310822_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qual

f
(Type of Visit: @JCor ce Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: I / I "T /I V Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �` r'C (-C- ^ ter•
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: r dF- 0 q 6
Certification Number:
Longitude:
Current
Design
Current
Design Current
IIMDesign
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle C*apacity Pop.
Wean to Finish
La er
j
jDairyCow
W to Feeder
Non -Layer
Dairy Calf
eeder to Finish
-r& D
7 p
1
Dairy Heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
i
RN
Non-DairyFarrow
to Finish
a ers
Beef Stocker
Gilts
on -La ers
Beef Feeder
Boars
EtEjrPullets
Beef Brood Cow
"Turkeys
Other
Turkey Puults
Other
1
10thl-r
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?
D Yes o ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
DNA ❑NE
❑NA []NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilit Number: - ZZ Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ---�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �o[_] ❑ 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 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 0 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 Ef 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
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 ❑'Na ❑ 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
❑.Alt`!❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[__,xo NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
I_fYo LJ 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 [LN�t,/❑ 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 [] rvu NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes No NA 0 NE
Page 2 of 3 21412015 Continued

lFacility Number: f3 1- 2 Date of Inspection:
r/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
❑'50 0 NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ff No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No I__,K II NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D Ilv o 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
��
0<0 ❑ 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
❑- o 0 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
[3'1 o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]-1Qo ❑ NA
❑ NE
[�cvicwcui��aNa.a.wi irann.. � wiw. --7".4
� — I
Reviewer/Inspector Signature: �-/�( Date: / 7
Page 3 of 3 21412015

� i'vi"lion ofWater Resources
Facility Numbeision of Sail and Water Conservation
i� Other Agency
Type or Visit: Com ance Inspection Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: (O / County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: & r L k�% 1—K'L ' � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design C•urrcnt
Deign
C*urrent
Design C+urrent
Swine Capacity Pop.
Wet Po11trNymap,
acity
Pop.
C>attle
Capacity Pop.
Weto Finish
Layer
DairyCow
)Yean to Feeder
Non -La erE
1
DairyCalf
Feeder to Finish Q
Dai Heifer
Farrow to Wean
Design
C►►urrent
D Cow
Farrow to Feeder
P,oultr,
Ca uci
l:o
Non -Dairy
Farrow to Finish
La crs
Beef Stocker
,PPQ-r,,
Gifts
Non -La ers
Beef Feeder
Boars
ullets
Reef Brood Cow
Turke s
Qther
TurkeyPoults
Other =11
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other; _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o �❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes No ❑ NA ❑ NE
0 Yes No ❑ NA ❑ NE
Page I of 3 21417015 Continued

Facili Number: IDate of Inspection: 4177
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P3'l o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Ej No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 dNo ❑ 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 ❑ 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 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNco ❑ 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
❑ Yes
L'J 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 l ❑ NA ONE
❑ 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 d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: ( b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E35o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesEl"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [] Yes 7" ❑ 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 ErNo ❑ 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 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [; " ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑'905 N . ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
.�EanswArmy`ohrcaCmEdnremmens:
-y;
pages asnecesUsaewlain situation i(usditional sary) i,,;q *' y#"• r rt ,v
C-4
Reviewer/Inspector Name: q ( Phone: �{ 0 [ G 7-1
Reviewer/Inspector Signature: �`�-4�"1 Date: �� l &
Page 3 of 3 21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: OomRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
q#lsn
Arrival Time:
Departure Time: rJ0 County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: VJ7 L w `% c
Title:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dai Cow
DairyCalf
Current
Pop.
Feeder to Finish
Farrow to Wean
7 Q
Dr, P,oultr,
Design
C•.a acit
Current
I;o ..
DairyHeifer
Dry Cow
Farrow to Feeder
Non-Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharmes 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? (Ifyes, 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 RrNo ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑Yes [O
❑ Yes YNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: - ZZ I Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�E] NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
-[D No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
[:]Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
Q"No
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[31 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
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ld'`'-
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0<0
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphors ❑ 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
E3<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
C D'�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
01No
[] 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?
❑ YesEl-No
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili .Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3-Mo ❑ NA
❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Q-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?
es
❑ No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q'No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
r ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up by
❑ Yes
Yes❑
[] NA
FN
❑ NE
the require a visit the same agency?
❑
NA
❑ NE
Comments (refer to question_#) iExpia n anyS:YESyan'swers and/or any additional recommendations orsany other"comments:
'>
;,Tf E��
Use drawings,of,Wliiilty,-'to,;better�;c.xpla�n s�tuattops,(use'additionaa pales asinecessary).�;:-'
e;3
', ,h,i '
�e • ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '� o 796 730Y
Date: / I Ll
21412015

Type of Visit: la"Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint C) Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: l Departure Time: County:
Farm Name: Z— a a-L-r— /— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. C*attle E apacity Pop.
La er DairyCow
Wean to Feeder
Non -La er DairyCalf
DairyHeifer
Design Current D Cow
I) , P,vultr. C►.a acit 1?p , Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Feeder to Finish
Farrow to Wean
Farrow to Feeder
�j
Farrow to Finish
Gilts
Soars
Other
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 d�o
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[].Yes FJ�No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ;>o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes _allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes J[]-
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214,12011 Continued

Facility Number: Date of Inspection: 1 L
Waste Collection & Treatment
4. Is storage vapacity (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 J<J No ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oNo ❑ 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 ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes E3'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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?
.12T
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes XNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Callo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 2fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'Callo
17. Does the facility lack adequate acreage for land application?
❑ Yes Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;1Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes (Z^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 ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 147ti j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
J No
❑ NA
❑ NE
[:]Yes
VrNo
❑ NA
❑ NE
❑ Yes
J'No
❑ NA
❑ NE
[:]Yes ,Ej No ❑ NA ❑ NE
❑ Yes ,yNo ❑ NA ❑ NE
❑ Yes Te] No ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes WNo
❑ NA ❑ NE
❑ NA D. NE
❑ 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).
btL d I�y 1 1 aL acl
Ine, C a S ! h a s
C-)7✓
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: L
/4/ 14

Date of Visit: Arrival Time: Departure Time; County: J)jA0jty\ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: L'6WA 1`eJi —
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
DairyHeifer
Design Current D Cow
Dr P,oultr. Ca aci_ Po Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets Beef Briiod'Cow
Other
Other
Turke s
Tirkey Poults .
Other
Discharus 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
7rNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins eetion: `
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
F1 No
❑ NA
❑ NE
[—]Yes
�No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VTNo ❑ 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 [jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f -]� No ❑ NA ❑ NE
maintenance or improvement? T
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
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JZ 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 jo No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,� No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 9No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes gfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VNo ❑ 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
1Vo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
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
VfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ 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).
Reviewer/Inspector Name: 146 41
Phone: a1_3LQ%
/I a-
Reviewer/Inspector Signature:
I C7.,
Date: y—
Page 3 of 3
21412011

(Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: KRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
w rw i irr�
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: �A G V_ L&H r lam-- Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,ouItr, Ea aci P.o ,
ILavers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s-
ey Poults
Other
EE
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)
❑ Yes
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
Lre
Structure 3 Structure 4
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?
Structure 5
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Applic_at_i_on
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes VNo ❑ NA ❑ NE
maintenance or improvement?
l 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ANo ❑ 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
V�
12. Crop Type(s): S� F_�L�l _+ _rt- _ 11- _ 1 5 (s _
13. Soil Type(s):
Co
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑i WUP ❑Checklists ❑ Design © Maps ❑ Lease Agreements
❑ Yes No ❑ NA [3 NE
❑ Yes o ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes Ki,
o ❑ NA ❑ NE
Yes *fNo ❑ NA [] NE
❑ Yes No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YespgNo ❑ NA ❑ NE
❑ Waste Application Q Weekly Freeboard ❑r Waste Analysis ❑r Soil Analysis ❑ Wste Transfers 0 Weather Code
Q Rainfall ❑ Stocking M Crop Yield Q 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ja No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

l;acili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes JkNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
VkNA
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
UJ , tt
CWug0A71orl DBE
0t,t7Tl �c,cLaDu7��—
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
Phone: 9' -7-H &'43 9q
Date: 1a
21412011

Divis""ion of Water Quality
Facility NumberDivision of Soil and103F e ation
Q 1'RtrjAgtnSyBm
y
Type of Visit: Xcompliance 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 O>Denied Access
Date of Visit: © Arrival Time: Departure Time: County: t](�t,7L,1/V Region:
Farm Name:
Owner Email:
Owner Name: Sz. CLoq L p N C AN, 6 9— Phone:
Mailing Address: ��IJ � NTt9lIV Town( �6 1 f=Lk 0 L)iLQF , /V C1 p. (R S T
Physical Address:
Facility Contact: ((�� Title:
Onsite Representative: '1--1 G L CAME E
Integrator:
Phone:
Certified Operator: Certification Number:
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C•urrenf
Swine Capacity Pop.
We an to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design C►urrent
Cattle Capacity Pop.
DairyCow
Wan to Feeder
e
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
1
Design C►►urrent
Dr, P,ouitr. Ca aei t o
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other =NrTother
key,
Turke Poults
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �6No ❑ NA ❑ NE
❑ Yes [:)No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesXNo
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 16U
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 ❑ o ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAQW(�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which arc 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YeskZ
❑ 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
0
❑ 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): p CO (zS`r0AI
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
9No
❑ 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
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
o
,,,TTTT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
!�
[]WUP []Checklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ "ste Transfers ❑ Weather Code
0 Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and l" Rainfall Inspections Q 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 TTT�]��� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - RD Ds ection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
D Yes
❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
4No
❑ 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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
r No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance'of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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).
W.A9-0 . a
OF OlCC�10.1� �C�I w��.Eca4ra� — C,lCD �� MS -tDIG uE
as �cn
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: ! 945(o' 7 3DI
Date: &/5/ZZ
21412011

Type of Visit ;R Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit .Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j b Arrival Time: ® Departure Time: County: 0AI Region:
Farm Name: 1ZCC+ U�1Ll..l_QM _-L_RIV►E(Z- rAQM Owner Email:
Owner Name: �- 1��}Lf7f �- (JqN/EiZ ��.. �P1hone:�}�?1�'�1$-4a3�
Mailing Address:d
Physical Address:
Facility Contact:
Title:
Onsite Representative: CU�Ui is IC.Ic'-_
Certified Operator:
Back-up Operator:
Phone No:
Integrator: C
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = 4, Longitude: = o = 4 =
sign Current Design Current
Design Current r0apact�
Sw
Capacity Pop_etlation Wet Poultry ' Population C►attle Capacity Population
❑ Wean to Finish
❑ Layer ❑Dai Cow
❑ Non -Layer ❑Dai Calf
(.oCl ❑ Dai Heifer
❑
Wean to Feeder
Feeder to Finish
Dry Poultry ❑ D Cow
[:]Farrow
to Wean
❑
Farrow to Feeder
❑ Non -Dairy
❑
Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑
Gilts
El
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Boars
Other
❑ Turkey Poults
10 Other Number pf Structures: 1
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
V No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JKNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection LLI 1 P6
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: L"'Z)6"
Spillway?:
Designed Freeboard (in): 1 . ds
Observed Freeboard (in):
31 8-
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 0 No ElNA ElNE
[IYes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IV
No [3NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) A
9. Does any part of the waste management system other than the waste structures require [] Yes No ElNA [3NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) S( -1 {JCo&t-1 w(460-T 59
13.
Soil type(s)A 4 1 rr
-,�S7oA,, Naff Q co
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 El
El NE
I &
Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
s., S
Comments (refer to question #). `I✓xplamany YES`answers and/or any recommendations or any other�conitnerits ; s �; :: t=
Use -drawings of facility.,to'bette'r..explain.situatiogs. (use additional pages as
AL
Reviewer/Inspector Name '`. } 'v �Sl � Phone: ��Q - 0
,' !/V` : .; 3: ti��; k v
Reviewer/Inspector Signature: Date: 14 / /
Page 2 of 3 12/28104 Continued

Facility�Number: Date of Inspection 1 b
Required Records & Documents KNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ❑ 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 El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Vste Transfers ❑'�Knual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections i❑ 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 )i�' No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NE
Other Issues
'VNA
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes A 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 kNo
❑ NA
❑ NE
Additional Comments_ and/or Drawings:
OC 1 ��II v ! • �]
VC3 ,
46/119 la 9 1
gJ M S a fL RcTIUE - C E i co(� OF DO1d aiC c.44�a-
QZ.E cc�2O S
Page 3 of 3 12128104

Type of Visit compliance Inspection O Operation Review 'O Structure Evaluation O Technical Assistance
Reason for Visit NLRoutine O complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Z,1C 4- U-)' L4 Ap(-\ Lf�11i�ECL �HaM� Owner Email: r-p r�
Owner Name: 'lljcgpQ-b E. L-AAi-9 nn,, �j - Phone: 9AC)".f3__90'l , _
Mailing Address: 2L00 E_a"N 7-A/W .� [� 1�tLA_LPU ILL E C G p Si O
Physical Address,
Facility Contact: Title:
Onsite Representative: CA-T15 ] Qg_'1akCr,.jeI CIC Lti1E0—
Certified Operator:
Back-up Operator:
Phone No. -
Integrator:
Operator Certification Number:
Sack -up Certification Number:
Location of Farm: Latitude: = e 0 6 =16 Longitude: = ° 0 1 = N
Design Current
Des00-11aign Current
Design Current
Swine
Capacity Population
to Finish
ean to Feeder
Wet Poultry C+apctty Population
❑ La er
❑ Non -Layer
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
PRwean
Feeder to Finish
mg,
169LI
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Puliets
Beef Brood Cow
❑El
Turkeys
Other
Other
Turke Poults
PC Other
Number of Structures:
Discharges & Stream Imt)acts
1. is any discharge observed from any part of the operation?
❑ Yes
$,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes,
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: j — Date of inspection
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure In Structure 2 Structure 3 Structure 4
Identifier: e"6 0'Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes `0 No ❑ NA [I NE
❑ Yes ✓✓❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V No ❑ NA ❑ NE
❑ Yes 14 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes jRfNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ANo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes YKNo ❑ 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 El Evidence of Wind Driftrr [3 Application Outside of Area
12. Crop type(s) S 8 9 E (- (W� C.o1L V W ,q %
13. Soil type(s) -,No L3oeo FOES jaA/
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 JKNo ❑ 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?
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
_UR No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
" 'q' �) p ' y YES�•,answer�eandIor any"recommendateons or. any,�other�comments
Comments. refer to uestton # Ex °lam an o <` e + o "`r
Use drawm s of tacilif to "better ex lain situations., uge";additional a es;as necessa :• °<, _.� '� ���":
g y P ( P g ry), E, p�
GT CUp 0 r / o 1�- 5 Lun46�E '3UZ UC t � CRU074 n oM W PU-r qR� CgDS
Reviewer/Inspector Name - - ty,,�6 I Phone: J%C? 4% 6 93
Reviewer/Inspector Signature: Date: f4 92 Q
Page 2 of 3 12128104 Continued

r Facility Number:Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box.
❑ WUP 0 Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ANo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ V/aste Transfers ❑,/nnual Certification
(] Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 3 Monthly and I" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P.No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
k4No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2§No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Pq No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;?LNo
❑ 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
A 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
M 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
14 No
❑ NA
❑ NE
Page 3 of 3 12128104

j Division of Water Quality
Facility Number 0 Division of Soil and ,Water Conservation;
- 0 Other Agency
Type of Visit 6
Compliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine Q Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 'V Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: nTitle:
Onsite Representative: `1� l C)C CAA/l �r /Cu a z t'S Y" A q_W I C L
Certified Operator: Q I CN 1q 9- V> 1 - . C A A11 e (-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= 1 0 Longitude: = o= d 0 `l
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys_
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
DTNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: '!j ! - �jaa Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X 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: Ca0
Spillway?:
Designed Freeboard (in): i9.s
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 pq No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
K No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
01No
❑ 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
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
Isa,No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name 0 m 04 Phone:
Reviewer/Inspector Signature: Date: /dp
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 XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2CNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
..OrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
-9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'�No
MNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
11� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
4LNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality.
Facility Number �. Q Division of Soil and Water Conservation
,, O: Other Agency .., ..
r
f Visit QjCompliance Inspection Operation Review Structure Evaluation Technical Assistance
n for Visit 6 Routine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Z Q Arrival
Time: ' D`parture Time: %1��f� County: n/ Region: ��
Farm Name ��i► K �� ., / .4 1: o M.,nTT., ff>c... ,
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
-el
rt
Onsite Representative: ��e'e7 Integrator: I"'-aE_
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° 0 i =
di
Design Current`" Design Current Design Current
Swine Capacity Population ,Wet=,Poultry Capacity, Population;, Cattle Capacity � Population
Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures".';". �t
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
Ef No
❑ NA
❑ NE
12128104 Continued

Facility Number: Hmd Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes A No
❑ Yes. ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P(No ❑ NA ❑ NE
maintenance or improvement'?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
XYes
'0
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�bNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments.
Use drawings of facility to better explain situations.,(use additional pages as. necessary):
�S, �0�3o�ocs ✓!"off �� �PoRT �]�4i 'l
��G ��� �
�
70/1
Reviewer/inspector Name ^� — Qg� T
----� Phone:
Reviewer/Inspector Signature:
Date: Z O9—
Page 2 of 3 12128104 Continued

Facility Number: flDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes JZ(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 El Other
2 L
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
toNoEl
!(❑
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
PNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JZNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
El NE
and report the mortality rates that were higher than normal?
//////
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ZNo
❑ 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
0/!'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PdNo
❑ NA
❑ NE
Additional Comments and/orDrawings:
61AM V A/
Page 3 of 3 12128104

Division oUWaterQuality..
Facility Number O Division of'Soil and water Conservation
Q Other Agency
Type of Visit (3f Coynpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t ob Arrival Time: Departure Time: County: t)dP�7N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Zjr =K. %Q1 d_61C Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = H Longitude: = ° = i
Design Current Design:., - Current 'Desrgn,a Current.., ;
Swine Capacity Population Wet Poultry Capacity_ 'Population Cattle.; Capacity Population
❑Wean to Finish ❑ Layer
❑ El Dairy
Wean to Feeder ❑ Non -Layer h ❑ Dairy
® Feeder to Finish I L V
ElFarrow to Wean
ElFarrow to Feeder
ElFarrow to Finish
ElGilts
❑ Boars
Other.,
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
ElPullets
❑ Turkeys
El Turkey Poults
ElOther T
Cow
Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structur
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 E No ❑ NA ❑ NE
❑ Yes
Number of Structur
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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
I
El NA
❑ NE
❑ Yes
VN
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — g
OP
Date of Inspection I OG
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: (A600te
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z/
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 L'J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes iNo ❑ NA ❑ NE
❑ Yes iNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tpreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [1� 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 YNo ❑ NA ❑ NE
maintenance/improvement?
L 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
rr ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13e✓a wwrnq
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
❑ o
❑NA
El NE
NA
❑ NE
;'N
o
❑ NA
❑ NE
dNo
❑ NA
❑ NE
C/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any -other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):'
Reviewer/Inspector Name FAIL Phone: i? '" %x
Reviewer/Inspector Signature: Date: b (I
Page 2 of 3 112128104 Continued

Facility Number: Date of Inspection
Required Records & Documents dNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes dNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q4410
❑ 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
E�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
dNNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
LAVA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;<O—
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
, ,,
EKo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
hIo
❑ 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
2No
❑ 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
El Yes
IQ 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
LKI
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ YesEI/No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit CrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine 0/Complaint O Follow up O Emergency Notffication O Other ❑ Denied Access
Facility Number Date of Visit: 1 i' � Time: 12 d
O Not O erational C Below Threshold
Permitted dCertified © Conditionally Cerdfied 0 Registered Date -Last Operated or Above Threshold: » ....... -..
Farm Name: ...»mT b!J .....b t!T }3 �.fr r.? n...wa:Y[!n........_........... County: » ..� 4, .._ ............ .»». » ».».»_» .......
OwnerName:......_.__.._ ................ »......
Mailing Address :....._.......... »................. _....... _._......
........» ... _...... .. » . ...__»
FacilitvContact: » .. _...._ .__._............ »............. ___._._.. TitEe:.._............._._....
OnsiteRepresentative:.(?'�_So+?1_�LL�r
CertifiedOperator:._ ......................................
Location of Farm:
PhoneNo: ..._.......... _.__... .......... _.._......... ...» .... ..,........... .............
__._. .._ ... __.. Phone No:
Integrator:
Operator Certification Number:......... „„.., , ......, .__........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • ' 64
Destigp •Current F' F" r �� Current
Dewsi�f "Current
Swine ! aPQni f< 4 Cattle
Ca ci Poilat<Qn „ PO plahQn
_' ....
Ca 8ci `'PO li)fQ1t1QI1 ;
,
❑ Dairy
"';
❑ Non -Dairy
7-
LI�
Cape
Total i
Namiier oi�'LI goons
E-Holl
��.�,.t
��_
..�. _ �. ., •.
y1
..
A
R. y�'I�•y"
PLC--.
can to Feeder
Feeder to Finish
HEayer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Total �es>Ign
Gilts7".f,
t
Boars+.T
Mcharees & Stream llmpacts
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 gai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [] Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure ti
Identifier: ........_.. .... ......... _._ ...».... .. _ . _.. . _ ..__ .... _ .._ ...... _._..._»_».. _ ....___ _ ___._.
Freeboard (inches): 44 17
12112103 Continued

Facility Number: -- Z Date of Inspection t
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes a<0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Rio
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) �
7. Do any of the structures need maintenance/improvement? ❑ Yes lWNO
1 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? El Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes &o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Lf Nc
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [!fNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type aZ Lr'WVjV-> a [ w� 5 (' 6
13. Do the receiving crops differ with those designated in the Certified Anima] Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Lssves
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
i S,) 1 Ae,, VR N Ua (pUCO s `rd 9PR2 A F-wV_
Q &CK . SG a t,r P, Q2oP.,> GAS A
`��°►IJ Ta OR.zr�� A t~ �"E,t� C orJ-T�,o 1.
❑ Yes ['No
❑ Yes [Zo
❑ Yes
❑ Yes [�io
Yes ❑ No
❑ Yes 210
❑ Yes ❑ No
❑ Yes M<oo
❑ Yes Q140
❑ Yes Ul o
Field Corn ❑ Final Notes
LJ E(- D C a r.tT-eW L, l.,rl Tl i _F� C_
v C 2� i•1-TT i_E is Q o wsT N 'CU o.
r✓6 066tx'C-'.S ,
4P✓MeT_0 G O Gt-Or- G p SZO(t e g i�j0 A r^ J /Jc '5J5&1J S o �� � L �Cr oR
p=SGNAuG(�.. Pvt. c.ANsr_•m G0y:fit-C2.ATXVE. L,)iTu Duo.
Reviewer/inspector Name
ReviewerAnspector Signature:
12112/03 Gonunuea

Facility Number: 31 — Date of Inspection I 1 ti o
leouired Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[](No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
7No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0
Yes
25. Did the facility fail to have a actively certified operator in charge?
❑
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
,_,,
(ie/ discharge, freeboard problems, over application)
El yes
011
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes�VC
28. Does facility require a follow-up visit by same agency?
❑ Yes
Yes
�O
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

----= Division of Watcr Quality
LEM�M�
3 ] , g -R�� O Division of Soil and Watcr Conservation
©ther Agency11
Type of Visit i;K7Routine
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: a 0 Arrival Time: 3G Departure Time: County: j{[t[0 L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Gk LAO-
Ef _ Integrator: 1� _
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 00 =' = Longitude: =° =' ="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
`Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
I
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

S
Facility Number: 3 — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: W-,WA)
Spillway?:
Designed Freeboard (in): Cl, E
Observed Freeboard (in): 3
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
VNo ❑ 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 tore , notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
No ❑ NA ❑ NE
.
8. Do any oft he stuctures lack adequate markers as required by the permit?
❑ Yes
No EINA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,..,/
IJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
ONo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;<Q"
❑ 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
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Z/o
❑ NA
❑ NE
8wh1Cn_ 14A3 PUT ALLOT OF' :LtJ-rQ X(nP1-•6V:n0C- SPYL►4Yr_T_f_-(0, T-LE
�Xjn !�v �t.S.iJG D d n1E,. Co�TiLaL EV�pE+�,
Reviewer/Inspector Name. Phone
79G — 7 7— t.9
Reviewer/Inspector Signature: Date: s-,Pq 65
12128104 Continued

4
Facility Number: Date of Inspection W ds
Required
Records & Documents
�
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
D1 -
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
I /I 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
InspectionsEl Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Led No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
C?"NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
LQ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
L'No
ElNA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
El No
LJ
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElQ Yes
�'
L�No El NA El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElEr 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
EXo ❑ 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
ElLI 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
`/o ❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o ❑ NA ❑ NE
Additional Comments and/or DrawingsE
12128104

Type of Visit ('S Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Z Date of Visit: 10 f d4 Time: /430
Q Not Operational C Below Threshold
ermitted ertified © Conditionally Certified 0 Registered Date Last Operated or Above reshold:........ ...»..» .__..
Farm Name: County: _._ _.__V if t ...... _ . __ . __ __
OwnerName: ._._._..........._........__ _ ......_..._ .__...._..._ ......._......_._............. 'Phone No: .._......._.....__.........._._.........».........................
MailingAddress:..._..._......._._........._.............._...__._......_...». ................_ _ __-__...._...»..».» .................».... __....
Facility Contact: ___ ..__.__._... ___. __._. .. w_ Title:
Phone No:
OnsiteRepresentative:.._..... la4 _.. L .r_._._._...._._ _............. Integrator: � ..._...._......».............
Certified Operator:._......._._ .._._.....__._._....._.___._....„... .......... ......»......... ..... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude o 4 4s Longitude ' 4 «
S *ine CaM
Wean to Feeder
❑layer
eeder to Finish
o
'7�
❑ Non -Layer
Farrow to Wean
Other
Farrow to Feeder
y
Farrow to Finish
3' 1, '', TQtsI3Desy 1
1 3 yu
P
Gilts
a w
fi3
5 ✓ d
1308r5
Disc es & 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?
3.,
R1 �PSCItp,
'Oltai `�L�
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?
❑ Yes ❑'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --- --.».»
Freeboard (inches):
12112103 Continued

Facility Number: 31 — 2, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.) ,/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes [! No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [R�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes EYNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [Ao
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [Tio
11. Is there evidence of over application? If yes check the appropriate box below. ❑ Yes ffNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type G5 w 66 K 4V VA (6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [T No
b) Does the facility need a wettable acre determination? ❑ Yes 0<0
c) This facility is pended for a wettable acre determination? ❑ Yeses ['Flo
15. Does the receiving crop need improvement? [T'Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes Cd No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes QNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes C o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ETNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ErNo
Air Quality representative immediately.
Use`draw:ngs of lacilityAto >better,;+eicp sitrxala. (Ytse' Hlditinnst! pgges'as necessa )W ` ' ❑ Field Cop Final Notes�¢';�;
�'H ?."?:�PUP&M;'i?�r�.�l,���:4,�$
t'6"j wve &*j NZTA ' Syu
Reviewer/Inspector Name..;'����
Reviewer/Inspector Signature: Date: _I0113W
IZAIZIU.7 %tuff" [wcu

Facility Number: 7, — Z Date of Inspection
I�eauired Records & Docamentti
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
io
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
rp
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
a,
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
90
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
No
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2NO
28. Does facility require a follow-up visit by same agency?
❑ Yes
O'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0'Ko
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (1f no, skip questions 31-35) ❑ Yes No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

(Type of Visit jo Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date o1 Visit: ZO D Time: 0
Not Operational Q Below Threshold
is Permitted [3 Certified © Conditionally Certified ❑ Registered Date Last Operated
or Above Threshold: ... .»...............
01.55 Farm Name: ..l :..i. � .....: �� f lJ......L...t !j :......._... County:.... ...... __-------
Owner Name: _. _ tfr4 �� ... L! lJr .--- ------------- ----- ']Phone No: ...» ...._ ... _.M.._» . .. . »..»._......
MailingAddress: ...._................. ..........�....».»....... ...... _...._....... .............. _................. ....... _...........»».......».»»......._.. .........................
Facility Contact: »_».. ....... » ....» .. » »_ ... _W» Title: ..»».» . _._ ._ . _.. _ Phone No:
Onsite Representative: ................... »....._........ .. _..»»...»_........._................ Integrator:..2�.�..»»»............... _»..»......_..
Certified Operator , . _..._.... _------ - ..._ .. _ .._...... Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • ` 44
Swi»e Ca city= Poai la
Brent
tllfltldll' •,•Cattle r
El Wean to Feeder
�E
Feeder to Finish
'°''-Layer
EOer
I
El Farrow to Wean
Farrow to Feeder
Other
Win:
Farrow to Finish
''' tT IA D"""
❑ Gilts
El Boars
Disc es & 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?
I
' a-
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 galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes JoNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
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):
12112103 Continued

. Facility Number: 3— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Ap0cation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
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
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [:]No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Field Covv ❑ Final Notes
&,4 C10e_- :So.P•�
FOR�/nur-� r`�'sI�
/lip f ��R✓F_ �� G(%i�k5 �� �i•I � � C� �2 r/7�� (.(Jiq-STfy �,✓%i' -'
Reviewer/Inspector Name iL
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: 31 —gL Date of Inspection !T
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
" 25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.' ❑ Yes ❑ No
❑ Stocking Farm [:]Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
W/55
R
JQEC�z ✓IJ Cr �1-LL_71�vlo 9M ?WA 7- 1,az"40 �,a_ Ake
LA �f 2 ,Qi4 r,E �vr�C�r!y �� ' f� ��r►��Aanl�
eta �d Fq�atL A F�fl l Gn OvFlz ��5 In/SPccrxo d Or rd
L. ,4e,) �' Es �on�Ptzq�c� . Ns�ric'��an1. C s7r�.n-(�a3B
47 30,0 `f
12112103

N.C. DIVISION OFWA WA TER QUALITY
Water Quality Section
Complaint/Emergency ReportForm
WILMINGTON REGIONAL OFFICE
/a."%
Received by tl �744iZ 0.64 Date R o�f Time
Emergency Complainf City County__ / y'!a _
Report Received From
Agency,
Phone No.
u nr-rl Addqrv-2q46- 523Address Plr��
Check One: Fish Kill SpAI Bypass j Animal NPDES N.D.
Storrnwater Welland Other, Specify:
Time and Date
Location of Area Affected
Surface Waters Impacted Classification
Other Agencies Notifi
Investigation Details /-IKK'V n !/n! `
y tom/ s Aezr
Invesdgator 4 _ l,.( _ _ _Date �, P
SAWO SHELLSWEPOR7.SHL
EPA Region !V [phone] Aestkldes 733-3556 Emergency Management 733-3867 W/diffe Resources 733-7291
Solid and Hazardous Waste 733-2178 MaNne Fisheries 726-7021 Water Supply 733-2321 Coast Guard MSO 343-486f
7,0'
�bn
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 0 Telephone [phone] Fax [phone]

r..
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation �
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:E3TDQQl%
Not Operational O Below Threshold
10 Permitted [3 Certified 0 Conditionally Certified [3 Registered ate Last Operate'/or Above Threshold:
Farm Name: .. � 1i1... Q.fl. � j .. F � ,..... � County: 7.?�L`d.................................w,l..l5`...�
OwnerName: ......L......7... ...................... � l TAT �� ........... Phone No:.......................................................................................
FacilityContact: .....................:........................................................ Title:................................................................ Phone No:...................................................
MailingAddress:........................................................ ......................................................................................................... .............
*"***.......
Onsite Representative:..... TJ ..� y.......... ....Q. ... integrator:......&/?49.�......................................
Certified Operator:
Location of Farm:
ASwine ❑ Poultry ❑ Cattle ❑ Horse
Design, Curre
Swine
:Ca'iaci ;Po ulal
Wean to Feeder
Weeder to Finish Q ..
Farrow to Wean
,ii! ❑ Farrow to Feeder
❑ Farrow to Finish
" ❑ Gilts
i ❑ Boars
Operator Certification Number:
Latitude • ' " Longitude a & 64
t Design Current Des1911 Current
i n Poultry.:,Ciii acit ,,Po ultiition:Cattle' Ca -pad , ,Po 'ult tiat
❑ Layer ❑ Dairy
[] Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSIW`
Nuber`"of Lagoons ❑ Subsurface Drains Present I[] Lagoon Area . ❑Spray Field Area19
Holding Pontis`I SolidTraps_❑ No Liquid Waste Management SystemQ
Discharges & Stream unpacks
1. Is any discharge observed from any part of the operation? ❑ Yes F(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/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes 9fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes e53"No
Structure 6
Identi r iier:....................................
Freeboard (inches):an
i%
sioo
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over apolication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type /f (�
13. Do the receiving crops differ with those esignated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ANo
❑ Yes XNo
❑ Yes No
❑ Yes /0 No
❑ Yes I2 No
❑ Yes
❑ Yes
No
XNO
❑ Yes J�zNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ko
❑ Yes FNo
❑ Yes No
❑ Yes l�No
❑ Yes X No
XfYes ❑ No
❑ Yes 111 No
A❑ Yes No
❑ Yes XNo
❑ Yes �No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coin nents .refer to aes>'ibn # E, "'lain an"'�YES�answcris,andlar any recommendations or n Anther
(.. q } P Y Y Y t
,
Ilse drawings of facility iiPhetter:explain,slituatrons. se additionalipages as necessary) ' Field Copy ❑ Final Notes
2),4 n rj 7
G2rv'0 A)
S tjlc� ,a
v
T
ReviewerllnspectorName
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: Late of Inspection Printed an: 7/21/2000
Occur 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 XINO
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INO
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 /INo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑ Yes �J No
Additional Comments and/orDrawings:
f�
)O>F L�'OD�.I �1V0 ��A�FG �j� GOaKE,O CroDD
/S EC9R✓� S /�/G� � �pF.,P.
—lc4k1y,� -�s 1i✓ FSTA-T6 S�TrcE�rl��✓T,
J
5100

of Visit Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Q'floutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 2 Date of Visit:
© Permitted U Certified
11 13 Conditionally Certified [3 Registered
Farm Name: ..........M!,/v,-PA_ S.D1:t"�.kee 1ol0"lA..f'c,,�...................
OwnerName: ......................... 1 ................`.. .............................................................
FacilityContact: ............................................................................... Title:
Mailing Address:
Time:
Date Last Operated or Above Threshold: .........................
County: �.y f./..................................... .......................
Phone No:
........................... I....................... Phone No:........,.......,..................................
Onsite Representative:.... U rr....h �r Integrator:... �fo 1 �S...............................................
Certified Operator:... ................................................
Location of Farm:
Operator Certification Number: ..........................................
l2(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude e 4 «
h Design..: Current' '
pine Dnnulaiinn
m
❑ Wean to Feeder
eeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current,
Poultry Ca aci Fo� elation Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design, Capacity, C
Total SSLW
Y .'�PoPI
4 F Number: of Lagoons
Holdin Ponds Y Solid'Traps `
g
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
f
❑ No Liquid Waste Management System
.� i
E-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;dNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes 0"No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes 01No
c. If discharge is observed, what is the estimated Flow in gal/min?
yj
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes J�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes jZf-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Q Yes P No
Strucure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identif ter:......................................................................................................................................................................................................................
Freeboard (inches): 36
5/00
Condinued on back

Facility Number:3 —,62 Z- Date of Inspection y G
5. Are there any immediate threats to the integrity of any of the structures observed. (iel 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 �Na
(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 E(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jzfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [:)Yes Zf No
Waste Application
10. Are there any buffers that need. maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes WNo
12. Crop type 6c r wt.Ud-� Pr,-4, .5--va11 r;v t,'h 1 Con Lj�eer) ,.Sov beQnS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
(CAWMP)? ❑ Yes D440
❑ Yes�No
❑ Yes.X1
❑ Yes
❑ Yes )2 No
❑ Yes
)?fNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
'N4•$i0bt'00gs'o1401c e' o' Nei vt�re �tQte� �11N°tr�g ��is:v�s�t; Yak wili ><ee�iye 4o fuirth�r .
6ires�orideiki abbot this visit.
❑ Yes A!fNo
❑ Yes �No
❑ Yes ,fNo,
❑ Yes,&No
❑ Yes �No
❑ Yes /'No
❑ Yes No
❑ Yes,,eNo
❑ Yes ErNo
(` to,question'#)� ,Explaunia�ty�YE5ran�sweis"and/or an yltecomaien�tiations or,any atlier�cbmmehik, ; �<� kr "' P
Comments refer
'Use drawings of.fa l . r .. P ( p, g ary)� ' ' ' ti �, : �� lt k • I
cili to better:ex lain situations. use addjtional a es as nec p t,., ,
S-�andi � 6erw�J41*c� 7°S �baOj. Gond Carn C►^ad0.
AL
Reviewer/Inspector Name me(„/Ol11,-,'m44h;
Reviewer/Inspector Signature:
Date:
5/00

Facility Number: Date of Inspection rp12GfOJ_]
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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? ❑ YesNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes /Ef'Ro
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 YNo
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 /P'No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional 'Comments and/or Drawings:,,
J
5100

I& Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit t$ Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 2 Z
Date of Visit: 8 d0 Time: 1 Z 1 D Printed on. 7/21/2000
!
0 Not O erational Q Below Threshold
JMPermitted [a Certifii�e11d © Conditionally Certified [j Registered Date Last Operated or Above Threshold: .....................
Farm Name: M rTTOh Ye tJ� c.r lot>� Fe, ✓v\ County:...,.0 I h..................................................
.........................................................................................................
Owner Name: M Ao 1 SOu 4 k cr-IA �� Phone No
Facility Contact: .............................................................................. Title:................................................... Phone No:
................................................................
MailingAddress:..................................................................................... ............................ ..
Onsite Representative: Hn.ni l SvLe)i .c►-tot "v4 lntcgrator:,,Cq✓will/.:�......................................................
...................................................................... ...........................
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Longitude a 4 46
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer 10 Dairy
Feeder to Finish rf 7 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons JEI Subsurface Drains Present ❑ 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? ❑ Yes JZ No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. II'discharge is observed, was the conveyance man-made'? ❑Yes No
b. if discharge is observed. did it reach Water of the Stale? (If yes, notify DWQ) El Yes ;N No
c. If discharge is observed. what is the estimated Ilow in gal/ruin? 1h G'
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ;] No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes f} No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;] No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes I$ No
Structure I Structure 2 Structure ; Structure 4 • Structure 5 Structure G
Identifier: ...........................................................................................................................
.............. .... ............... ..................... ....................................
Freeboard (inches): 29
5100 Continued on back

Facility Number: i — Z Date of Inspection 1 0 Printed on; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes JF�51 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,BNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes No
Waste Al2plication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application'? ❑ Excessii+ve Ponding ❑ PAN ' ❑ Hydraulic Overload El Yes C No
12. Crop type e e I'm u d', Ff Atj Sr+ -.a i 1 b r A I, Cer' , Iw Z►. e A 7 L �'4 KS _
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 10 No
b) Does the facility need a wettable acre determination'? ❑ Yes 21 No
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? J9 Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes 'R No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
P 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
�ffNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
9No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
O No
23.
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative'?
❑ Yes
� No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
A No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RfNo
�Vo •yiolations:or• deficiencies -were hated. during 4his;visit: • Y;oil will tev6i ie iio fueth4w
•••icor'res�oridence:a�aut:th'is:visit:.•.•.•.•.•.��.•.•..•...•...�.:.:.:.:.�.�.�.�.�.�.�.� � ..�.�.•.�
Comments (refer to question'#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
rvlod ��� 1,qe oot1 ✓►1ae,/Z01 4,a oP ma•-ke✓ �o !ow e�7 �o r✓1�
Ole 40 f :�c dike. y
)S. Wo✓* -fa 21 i,,,, .,L.A- G Z44e✓
Reviewer/Inspector Name
Syo YctUS 11 M-qa 4 i1-
Reviewer/Iospector Signature: J%-t+ Date: glgld6l' .5100

Facility Number: 3� — ZZ 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 .9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes J29 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1?5 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 O.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 JE No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NO No
32. Do the flush tanks lack a submerged rill pipe or a permanent/temporary cover? ❑ Yes No
VV
AdditiqlnaU Commentsan. or_ swings. ,,.
.&t
3/23/99

11
3 Division of Soil and WWater; Conservahon UperaGon RReview �� ! �frb'
7 s 0 Division of Soil and Water Conservation CompE ince Inspection
ZrDivision of Water Quality ' Compliiuke jhspeetlon' ` ';; "E ' ` ii i� €' E ! JIB i i. 't ; k F E ' 1 , I13 e
:!
Other Agency : Operation Review r ' �, sE ^ 4 y'1
LOrRoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
. �.......!! ..ram
Facility Number 3 r $Z Date of Inspection 8 p
Time of Inspection a 24 hr. (hh:mm)
Permitted jxCertified Q Conditionally Certified [] Registered 0 Not Operational I Date Last Operated:
Farm Name: ..............M....1....^........S�.stT..t..1.1.�.s�?..........................County :...........
............ ...,................ .......................
Owner Name: ....... ........................................... .................................................... Phone No: ..... ......... "6. ............
V4 3 S
FacilityContact:.............................................................................. Title:................................................................ Phone No: .......,...........................................
MailingAddress:........................................................................................................................................................................................... ..........................
Onsite Representative: '...................• Integrator: ........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
.............................................................................................I..... ......................... .. ....................... ..........
Latitude Longitude • �� �4
Design
Current Design Current Design Current
Swine' !'i" Ca acit
Po elation ';''Poultry; ' "'`tCa city' .I'o `ulatiori.: "Cattle' Ca acit Po '�ulation
❑ Wean to Feeder
ElLayer El Dairy
Feeder to Finish $ t5z�
Non -Layer' ❑Non-Dairy=a
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ to Finish
'
Total Design Capacity
[IFarrow
LiltsE
❑ Boars
Total SSLW
er o
Num of. goons
❑ Subsurface Drains Present ❑ 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?
Discharge originated at: [ILagoon ElSpray Field [3Other
a. If discharge is observed, was the conveyance matt -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: 174"0
Freeboard (inches): ................................... ..... .................. I...........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0No
❑ Yes ONNo
❑ Yes ,No
❑ Yes
6 No
❑ Yes
r—
❑ Yes
P'No
❑ Yes ❑,PQo
Structure b
❑ Yes No
Continued on back
3/23/99

Facility Number: ? — svi_ Date of Inspection 3
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes IeNo
(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 eNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes FfNo
elevation markings?
Waste Ap,_p lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes �No
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes ,�No
12. Crop type C-- (XR-M v o A. .S' • C-r:
13. Do the receiving crops differ with those de ignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes P40
14. a) Does the facility lack adequate acreage for land application?
❑ Yes �2rNo
b) Does the facility need a wettable acre determination? •
❑ Yes gNo
c) This facility is pended for a wettable acre determination?
❑ Yes 9No
15. Does the receiving crop need improvement?
❑ Yes D'&o
16. Is there a lack of adequate waste application equipment?
❑ Yes,,ZNa
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
24fes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ONO
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ief irrigat on, freeboard, waste analysis & soil satfiple reports)
❑ Yes ZNo
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 Lallo
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 L'<o
24. Does facility require a follow-up visit by same agency? [:]Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ;2rNo
y�ovolaiigrisor eieience5 ver3 hitW' ioiye lib fu'tgr:•
corresUon, deirce: abOUi this :visit. .
q ') Ii y p.._ i
Gorriments;(refer to uesttti"lt,# :lax fern°an YES'answ,ers"and/or any recommendations or, anyiotEier comments.'`,, ,
onal pages asnecessa
r r
Useidrawings of facility.to'better explain situations (use additi , r, y)
i : s� t 1
►7 � ca?� 3F J*-- WeA.�kT To KEEP ..1;z-" cWl PAC-K Q-5`.cDeDS f
m pq Be Vr- LAw y r-f-S As t-ftrA-rv_ i s d oar (X-r S' rr Lxlo ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
�Vu •^[j y r a � q erp. �'^' �� r/� E e'�[t� ro
Ll . Date:
3/23/99

Division of Soil and'Water Ca
3,Division of -Soil and Water Ca
t'Division of Water Quality ,C
C[Other Agency - Operabon Re.
iervation Operation
p'_:,
Inspection
'ft
, r
�ervahott -;Compliance
1 I
� I • ,
-
r�,r.
eW
s
A Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other �
Facility Number 5 I 7a Date of lnspectio 1 r
Iinle or Inspection 24 hr. (hh:mm)
Permitted Certified © Conditionally Certified 0 Registered 113 Not O erational 1 Date Last Operated:
Farm Name: .........................................
a°7.?........64.'r.D ....................... (aunty: �S.T�..4t.'...............
OwnerName........................................................................................ Phone No:.......................................................................................
Facility Contact: ..............................................................................Title:...................................... Phone No:
.............................................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
�"1
Onsite Representative:........�%......................... .[..qs�) ..... ...., .Integrator: .......�l�Lt'i��C..V S..................................
CertifiedOperator:....................:........................................................................................... Operator Certification Number:.........................................,
Location of Farm:
................................................................................................................................................................................ ............. .
Latitude 0 6 i4 Longitude 0 �«
Design Current Design -Current Design Current
Swine Capacity PopulationPoultry - eiCattleCa acit Po ulatoCapacity Populatio
n
i
❑ Layer ❑ Dairy '
,I ❑ Non -Layer �' ❑ Non -Dairy
❑ Other
Total Design Capacity
TotaIs LW
;. Number of Lagoons ' , ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Feld Area
3 ! Holding PoudiV'Solid Traps ❑ No Liquid Waste Management System
t 3
❑ Wean to Feeder
❑ Feeder to Finish
CZFarrow to Wean
Z-4 ao
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WrNo
Discharge oribinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes J?J'No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ) ❑ Yes ,oNo
c. li' discharge is observed. what is the estimated flow in galhnin?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes j2No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes r2No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Mo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 .
Identifier:
77t-reats
G
Freeboard(inches): ............ ?.................................................................................................................................................................................... I......
5. Are there any immediate t to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (INo
seepage, etc.) i"
3/23/99 Continued on back

Facility Number: 3 — Dale of Inspection //22
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes . Fe'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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes OINO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?, ❑ Yes IdNo
Waste lkvplicatiort
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
�No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
Zf'No
12.
Crop type C, 132?-ien S.G,
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
OINO
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
P'No
b) Does the facility need a wettable acre determination?
❑ Yes
PrNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ONo
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
PNo
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes J2 NO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes )eNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes 01NO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N0
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
L^
�4vioiati9 is;or• de#"iciencies mere pQt;eO during phis;visit: Y:oti} ;will reegiye rio fui•titer; • ; :�
•corresporicience:a�out:this.visit.:• •••-••••:•••• .•.•.•••• •••-
Coriim'ents (`refer` to qucsba #} Explain any YES answers apd/or,any recommendations or any other comments' viz!
, --
Usedirawtngs of facility to better explain situ 'ations (use,addthonal.pages-as�necessary)
.s ,.-�,r> ,r•,.i: '.t-� 9�.� r'� t ;t`�
A
CfI 397
Reviewer/Inspector Name <�.j t`' ' LJ:r
Reviewer/Inspector Signature: �� _ �. � Date:
b- 1 3/23/99

Facility Number: 3 — 37p I)atc 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 XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes CNo
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 ;3"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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 21"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality "AP
r»7ru v„x '' `" �. ,'7M! .. ,�1`o-
Routine O Com taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of lnspection l
Facility Number Z
Time of Inspection ! D 24 hr. (hh:mm)
Registered 3 Certified 13 Applied for Permit © Permitted 10 Not Operational Date Last Operated:
Farm Name: lY. _...../ ...., { �'� ..,<.................................... ............ ....................
/f County:....,..
r✓. ..�`..'d.zt .................
Owner Name:.A4.�.,/A1 .?" ........................................... Phone No:.......... .....TVY....................................
y 7`r1 XA(........ l,r
Facility Contact: ..,., ... �... � `t±:............ Tit.le:..... ..�J.a!'�::r,?::.(x, ��.. ,. ........ Phone No: .. .....`.f..,
-Mailing Address:..,....��.��.,........�N1. L�:,.....��.�.......................................................ilY�...r.1..1�...s.�.��!...�.............................. ........��... ��;f
Onsite Representative...f .t9?� ........... ......?`'..�wtvrL......................... Integrator: ............ �,4t �.reedl_�.........................................
Certified Operator............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude • 4 0" Longitude • 6 "
Desig
Swune�ti Caac
❑ Wean to Feeder
.Feeder to Finish " f %1P
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
_ ❑ Gilts
❑ Boars
Current
r Population. Cattle
LJ Laye.
❑ Non-
❑ Other
a
L Subsurface Drains Present
❑ No Liquid Waste Managen
C
C
urrent
�ulat�on
[LJ Non-Dairyl I �.
t Capacity
►tal SSM
Lagoon Area JU Spray Field Area
............
System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No ,
2. Is any discharge observed from any part of the operation?
0 Yes
GdNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M No
b, If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
91 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
O No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
XNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R) No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C4 No
7/25/97
Continuer) on back

Faci ty Number:'31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes RNo
Structures (LagoonsAolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes M.No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):...................................
10. Is seepage observed from any of the structures? ❑ Yes [a No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes .0 No
12. Do any of the structures need maintenance/improvement? 0 Yes i1 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 aLNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes O�No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................. 4-15.6 4..............................................a..P......................................................................................,................................,.,......
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [9No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 0.No
18.
Does the receiving crop need improvement?
❑ 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 Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Z3 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
G' io
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
AM Yes
Q No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
O"No
[3•No.violationsor. deficiencies.were.noted,durink this:visit.;:Y.ou:will 'recei.ve:no,ftirther;::
• correspor�deirice. about this:visit �. � : .::. • � � . :: , � ; ; - � :. � :: � .: . � � : .
20. 5rr, 7 . �C c�vr�� 04' S4 ►a.(-. � or, &14"5 � r -;�
X 's2 rQ 1 =� To TR_a iV pop.) ZQ t.�►'�tJc-�S
r
7/25/97

..::.r,.-„ :so-.. _ .. :... »... ..:., «.: r ,
DSWC Animal Feedlot Operation Review
;,DWQ Animal Feedlot Operation Site Inspection
Routine O Complaint O Follow-ut7 of [)WO inst)cction O l oilow-uD t►f DSWC review O Other
Date of Inspection f fly
Facility Number 217—
L ...... .. ... . Time of Inspection 't70 24 hr. (hh:mm)
13 Registered QCertilfiied ECApplied
f for Permit D Permitted 0 Not O erational llfate Last Operated:
Farm Name: Ai%..Itr.......:�4taFla &J......rA ...................... ..... .... County :....... �1;o,.......,.,............. ................ ............ I..........
.............. ...... .....
OwnerName: µl..t.1A ..,...iau............................................................. Phone ..........................................
yy
Facility Contact:.... .1..� ?A....... d..................... Tide: ..... e3 jr.....,.........,.......,.,................. Phone No:.��1�.Q.�.z .............
Mailing Address: �.�. W.L.....y*.....,.......+........................... .Z.�...........
Onsite Representative: ...... 1`!1.1..6s...... .. � .... GM.�.......................................... Intel;rator:........�l:rt7.�{.5.......... ............
......................................
Certified Operator,................................................................................. ....... Operator Certification Number,................. 1
Location of Farm:
...,....ql.... Aa............... . I,l.... tttM.,.....rm..... ( ......................
.��..tT�1� ...... . '......Q.�r......: . mow........0....... r ....+c?.e,........I.e..............................................................................
Latitude 0 1 44 Longitude • 4 46
Design Current Design - Current ..Design Current.
Swine Capacity Population Poultry Capacity Population Cattle Capacity, .Population,,
❑ Wean to Feeder JE1 Layer PET airy
Feeder to Finish 0 ❑ Non -Layer I j JEI Non-Dairy
Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
-,Number of Lagoons /Holding Ponds CBSuhsurface Drains Present ❑ Lagoon Area Spray Field Area
❑,`°o Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [$No
b. If dischagge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes V3 No
c. If discharge: is observed, what is the estimated flow in gal/min?
d. Does discharge bypass n lagoon system? (4If ycs, notif'v DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require "SYes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'? ❑ Yes 1WNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 19No
7/25/97 Continued on back

0
Facility Number: 3 — $yZ
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,llolding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
Freeboard (ft): ...........`+r.`�.........
Structure 2 Structure 3 Structure 4
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes &: No
❑ Yes Q No
Structure 5 Structure 6
12. Do any of the structures need maintenancelimprovenient'?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) 15. Crop type ............COOS4k.....]L Lrm.v. AO,.. ........................................................... ...................... S&A-D A.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application'?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did ReviewerAnspector fail to discuss reviewlinspection with un-site representative?
22. Does record keeping need improvement'?
For Certified or Permitter) Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No violations or detieiencie's.were noted-d66n' g this'visit. Noil.Will receive no further
coerespbndence about this;visit:
Comments (ieffr:to question #)::Explain any'YES answers. and/or any recommendations or any other
Use drawings of facility to better explain situations. (use additional pages a5 necessary),' '
5 . f3eM. a.rtA IA %Pro l sk%ov l b 6 (L�-ejc j . 13e.yrns SPiodd ioe_ 6j, 1 �-
.OK r'ta5oon KlirrvIk
J K l S� ay A-eld locA l'u-I
v-- -4c us.
12. crops; av� are�S OK '4. CYIALr-Ic al a J < pAR S 4 &Ioot, !i C000
CAO, a.t"J 130M a.rtaS )kOU13 64, r0tedd ,
t$ Cori c.l t 9ro� x��Ma foc_ iMpy4ved+
5a"(- c�.`° �� a SIVU � e �►
❑ Yes EgNo
❑ Yes JZ No
IN Yes ❑ No
❑ Yes ER:No
❑ Yes ['No
❑ Yes SrNo
❑ Yes �R No
E'Yes ❑ No
❑ Yes SNo
❑ Yes 14 No
❑ Yes E9 No
.Yes ❑ No
❑ Yes DKNo
❑ Yes E$ No.
❑ Yes Wo
be A 1W W 14,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Ian L.A. Wn tin
Date:

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