3 17/7RIA1 ("nniis�uod

Facility Number: 404 Date of Inspection 7 a
r
Re `wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ld No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LT No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
El"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
eNo
❑ NA
❑ NE
23.
If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q<
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RJZo
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L�
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z 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
111
❑ 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
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�(No
❑ NA
❑ NE
Page 3 of 3 12128104

1i
Division of Water Quality
r Facility Number 0 Division of Soil and Water Conservation
r. 0 Other Agency
Type of Visit Co (lance 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: eir 07 Arrival Time: 6 Departure Time: County: 04 L-Vol Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 0 oA16194 Uk9— _ �. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = ' = Longitude: = ° = t = "
Design. Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Ltv G DQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy 1-leifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
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 O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VN
ElNA
ElNE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: ,3 — (}�, Date of Inspection
f) Waste Collection & Treatment
_,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes C No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1,P 6- I (- A ^� _ {�G� r.I _3
Spillway?:
_
Designed Freeboard (in): 1y. S� %g, l �, S
Observed Freeboard (in): S ,i S Ly
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes &o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes f 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 th at, 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 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,_..,�
9. Does any part of the waste management system other than the waste structures require Yes L 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 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑/o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ YesE;X�,
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
b'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[), o
❑ 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):
dT) copy ANA"T car 7 SToGl rvc -9
0660 P,94 re- s� ✓a� 6 :!I/ GAGaa,v 3 'o C# ✓J
Reviewer/Inspector Name VIA/ AA Phone: 7 ` 7 3 ��
Reviewer/Inspector Signature: Date: 0 16 0
/ 12128104 Continued

Date of Inspection
Facility Number:
r,
Re
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
E�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
CJ 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.
0 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Week y Freeboard ❑ Waste Analysis ElSoil Analysis [IWaste Transfers
Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes.
No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L�J N
❑ NA
❑ NE
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?
Additional Comments and/or Drawings:
❑ Yes ONo ❑ NA ❑ NE
❑ Yes L�N ❑ NA ❑ NE
[I Yes ��No
[I NA El NE
[]Yes ❑ NA ❑ NE
Cl Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
12128104

lFa..iity Number
Division of Water Quality
SQ0 Division Hof Soil and Water Conservation
-- 0 Other Agency
Type of Visit le -compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit( 0 outine o Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time: County: Region:
Farm Name:
AA
7 It /%
Owner Email: _
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Via i1 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = = « Longitude: = o =1 = "
Design ;Current Design., Current E, Design Current
Swine �' Capacity Population .Wet. Poultry ,Capacity. . Population Cattle Capacity Population
❑
Wean to F pish
❑
Wean to Fe der
❑
Feeder to Finish
❑
Farrow to can
❑
Farrow to Feeder
❑
Farrow to Ilinish
❑
Gilts
❑
Boars /
r
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouifs
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Broad Cow
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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ 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 ❑ 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:
Q,l
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 ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) F &L/— —
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Ex plain any YES answers and/or. any recommendations or:any other=comments
Use drawings of facility to better explain situations., (use. additional pages as necessary):
c 6Ge y1dc's
-
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/,18104 / Continued

'!Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate 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 jamonthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4�lWec Cl)
a 3 0 � 3.0
2.e
[3) z s- 3 ,1
Cd) 3 �
Lt_o
.3 ��erf lead,
J �
Page 3 of 3 12,28/04

31
❑ Wean to Feeder
Discharges
Feeder to Finish
� av
S Oa1.
N
Type of Visit Q5 7Routine
'pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I I L3'b I Departure Time: f 32,5 1 County: 01_Psri
Farm Name: tJ ito, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GC—NaEN I�, D
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Humber:
Region:
Location of Farm: Latitude: [= e = , = 1, Longitude: = o =1 0 11
4 D Si n CurrentF Desi n , Current' "�AM
Design;`` Current
g rs� g =�
Swine F . ;Caprac�ity Population Wet B;ouliry Capacity PopuiatonCt�tlel 11i pa�cety�Pkop�ulation
❑ Wean to Finish ❑ La er ❑ Dairy Cow k
s�
❑ Non -La er ❑Dai Caif
€. ` ❑ DairyHeifer
❑ Farrow to Wean 1Dr6y Potiltryr' ❑ D Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets 4"
El Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Puults y
g' i 1
❑ Other ❑Other Number o.f Structures
&Stream Impacts
Is any discharge observed from any part of the operation?
El Yes
[� No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made'?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Q''qo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
12/78/04
Continued

Facility Number: 3
Date of Inspection 4
-'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: LAEch>a I L.AGvDoJ '?, C,AGrmd 3
Spillway?:
Designed Freeboard (in): Vy I t ­L .�
Observed Freeboard (in): thC. t lCo _kld
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 ENo ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo. ❑ 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 2 No ❑ NA ❑ NE
maintenance/improvement?
I I. 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 Drifl [I Application Outside of Area
12. Crop type(s) CJ W (36a M UDA CC,) �Gy
13. Soil type(s) LV A KA A M CC, Ada L- i j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Eryes
[I No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]Yes
L 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
No
❑ NA
❑ NE
l 5 (Z6 vUov & D -o Na ,? - t" " F-Teu!> ­ I .
�. to C 4 ? tafi,war ro W W a-rN 2E Ga (Lo S.
Sy.A At_t, T czE E S a,� s L.Al�cxar.? ~L i is ra tc ( twat c D
Reviewer/Inspector Name 6 tJ Fla ,rv�� �'`.y' . ;b" u Phone: (49W *jqo� 4C Zo3
Reviewer/Inspector Signature: Qa Date: /0 S
12128104 Continued

Date of Inspection
Facility Number: 3 f —8 p I r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ Wi1P ❑ Ch klists ❑ Oth r
❑ Desi n ❑ Ma s
Yes ❑ No ❑ NA ❑ NE
❑ Yes [%No ❑ NA ❑ NE
ec g p e
21.
Does record keeping need improvement? If yes, check the appropriate box below.
IJ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
LJ No
❑ NA
❑ NE
24.
Did the facility fail to. calibrate waste application equipment as required by the permit?
❑ Yes
NEo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L'J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ N
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[ to
VNA
❑ NE
Other Issues
28.
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Did the facility fail to dispose of dead animals within 24 hours and/or document
❑ Yes
[f�No
❑ NA
[--IN E
properly
13 Yes
NA
❑ NE
and report the mortality rates that were higher than normal?
VNo'
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
AddEhonal Ci uimenfs an&6r,Drawings
I2128104

Date of Visit: / Z% 4Si Time: /ZN�A�1
Facility Number
Not Operational 0 Below Threshold
Permitted acertified [3 Conditionally Certified 0 Registered Date Last Operated or A ove Threshold:
Farm Name: ,_„/_'� �r� County:K / '�
Owner Name:
Mailing Address:
Facility Contact: `rifle:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No.
Integrator:v�"
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 a LL Longitude 0 6 Du
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish G ®/
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
:Holding Ponds/ Solid.Traps F
Design Current Design Current
Poultry Cavacitv Population Cattle Capackv Population
❑ Laver I I I[] Dairy
❑ Non -Layer I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
L❑ Subsurface Drains Present 110 Laeoon Area ❑ Sorav Field Area
.1, LLI No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 ,_' 2
Freeboard(inches):3
05103101
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facility Number: &— Date of Inspection 4
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?
❑ Yes ❑ No
❑ Yes ❑ No
OYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑A Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type G!✓,S �/3!/,, �c/G1 / r C%iGc,.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15,
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conidients (refer3 td question ti) Explaln any YES $nsrvers and/or;asty reconimepdatiops or anv other comments., F N ,
Use:drawtogs of faci]Ity to better explat>, situations:' (use addiaonst; pagesAs necessary) Field Conv ❑ Final Notes'
4�%reeo *eel -fo ,6c rc�.ve-.� s7� a-1Q �A 6«� $.�� �4 l.��a�h 'rZ,
/ffurl $Ap}T O A ^ 50 o //�!� /// R! yi o Ad ll4f'ro A# " 674 ho -7 3fa L .6-A* 4 /G
.
Gt0/t t � 4 7�L i �! � V� �%�OW G��[ (/ ��� S 7i1 �t �f�� � �l/�t •[�Q .
l
lZeel A /k1.i� V
yP
Vf� `P�r` IO 7,d
Reviewer/Inspector Name t '�,� . ;, � �, , �� ,. i` .E '' ". , ea a �•
Reviewer/Inspector Signature: Date: ! Z
O5103101 r Continued

r
• Facility Number: Date of Inspection
Odor .Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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 Cl No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover`? ❑ Yes ❑ No
l 1pRa Comments and/or rawingq :x. '..i''Qt` # "" .'
7
3/23/99

Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit & Routine 0 Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facilih• Number 3 I)atc ofVisit: *� � r?Z -rime:
Not Operational 0 Belon T reshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered pate Last Operated or Above Threshold:
Farm Name: „�T�—ti-.� Conntv:
Owner Name: - `�� `P iC - -__- Phone No,
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: +° Integrator: c:!:2/ia%_
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' ' " Longitude ' • N
:-Design Current,
Swine : `Capacity -Po etlation iP�
r ❑ Wean to Feeder
FderFinish
.7; ❑ Farrow to Wean
` ❑ Farrow to Feeder
❑ Farrowoinish
❑ Gilts
a ❑ Boars
Design Current DeAgn Current..;.
uitry •: Ca achy, 'Po ulatioti . Cattte T Ca aci = 'Population
Layer ❑ Dai
Non -La er ' ❑ Non-Dai
;�❑ Other r,• r'
f
Total+Desi&kCapaci-Y.
z
otAISSEW
;)
.t f ❑ No Liquid Waste
Present
.u.
12ischarges & Stream Impact
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, notif}, DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes El No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & T-re-atment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [9No
Structure 1 Structurc 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (inches):
05103101 Continued

.T.L-
Facility Number: 3% — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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? l
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required, maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes it No
❑ Yes 9 No
Yes ❑ No
❑ Yes No
❑ Yes allo
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
11. Is there evidence of over application? / El Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 4 No
12. Crop type A --or, /< ! "
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Irl? No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes allo
c) This facility is pended for a wettable acre determination? ❑ Yes R No
15. Does the receiving crop need improvement? ❑ Yes 4 No
16.
is there a lack of adequate waste application equipment?
❑ Yes
Cj�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, traps, etc.)
❑ Yes
Z No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Uq'No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
21.
Did the facility fail to bave a actively certified operator in charge?
❑ Yes
`mot Ne
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[jjNo
.23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(RNo
.24.
Does facility require a follow-up visit by same agency?
❑ Yes
5�No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.gNo
113 No violations or deficiencies were noted during this visit. You will receive no furtber correspondence about this visit.
r�tg,«.� �rCftffi,
(linttum oner3tvn .Ja�dlnr xecommeages❑Field CovY !nal
CL mo
411
4a-1-.,A A44-e-
Reviewer/Inspector Name sii '' ,�.. ` '„ f� IN
Reviewer/Inspector Signature: Date:
r'
Continued

facility Number: 3 —1WG Date of inspection
d ss es
Q ox
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
i
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
K[No
❑ Yes
R].No
❑ Yes
t No
❑ Yes ® No
❑ Yes ® No
❑ Yes [M No
❑ Yes DRrNo
Addilimual�_��6mments�sndlor�DrawJn � " "
05103101
/I
05103101
/I

Facility Number Date of Visit: '^V Time:
O Not Operational O Below Threshold
Permitted 13 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ..`.`i. r...... .... County:..............a..............................................
..... .................................................................. . ..
Owner Name:
Phone No:
FacilityContact: .............................................................................. Title:............,,........,......................................... Phone No:
MailingAddress:........... ................. ................................................---.-•--........ .- .-.--•--.-.................. ................... ..........................
i L
Onsite Representative: ... ...... ...........I ............................. Integrator:.....` �................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • 4 66 Longitude • d «
-Design , Current
Cs` aci ,. Ptipulatidn'
❑ Wean to Feeder
Feeder to Finish
t7Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current „ Design Currc
Poultry Ca itci Fo'' tilatio CiiEtle Ca' aci :. i Po i alai
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total DeMga Capacity
,Total SSLW,
Number"of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JL3 Spray Field Area J {_�
k
Holding Pouids ! Solid Traps ❑ No Liquid Waste Management System i
Discharge & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. It' discharge is observed, what is the estimated flow in gal/thin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes W No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes KNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Af No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.........I+,—?........................I �`.1.............. .......... ?.-'..r........... .................................... .................................... ...................... I ..........
...
Freeboard (inches): �C) 3 4 3 p
5/00 Continued on back

[Facility Number: — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes )I
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?
t4 Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
01Yes
1KNo
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 maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
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
A No
16. Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
KYes
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes
(ie/ checklists, maps, etc.)
,KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Kio
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
RNO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�;fNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
No •Yt0fpki}4ris.ofi il$ 10600M ware 00e4• 00109 S.05 t; • Y00 IR- eet' W 00 further
ror'res• otideir & A66f this 'visit:
Use `dirarrings;of facility to.better eaiplaih'situations °(use;ailditional pages,"necessary)p
It
�►�` �-2 ��, 5 -e�c� ��-•�',•� �.� l h off+--�- .
�— � �•. ice. �i �. 2—� �
Reviewer/InspectorName A Cf ;:ts�.fr
Reviewer/Inspector Signature: Date: 5/00

Facility Number: 4061 Date of Inspectionf="
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments oil of rawings:. i
❑ Yes ❑ No
5/00
J

a Division of Soil and Water Co'A's' a4an tOperat>iomkeview
,.i � t rI i � u � tNra #'+t
9 � Division of Soiland Water'Conseryabon Com Nance Ins ectlonG= z ah * °!� �i'.'' 1 r'
EY1SlOn Of Water QUallty COillp]ialACe YnSeCtlOn
OOtherAgency Operat101ReYieW
Routine O Com taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection j}
Time of Inspection 24 hr. (hh:in
Permitted 13 Certified 0 Conditionally Certified 0 Registered Not Operational Date Last Operated; ,,,,,,,,,,,, ,,,,,,,,,,,,,
Farm Name: `'. % z�S.:S. %'�. County:.......... .�`i...................... ................
...........1............. /
OwnerName:...... 110A.........f:!.............. ..: ....\' .1`............................................... Phone No:.......................................................................................
`PILL ,; H r / Phone No:
Facility Contact: .............i�...............Title:.''"S.:YL�?'tQ-I���......k.. ...
MailingAddress: ........................................................... ...............
Onsite Representative: f�-. Intc rator
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
i
.. _..................................... .. .. ...................... ..
Latitude 0° Longitude 0 6 44
Design
Current "'1° Design
Design Current '
,' < ;
Swine Capacity
P1. , : ,
Population Y' _ Ca acit P6".ulation Cattle
Capacity Po `ulation .,,
❑ Wean to Feeder.
❑ Layer " ❑ Dairy
Feeder to Finish
,`., ❑ Non -Layer ""' ❑ Non -Dairy
❑ Farrow to Wean
:., , .,
❑ Farrow to Feeder
❑ Other
r
❑ Farrow to Finish
Total Destgtl C�pa6ty
`
Gilts,
ISSLW'
•`
❑Boars
f '' 'r TOW
'�Number of�Lagoons-�:
'., �' ❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
' iHolding'Niic / Solid'Trap s
�_
❑ No Liquid Waste Management System
Q g Y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'? (11'yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/ruin?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [KNo
❑ Yes ONO
❑ Yes 4No
,(� St ucture i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
6M °s �� l-6 ws.,r 3-c..r /frit.� s .- fr
Identifier:`, �&t� a 3
If
Freeboard(inches):................................................................................................................................ I...........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — oe Gate of InspectionOU
5. Are there apy immcdiate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes 91,No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an '' \
immcdiate 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 maintenancelimprovetnent? es No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes �kNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes P&No
12. Crap type I!.".I.}................... ....:.......L...��i,.,.,..........,.,.................................. ...................
�' }......
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KIo
14, Does the facility lack wettable acreage for land application? (footprint) ❑ Yes KNo
15, Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes RN
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONo-
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes D�Vo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes io
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes NNo
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes X�'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0
24. Does facility require a follow-up visit by same agency? ❑ Yes �'No
:1Vo.vialations.or. deficienrit�s .were noted during .this visit:. Y'oti vvill.re� eive no' fiirilier . .
• et�rresP6ddence' about' this visit.; .......:.:.:.:.:.:.:. • . • .:.:. -. -. - ... • . • ..... -
Comments (refer to question #): Explain any YES answers afiWor any;recommendations or ariy other comments ! , �
i'
Use drawengs'of facility t better explain situations. (use additional pages essary) '
as nee ,
I .,
;6 i X>Ifsl V6V/ s 0, 0� sty
So
'7 MLO - �'
S //, ills / �s .� /".mac
la
?� z7 Ae ca.,,tic 01 rrJb.�i, ►� c6,
�r� �ahC �r/ua_r G�Y.G �ci.rfi
Reviewer/Inspector Name
ReviewerAnspector Signatur t Date: — 11/6/99

Facility Number: —
Date of Inspection
Odor .Isstius
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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
UNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ YesN0
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
kN-0
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/E�,No
31.
Dt) the animals feed storage bins fail to have appropriate cover?
❑ Yes
JC�rNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
34yes
❑ No
Xdditional Comments an or rawrngs
T
3/23/99

Type of Visit 0 Compliance Inspection 0 Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine *Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 31 80b
Date of Visit 3/17/2000 Printed on: 3/23/2000
Not Operational O Below Threshold
Permitted M Certified ❑ Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
FarmName: NA.T.)hum.1-1 .............................................................................................. County: D.upUa............................................... ..IRQ.........
Owner Name: IYA1.A.Tam.......................... Whitficld.................................................... Phone No: Q.I Q.:1,2£: X1} .ux.9�9-515 -2 2�.......................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:29.5.4.NC..111.,&.20.3............................................................................ A1b.cxftaU.N.0 ........................................................ 285.011.............
Onsite Representative: ........................................................................................................... Integrator: CarmlKA.Foads.1m ...........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
.......................... I..........
® Swine ❑ Poultry ❑ Cattle Latitude 35 • SS 01 ' " Longitude 77 • 52 ' 30 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/miW
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes ❑ No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(inches): ............... -12 ............... ............... -16 ............... ............... 3.0 ............... ............................................................................................................

Facility Number: 31-806 Date of Inspection 3/17/2000 Printed on: 3/23/2000
5. Are there any. irrgnediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancc/improvement? ❑ Yes ❑ No
4. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application.
I0. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
[] No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage &. General Permit readily available?
❑ Yes
0 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
14. 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
[j No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
O No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
4 N6-i i;olaii6ii dr'def'rciericies'ivi!re:rioieA'du'n*hk iiiiiwiiii:. Wti ivflfreceh a irn hift i&
.'.i'wn�efialrinilt�rici� ahrti�it'tRi�•taisii.' • .
dom freeboard check. Also received complaint from the Neuse River Federation that this facility had been spraying in woods, near the
Cape Fear River, which does boundary this faciliy. During my inspection I found no evidence of a discharge. There was no spraying
ig done upon arrival, fields although were very saturated due to heavy rainfall the night before. All gun and reels were pulled in, and
-aced to be sitting in suitable locations for spraying events. All fields had good cover.
Q will continue to monitor site and request all spray records.
Reviewer/Inspector Name

•
[3 Drvjsion'of.Soil and •Water Conservation - Operation Review:,
n ofSod and Water' IospecEion E fr'i
oo�mpliance
Division of Water Quality.-.. Inspection ;
=.O�eratiori Review .. E
IR Routine 0 Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC.review Q Other I
Facility Number
I)at:e. of Inspection R
l'inre of Inspectiorr 1 OO 24 hr. (hh:mm)
Permitted 13 Certified © Conditionally Certified 0 Registered 113 Not Operaational Date Last Operated:
YIV
Farm Name: ................N+.Z....Virt�.................... .... County,................. ...................
} 1...........`....................................... ,.... ..
Owner Name:......4 ..L....'�:..TR!"............. ni.1,. �1.3.......................................... Phone No:.'�'�`..���.,..?`�.t!aE.�i34.4 ............................
FacilityContact: ..............................................................................ride:................................................................ Phone No:...................................................
Mailing address: ...........(?...$Q......... 1�R.... a.(I t.Nor...................................... ..Zf�7.i'�,.......
.................................................... ..... , ..... .....
Ir
Onsite Representative ........... D!1qj........ a�Y?�1.............................................. Integrator:....... CD.lY.01�..S........................................................
Certified Operator: ...... . ........................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
.1.=A..................................................... I..................
Latitude"�° ��° Longitude
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
JE1 Layer
I
I❑Dairy
Feeder to Finish
c 0p
4
❑ Non -Layer
I
I
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity IGLIOO
❑ Colts
❑ Boars
Total SSLW
Number of Lagoons I L ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)'?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-tnade?
b. 11'discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treat►nent
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freeboard (inches)
Structure I
Structure 2
Structure .1
Z
3
8.................................IM-1...........................
y...-............
Structure 4 Structure 5
❑ Yes VNo
❑ Yes 0 No
❑ Yes 7No
fJ JA
❑ Yes [PNo
❑ Yes 1p No
❑ Yes (A No
❑ Yes t5l No
Structure 6
1 /6/99 Continued on back

Facility Number: —to(o Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, �—�❑—Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes �No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
[gNo
Waste Application
10. Are there any buffers that need maintenance/improvcment?
❑ Yes
V3 No
11. Is there evidence of over applica�-tt[ion`? ❑ Ponding ❑ Nitrogen❑t
Yes
®No
12. Crop type ..........C91f ...h T...., �f1 ................. .Ctt411Qrn ........SIh l�....�ta,tn ........... Sum11^411r.,PfinUn
.1....,..ln?u.1�W....o`l�tl l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
29 No
14. Does the facility lack wettable acreage for land application? (footprint)
® Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
® No
16. Is there a lack of adequate waste application equipment?
❑ Yes]
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0No
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
(FNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Pa 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 certified operator in responsible charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency'?
❑ Yes
:No
7Vo.vI atI ns •or. deirk. ktieies Were nofe'd during .tfiis'visit:. You w' j)freMve nu further
• • et�rrespbndei�ee: tti,boitt: this visit.: ::: ..:. :.... .::::. ....:::::. ... .
Comments (refer to question„#): Explain any YES answers and/or any, "recommendations or any other, comments ",
e;
Use drawjn s,of facility to better'e essay ; .
V� �
g tT zplainsituations. (use additions! pages as nee' y)_ «,
1. S r».w�. wirsianac -;o �c.�oa� 3 5ou��j %e �t�aircc�, &Grt a}yeas a� t�z ��� •
$, Ltx,3 aYctks ir. be
SWr1��y ah�ulc} if�cJt o�tade _ct,,c� tt�su�ec�.
7 �wv1ev� +t35 ct5lf� a4 Nrv,'t 0A
poll lb 1 1-f-4 a SkOA 6e. 06StWE� . In/aL. " Z715'041
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ��a 1 /6/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
InRoutine IQ Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection .0 24 hr. (hh:mm)
0 Registered q Certified 0 Applied for Permit a Permitted 0 Not O erati I Date Last Operated:
FarmName: ........... 14... i:..T......... .N.ry......... �.71................................................................. County:.... thq.k L........................................ .......................
Owner Name:....... N e.,\-k...3:6h ............ ...
n+',A�It11�%.'ia.o........................................... Phone No: ..Cin).?�is::1�.1.............................................
Facility Contact: ...........TAt......... Tt.kl(1................... Title:................................................................ Phone No:...................................................
MailingAddress: ..... ?..Q.......2Y..... ..........,...........................................I..........I................i ! Y,...i{i1L.+..%1%Sl........................................,?83 ZL.......
Onsite Representative: ....... �)S�(!4�...............LhA.r ASar............................................. Integrator: ...... Cn..m..l.I3...........................................................
Certified Operator:..........................................................`..................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude 0'=,=11 Longitude =0=,=11
�• � Design ,Current Design `,<,Current, a a Design Current
Swme '.gapacity Population Poultry Capacity Population 'Cattle Capacity population
❑ Wean to Feeder 10 Layer �I. ❑ Dairy
Feeder to Finish &40 ILI Non -Layer I on -Dairy '
W ❑ Farrow to Wean" f -
'' ❑ Farrow to Feeder ❑Other 4,��;
❑ Farrow to Finish
,Total Design Capacity �
❑ Gilts "r
❑ Boars Tot
R
al SSLVY
y4Number of,Lagoons / HoldmgTP nds a0 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
r lr f 3 _..
r ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes 51 No
❑ Yes 0 No
❑ Yes No
NIT_
❑ Yes (ANo
❑ Yes No
❑ Yes No
❑ Yes T No
❑ Yes No
❑ Yes No
Continued on back

's
FaciUty Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures oons.Holdine Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: j 2
Freeboard(ft): .:............. ........... ..fir 7.............. ........ z...................... .................................... ....................................
.............. .......................
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?
t@Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .........ac!r..........w s
C t..............&aj. a...........................tU!axwvd.v!.............................................................
...I........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement? P Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes No
22. Does record keeping need improvement? Yes No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VJ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes IM No
0 No.violations-or deficiencies vere`no'ted during this:visit.• .You.will receive no further
correspondepce about this.visit
(refer to question #) :Explain any YES answ' ers and/or any recommendations or•any ether comments.`
wCotruiaepts
Use drawings of facility to..better explain situations (use additional PagcS xs:necessary)
. ,
iZ. eb,.�n�� t�vt� � �e�� a ;,�, �..�ti df la��►. �-z , o�i� a��. wa1� o� �a�o,� �z
%�%ZA �e MOWCO, F 5�0\% or, (c,ro,
!$ kkAZA- iu.y_ • eyyhuk is we(1 es�,.�,�+5�+cr1 {�;.� Svrnrtti►r se �rti,ee p� l` I�SPG Y �
gvx eG rkc)n .
7/25/97
// g�
+/y� �''�}..:' "' , s 3a ��' r `•z Y C". .3 ri 3 �' ;ix' .. °'ti'.,�...'' 2 �•�� -; �'
Reviewer/inspector l�amk
Name
Reviewer/Inspector SigtraturJeJ: Date: 3

�� '❑ DSWC Animal Feedlot Operation Review
P
' k : ijq DWQ Animal Feedlot Operation Site Inspection
X.
... . .__ __..,..w... w..., w... ,�
10 Routine O Complaint O Follow-up of DM) inspeetion O Follow-up of I)SWC review O Other
Date of Inspection q p
Facility Number ��
Time of Inspection t l�=�J 24 hr. (hh:mm)
C1 Registered ©� `Certified 0 Applied for Permit 1A Permitted 0 Not Operational Date Last Operated:
Farm Name: ....... i.V. ..T....... f..rh....... �.'..k................... County:
I----�� f..� �y�_ ......................................
Owner Name:.......f.'.t.i.........10tn........... �!�'•Y•t;�'G( ... ... Phone No:..�i0�:,.�? ..... +,
Facility Contact: ...wSJ(I A......S..IA� Q.i....................... Title:..............:Al1rAhjGjCl`'..:.:......:.,........ Phone No:..{..g�d�Z-.fk'�. +2..........
Mailing Address: ..... PC) ... CAR,x... 3.2z.......................................................... ... €�...Y_ . ................................... ..zZ%J7......
Onsite Representative: ...... .W... wt....... •.11W.MP-SLR-A............................................ Integrator ........... C.r,Y'AD..L................................................
Certified Operator;.................................................................................................... ...... Operator Certification Number,.....1 ....:
Location of Farm:
..................orn...... 4.e,kV1n!W.J. ...... 4A ..... ... .tmn..... Lf .or 6 !&K
13.....Q....... ! >n.....I!'. ....or... ...... r .. l .... cwr.,>n....,v.s�......Q., ►t.�l ......ate........ -.. r�.e:....Cl.e.L................................. W
Latitude • ' 4� Longitude ` 4 46
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 10 Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
,Total Design Capacity
Total SSLW
Number of Lagoons 1 Holding Ponds ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes'
WNo
2. Is any discharge observed from any part of the operation'?
❑ Yes
1�@ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`'
❑ Yes
M No
b. If dischar4-c is observed, did it reach Surface Water`? (If yes. notify DWQ)
❑ Yes
53 No
c. If discharge is observed, what is the estimated flow in gad/min?
d. Does discharge bypass a lagoon system'! Of yes, notify DWQ)
❑ Yes
M 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
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
mai ntenanceli mprovement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
fWNo
7/25/97
Continued
on back

Facility Number: -S
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes 2 No
Structures (Laeoons,11olding Ponds, Flush Pits., etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes gNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: �,'� 2.!..............:.. ......... ...................... ........ ............... ....... ............. I....................... ......................................................................
Freeboard (ft): ............................. ............... 4-1.3............. ..........Z. �..,.....,
10.
Is seepage observed from any of the structures?
❑ Yes
allo
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
CRNo
12.
Do any of the structures need mainten ancelimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
6� No
Waste Application
14.
is there physical evidence of over application?
Yes
If No
(If in excess of WMP, runoff entering waters of the State, notify DWQ)
15.
Io-r
Crop type ......... CDa:s'>rA�,_.- ]2.Y.Yt viL............................................ 5..agI.eans............................ Wy :L'j..................
M.i.tllt�.....
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)`?
[ `Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
S No
20.
Does facility require a follow-up visit by same agency?
Yes
04No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[A No
22.
Does record keeping need improvement?
J$Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes MNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? (:]Yes ;RNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes PQ No
No violations or d'iciencie's.were-note'd•during' this. visit. You:will receiwe-no further
correspatidehce &out this:visit:., '::
Corn rents (refer to question #): Explain any'YES answers.and/or any�recommendations or any other comt&nts.'
F
Use drawings of facility to better explain situations. {use additional pages as necessary): :
1z low ums cknwr in ?ties itn Gagoov, %+z 560 be AOU wA_ c,&y aJ Krceded. `
Urwc). wrMs or, i mu,r OJ I of 10�M, 5*4 s6u(( 6t Ahtj A),* cfI'm
CWJ reseeM,
,t -,Os -Slued be- reietQ. `irrees opi oCl6 wo} R of t,(woen 3+4 Je rerrtovc
14- i iwk t-ot,% s� , n YvA "t) ova edge 4 wac, s. N 0 y vrt04j e. � w4a-)
tz-``R:se�rl_t�fvr� er arn�n I -to atn �U;tkrt)n,\
rr� Zl b!Q 1a.&IJ Or+ 5�1 I1�CQr�S. 7/25197
frnn . M,( I i t O r w Pr, i to 4 Pjli h � I w� OL e) 534 Y� , 'A Alt AO'ink,14J. �
........
Reviewer/Inspector Name �..jf
E
Reviewer/Inspector Signature: Date: 9

Lapiswu%nimai-i
. . . .. ......
FAcility.-Ntimb:
A,
y Contact-1,
J: lkb.&Kb.
I ,
i -0fl 1 01
.4 .................
ongi tude;;
VA
n- Yew u
in(� Site Inspection
tS 3 FolI&W.u0-ofDSWCreview 0 Other
;)f Insp,6W a11 24 .hr' (hh-mrri) i
t
Op6idtie)r. '14. 1,
..........
.............. ...... ...... . .. ... ............. .. .......... . ...........
Phoillic'No: . ............ ........ ............
6
....... ....... _?, .. .........
44tt (4 ... ......... ........ 'Phone No.
q
. .. ....il�.........................
.......... ............. ... .......... .
-A!
.............. ................ ...............
........awl Operator. Certification Nuinben,' ...... ............................ t .....
:t .
7-i
•
......................................... . ...................................................................
4.4 1 j � ,�j I.; "',
....... . ................ ......... ................ ............... ........................... ..........
.4 gin—,
Ms
u FF enCW:!
5 15,
4 _,I M Ai� I Design R IV# i
I Deiiih%' �Dkf6t::�!,j
citiv, W-444Rpikea Vd
­
FeedW
L6ni�, Dairy i4.EW6E6-id
E
Non-Layer] Non- Dairy to
0:
...... . . . . . . RM Igm
Fd66,kid Feeder'
ZL
]O'Othai
4 W', K­q
El Faii6%� iSH ri kh
V,1 4
w,
q�'x
71
7
esignz a
sob gg,
B&Frr
s
9f;
A :N
Lw,
[E3 S 6bsCrfd&D rain JO Lagoor!,Aria JC] Spray-Fidd-Areaf
4UP
10'NotiOW.Waste Manakinent SysteM7 7, jj
0 MItl
17
luff6rs that need maintenance
-ge,'o seryed frqqiany part of the,operati6n?A 4" No-
*-F-b.9If di§cHargejs'obs6rved;- did it reach SUrfac&Wq
* -g&'i%"0bser�ed;.What is.the estimated estiA
I ILI
d.-�Iijd�Michakfg­q-' bypass a`I'qg- pio-q,,s-yst�m.. f:yes,
S
444"Alf. i%
:'Is there evidence }of past Lfidrke*6m'arii part of the operation.
"4Were there any adverse Impacts to,the waters Qf the State her.th,
YesON6,
4- i
% No; ETY'es
r_1 0 Lheil,
'SA
7
'a' 7 A
:E3 Yes' 1,;
Ma C
'(If DWQ
�No
Elys M !'v",$
yeshibfify
in gaUnlin?.
)tify DWQ)';.;.i
Yes`.
13, yes MW
from,a discharge?.D
Yes`; ® No
t,
.4
io1ding­p`on*d,$)'req6ire
No
A
S"
V'
ffbct,k the timd-of design?
Yes Y N;d,,':
y6s. 04,1`4j
6nii�dedonback fW•,4-.s;,

Vlw
to
les S than atlei
, other:thr�ai�It " 6' t" ' " * )n,, or-an,Y,o. eintcgri yc)f ,any'do&�fs
..4
of the structures tuie s; need, ifia i b td iihfi'cWi dip ro-V� men t VjA
� .4
otof;qikWofis..Y.li�'i" answeredyesplandlhe situp';
nedlati-0A c- orie"hy ronmeEk a r6t,-;.fi6l
'h'M" th"
if 4
'IF 4--'g�e'fir'07 adequate, minimum u -
ofltbe:sb. ur8lkk- Am'or . . maximu
'
Z
Imp
­q.
phYsi'6M',eiiid6ncd
.y
.xEauf'wsp.";'or runoff anteing ,,;k;iicrs'W the'Stat(
R
i, y
PC � 6 f�IF
6
r ;c tops, differ M th,thb`se-, designated
e facility have ',Ia'c adequate acreage and 'a
unngf
iire'
C OS 4 ayes' 0
y.'f"
N' El 7�6s;
%S tfuct6ie
;xy
.................
...... .............. ......... ........... ..... I ............. I
('J
.............. .......... .................. ...........
8
es No A�A
r�A at t S V.. S' o'b C v
Y6§"l"❑NO �u
. 71 4 . ...... L
ses
markers..f T"'
I eve0 iyIi��" 64 No
rfy' IA -
ba-Yei; k
NO
'DWQ) It - "e . I .'
............................ .. t........ .. .
ante Mahag&nient Alan (AWMP) QQes ON0
I ? wt Ej Yej i I
0:yis., No
ZN
e-
S,
�&Yes
1
Y1_14;
representative? to, 0
+
N'
tYes
-P,
N
nt 'dil" 0 _f
Plan rqa i payai e.
S
4
9.
NO
.g k e, rm
YjS Nb
V
,
Sl Yb, u will receive h6ldrffie4,
-- T
J" .
U.. To
IMF
JAI
z
i F
T;TNC ;
o Lj
7/25/97.'
I lit
H� 'UHMI ME
EM'O. F
-Date :L LAl
'ft*"h 4 !i; '. , ", ; , , I - , o'°

ADDENDUM TO WASTE UTILIZATION PLAN:
FACILITY NUMBER 31-806
FARM NAME: N&T FARM 1-8
OWNER NAME: NEIL & TOM WHITFIELD
DESIGN CAPACITY. • 6400 FEEDER TO FINISH
DUE TO THE LARGE NITROGEN DEFICIT (3006.475 LBS) NOTED IN
THE CURRENT WUP ON FILE. IT IS PERMISSIBLE FOR THE
WHITFIELDS TO PLANT SUMMER AND WINTER ANNUALS IN TWO
OF THE SMALLER FIELDS INCLUDED IN THE LATEST PLAN
DATED 1/8/97. TRACT 71730 FIELD 3 (2.7 ACRES) AND FIELD 4 (3.4
ACRES) MAY BE UTILIZED FOR THIS PURPOSE IF THE
WHITFIELDS SO DESIRE. THE NITROGEN UPTAKE RATE FOR
SUMMER ANNUALS SHOULD BE 110 LBS/ACRE AND FOR WINTER
ANNUALS IT SHOULD BE 100 LBS/ACRE. ALL FIELDS MUST MEET
MONITORING AND REPORTING REQUIREMENTS WHEN USED.
THE WHITFIELDS PLAN TO APPLY THEIR WASTE IN
ACCORDANCE WITH THEIR SPECIFIC WASTE ANALYSIS NOT TO
EXCEED THE HYDRAULIC LOADING OF THE SOILS.
9/22/97
RONNIE G. KENNEDY JR.
TECHNICAL SPECIALIST