310837_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (moo ance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Y I7.1 /,I?Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� ^� � I "� Integrator:
Certified Operator: Certification Number: j lr 5-6 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Plop.
Wet Poultry
Gapa°ucFity
Pop.
Gale
Capa�cii
#Pop.
Wean to Finish
La er
Dairy Cow
We4n.to Feeder
Non -La er
Dairy Calf
eeder to Finish
ZY g
2 20,9
Dairy Heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
Dr, Poult ,
�Caa "i'
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
IPullets
Beef Brood Cow
Turkeys
Other
Turke Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of 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 E]Ko E:] NA ❑ NE
[]Yes
[:]No
❑NA
❑NE
❑ Yes
❑ No
[D NA
❑ NE
[] Yes [:]No ❑ NA [] NE
❑ Yes rN-o
A 0 NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Y-3
Facili Number: -65M, , Date of Inspection; 17
4aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2<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 totheintegrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental t at, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes"Noo
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo ❑ NA
❑ NE
maintenance or improvement?
�Noo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance or improvement?
I I . 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
N ❑ 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
j'NoNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z❑ 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
❑ Yeso
TN'❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections udge 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: `25 I- Date of Inspection:
/
2_4. 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
❑-i4o _❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ E:aiIure 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
[TNo ❑ NA❑
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No D-I AB ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality -rates that were higher than normal?
___❑
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0<0 NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Appfication 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 No ❑ NA ❑ NE
❑ Yes ❑-5o_ ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
0�❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
ncvccwarinspcc��ivauic. yi••- — y reivuc. - � — e i
Reviewer/Inspector Signature:--�0 - Date: 2 1 fr?
Page 3 of 3 21412015

Type of Visit: (YCo liance Inspection Q Operation Review 0 Structure Evaluation (D Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Countylw ) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 07 Integrator:
Certification Number: 1 7
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Wean to Finish
La er
Wean to Feeder
Non-L
Feeder to Finish
rrjayers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Poults
Other I I III (Other
Discharges and StreamImuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Certification Number:
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Longitude:
Dairy Cow
Dairy Calf___
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
DNA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes g
❑NA ❑ NE
❑ YesNo (DNA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Zr No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strucurel Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: A(�j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IyNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
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
o
VN
❑ 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?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
, 0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesZI:
❑ 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 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 6/10
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
o ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EKo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
EZ/No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o ❑NA ❑NE
rNc
o ❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone[WoA
Date:
2/4/201

Reason for Visit: O toutine Q Com Taint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 ' Arrival Time: Departure Time:® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: LJQ/tJdjd1� C°btr
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: / I'
Certification Number: �9
Certification Number:
Longitude:
Design
Swine Capacity
Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dai Cow
Design
Capacity
Current
Pop.
Feeder
Nan -La er
Dai Calf
Dai Heifer
o Finish Q
o Wean
EFarrowo Feeder
Design C*urgent
Dr, P.oult . Ca aci P,o
D Cow
Nan-Doio
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
r=60tth
Turkeys
Turke Poultser Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] o [3 NA ❑ NE
[]Yes Vo [3 NA ❑ NE
[] Yes (No ❑ NA ❑ NE
Page l of 3 21412014 Continued

Facili Number: - Date of inspection: l ,
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):
fStructure
1 Structure 2
NNW
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Ef No [DNA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes %[ No [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
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 [7No ❑ 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?
FYes [:]No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes M/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EKO
❑ NA
❑ NE
Required Records & Documents
N
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 �FNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreemcnts
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
i
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] 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 E2'<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[-j"
❑ NA
❑ NE
and report mortality rates that were higher than normal?
91
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(::Ko
❑ 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
Vo
❑ 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
Io
❑ 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
MN[]
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to; question-#):: Explain anyNYES answers and/or any additionaUxecommendations or a®ny other comments -
Use drawings of facility to. better'explain situations (use`additional pages` a's necessary)..:.
IS,) SaT6,� .LND'Tcnw ILW 1✓C600
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
Phon
re: Date:
21412015

Type of Visit: 0 Co fiance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: b 2 Arrival Time: Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Do 0 A dAA V MaLA . U Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, I;oultr,
C►a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes r No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -Y, Date of Ins ection:Lj
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 Ievel into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 04 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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 ZN9
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes hT
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

[Facility Number: - Date of Inspection:
24. Did the'facility fail to calibrate waste application equipment as required by the permit? t Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] YesYo
o Ej 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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
io
❑ NA
❑ NE
❑ Yes
C1 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes "o ❑ NA
❑ Yes NNo ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
(Comments (refer to question #): Explain any„YES.answers and/or any additional recommendations or any other comments I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
0)4
Phone: 6
Date: 111 D ?/
2/4 014

Type of Visit: CJCo Nance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 7outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 Arrival Time: $O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:y��►'�#1 A
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 ;q a 9
Certification Number:
Longitude:
11111111 Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr., P,aultr..
C•.a .aci
P,o ,.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I 10ther
Discharizes and Stream Impacts
1. is any discharge observed from any part of the operation? [:)Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 ❑N ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

[661ity Number: - Date of Inspection:
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
`4A
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [?I/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 YNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ( I es ❑ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �/No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ es ❑ NA ❑ NE
to have all components of the CAWMP readily available? If yes, check Yes
20. Does the facili �Xl CrJ J1e ❑ NA ❑ NE
the appropriaZWUP
ox.
❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Nupiber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Vo ❑ 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 C2''To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes EaNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 2 1Ve ❑ 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 io ❑ 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 to ❑ 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 9<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?
❑ Y s ETINo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes 14 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or any other comments.
Use drawings of facility to better explain situations (use additional ages as necessary). ,:
tn/ML L, NE C-D wo"t ,
CGNj tT C4 0 C•'tt.
C.rt,o p CZI. Lb was P-0 �-
"P eo
ow
&-,—%
Amm&ON►647 4(-GbC-p
-o WL)f.
-f,,R-
-T#C
3y•�
w.s1.l.. PCCO To
ve iLt o
JF'('
a1J
Reviewer/Inspector Name: COaU fA W
Reviewer/Inspector Signature:
Page 3 of 3
?6. JAO V'�S WQnIE. ?LM9'-Q0,
YCA Q ,
10f -413 ,
Phonel`%) "m-7 3 0
Date: 1D
/11/13
'21A 011

Type or visit: try compliance in pection V operation Review U structure Evaluation U technical Assistance
Reason for Visit: 0 Routine 6Jp Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: p Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: JTitle:
Onsite Representative: dej LIDAIAO �LtlK Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design
Ourrent
Swine Capacity Pop,
Wet Poultry
Capacity Pop.
Cattle
Capacity
Pop.
Wean to Finish
La er
Dai Cow
can to Feeder —Maon-Layer
Dai Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dry P,ouitr,
@.a aci P,n P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the ope ation?
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)? !ti/
6 A,j
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yles.
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters]
Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -T1,07 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lwywo
Spillway?:
Designed Freeboard (in):
q
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes N
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes [:]No
❑ NA
❑ NE
tenance or improvement?
Zma'
I 1. I 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?
❑ es No
E] NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
YYes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑ No
❑ NA
E
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 56NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Sury
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []No ❑ NA E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
Page 2 of 3 21412011 Continued

Facili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes [:]No ❑ NA E
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 ❑ No ❑ NA E
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?
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 No ❑ NA
Yes o„) ❑ NA
❑ Yes N" ❑ NA
❑ Yes No ❑ NA.
es No ❑ NA
Yes ❑ No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ 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).
�� , p •d��� �r;P�1�- alas e.� Cr-e� 5 �'f?' A 1 a 4:
R p�^ae+�► AV c m , w,eA 'h, -, a� 3'. o pm , Pl��pl-e w u C- Z n C'C4. j per, s
\r., t� �� ,n/Ik�'C - W"A� .'��r�(,: �el�"'T S �'K• a'r b~�o.QYh� R�
c�►jr � 0� 30itJa11�• .�'�,e U('� �� - �� cft-e* C •
�Ii3 �� �,��� ���d°�,►� r�nl V3A 35ayv a3�►�
v fG5 we -ex, tAVa.v
�\ a ton W A S a`.m r ' Ai' 1 b ;19 a w\ ML)5� i
J► r u i C�,l�V►n ► S TnC, a� u M
� n � Saw1 � � �� Sv � Ir✓l � '�L r�",e''�' �i ' 'ws n a� Ce vry' P',7 l rC�o.
CAS S i1Z
wk Ia 4 creek ,►,N
kc;l) uork 6r� wJtr W'A, k
3 01) \A),E" W kS Lb4 Vj6I ) 0 P \V A 0
3q, ) V\'-11 se+ VP 9 (low
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�r CaMPIPMAte i
rpm eel i
Phone: 4?5grib � 0
Date: 40
21442011

Type of Visit: d Co liance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit�Routtiine 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
� Date of Visit: Arrival Time: �Ql1 Departure Time: �j'S County: DCIfRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: .. 3t-j 4lw fA;,, u Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 11 qb9
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Wet Poultry
Design C*urrent
Capacity Pop.
Cattle
Design
Capacity
Current
Pop.
Wean to Finish
La er
10sign Current
Ga acI P.op
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dr, P.ouh .
Layers
aia Heifer
Da Cow
Non -Daily
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
tJther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 ENo ❑ NA ❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes V
o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: --1 Date of Inspection: 16 t-r—_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z/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: t-A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �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 environment I 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 FZ/No ❑ NA D. 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 UNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P",No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground , ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes yl o ❑ NA ❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EjNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes LrJ No ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesVNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2"N'o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes do ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: Z`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesE o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;2110
❑ Yes 2No
❑ Yes [ No
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
�o
❑NA ❑NE
[� ❑NA ❑NE
No NA NE
❑ ❑
❑ Yes
❑ Yes
❑ Yes
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:
Reviewer/Inspector Signature:
Page 3 of 3
Phone. 1�'16) 2% -'
Date: rb v1(o
2 4/201

+Type of Visit: Q Co�fipliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
(Reason far Visit:V( Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: JU i Arrival Time: Departure Time: County: 0L)ft4pJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (Ia Nt1THAX) fA ,.L,t #_ _ _ Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
Current
Pop.
Design
C attle Capacity
Current
Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
p
Design
Layers
Non -Layers
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Turkey Poults
I 10ther
Beef Brood Cow
i ther
01 Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [/No ❑ NA ❑ NE
[]Yes
❑ No
[DNA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑,No
❑ YesWNo
o
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 - 21412011 Continued

Facility Number: 3 1 - Date of Inspection: 1 13 11,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in): `7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes LJ "lo ❑ 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 [f o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes Wo ❑ 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 E2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
--//
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes f
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
o
❑ Yes �fNo
❑ 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 h10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes FINo
[] 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [7f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: d 43/
24. Did tfie 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 F2/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
[2f/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
ZNo
DNA
❑ 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
CNo
❑ 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
rNo❑
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„ 1
Use drawings of facility to better explain situations (use additional pages as necessary) �r,"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone( D / r�, - �3 0 0
QV
Date: �4
21412011

o�ty �
f Water:Qual
_I#66fi
i
�FacllltNOfifier' �' ��1
W.t
f.1 P Y-" TT-�'P
14,Q Division of Soil end Water Conservat�an}
r I
: �W��,-
�.�:3o-i
E
f Visit Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit C20utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !O 1 f Arrival Time: C7 00 Departure Time: County: lkj�Q Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
Facility Contact: _ Title: Phone No:
OnsiteRepresentative: Jon1Ai-kAd mM i HL- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = d = Longitude: = ° ❑ 4 0 11
y Design` Curr'enf
Swine Capacity ,Population ;Wet'P
< ❑ Wean to Finish 10 Layer
❑ Wean to Feeder ❑ Non-L
Feeder to Finish r
❑ Farrow to Wean1> �t
Dry, P,lc
❑ Farrow to Fecder
e ❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
try Capacity EPopulation" Cattle i5
�t
Itry,y'7j
❑ Layers
ElNon-Layers
ElPullets
ElTurkeys
El Turkey Po Its
❑ Other
4:, TYP 4i- i„ a !AS ��z ;.: "';FYY
Y'„•�.w.#i a'F%:':
❑ Dairy Cow
❑ Dairy Calf
i
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
S q
"r,Numbr1Structures,
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 MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes YN ❑ NA ❑ NE
❑ Yes lJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: j 1 —'7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): )
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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 tz(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ! No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 40 ❑ NA ❑ NE
maintenance/improvement? ,_ �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes Do ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 NN [I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El
L� N ❑ NA
[3NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYesV
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Evz ❑ NA
❑ NE
Comments (refer to question #):. Explain -any YES answers.and/or any recommendations or any other,coinments '
. et
Use drawings of facility to better explain situations: (use additional pages as necessary)'
IReviewer/Inspector Name q wt:k .• Phone:
Reviewer/Inspector Signature: a ell. Date: lo
Page 2 of 3
12128104 Continued

Facility Number: — �jDate of Inspection
7 d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi n ❑ Ma s ❑ Other
❑Yes 7No
❑NA [I NE
El Yes ❑ NA [I NE
g p
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJ 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?
ElYes
L"I No
❑ NA
❑ NI?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ef No
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElM Yes
,[3/
o
❑ NA
❑ 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
[2 o
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IjYo
❑ 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
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did facility fail by
❑
the to notify the regional office of emergency situations as required
❑ Yes
[' N
❑ NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El
�
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
A'ddit'
ional' Comments;and/or Drawt I i
Page 3 of 3 12128104
Page 3 of 3 12128104

31 H T31
Type of Visit &coompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e0 Routine O complaint Q Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit:
Arrival Time: ®
Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title: Phone No:
Onsite Representative: C_5'J&N'rj4A,,J rA:rU (=k Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o a 6 =ds Longitude: = o = 1
Design Current Design Current
Swine Capacity Population Wet Poultry C•aparity Population ,
C►►attic
Design C*urrent
Capacity Population
❑ Wean to Finish
❑ Layer
Dairy Cow
❑ Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
❑ Farrow to Wean
iL 6Z
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ DairyHeifer
❑ D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑Beef Brood Cow
Number of Structures:
1Other
1100ther
Discharges & 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑, No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
[ N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

i
Facility Number: 3 1— Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,..,�
6. Are there structures on -site which are not properly addressed and/or managed El Yes R 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 environmentaZo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ado ❑ 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 ld No ❑ NA ❑ NE
maintenance or improvement?
Waste Application dNo
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
9<0 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Z"No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VN❑ NA
❑ NE
Comments (refer to'yuestioh #).• Explain any YESanswer•�s andlnr+any recommentlations. or any other comments. � '.i
r rs f c1'Sai�# t
Use drawings of facility to better explain sithatiohs�(ufse a>>d..dittonal page stajsanecegssary),{i{v
�'4.'i
^ I. r* f a 7 CA A t^rc '1b �F t.o+t
LA Crco#�J A t&iA . rAI\� f►�,�►� DawAJ 8 �E t a�J
Ao N 6n-b 1s r—V �. 5
STop LAVA ,,
ReviewerllnspectorName A' Phone: 6
Reviewer/inspector Signature: Date:
12128104 Continued

1
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZfNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ 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 Inspectionss
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El, Yes
/[:]
NNo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ es
Iyes
,�
La No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'No ❑ NA
[IN E
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
,
E No ❑ NA
[IN E
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`?
ElE Yes
No ❑ NA
El"
❑ NE
Page 3 of 3 12128104

I
Type of Visit 0'Co pliance 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 [I Denied Access
Date of Visit: Arrival Time: © Departure Time: County: _ DU19 L--i Region:
Farm Name: Owner Email:
Owner Name: _ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 701jq &t ��-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: n 0
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number-
:]' ] Longitude: 0 ]
Swine
Deign ,Current
Design Current
Wet Poultry
Cattle
Design Current
Capacity P`opulatign
apcity Pop lation
Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
0 Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Caw
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L21 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
❑ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
LI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Fae lity Number: Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structu�re/ 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (4[�N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): !j�
s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA [IN E
(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 t eat, 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? El Yes Ld 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 2 �No ❑ NA [--IN I,
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
[rNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
PKNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
ElNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Fog, UV-7 tA4Z-JSfJV - t.OWC M &K)GA 7 W:�TrAZ►✓ ,o av z(l
0,41 gtfio A/E e --Air - L aG/7�' PEEV_LjOTL Y M64) ?talep AN A!✓/,r*L f JET
Iry
Reviewer/Inspector Name Phone: 791 PP
Reviewer/Inspector Signature: Date:

t
Facility Number: — g3 Date of Inspection i
Re%uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WDP ❑ Checklists ❑ Design MAXaps ❑Other
❑ Yes ENo ❑ NA ❑ NE
❑ Yes�No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspection�No
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ es
�
Ld' No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
yYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
11I No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
L;,,J 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
CJ No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[D"No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additionsl:Cornimentsand/or�Drawings a
. r .'y x Y t t v `r
Page 3 of 3 12128104

a
II,#
Facility Number $�,7
dDivision of Water Quality
,0 Division of Soil and Water Conservation �
Q OtberAgency ✓ a h
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a i. A Arrival Time: Departure Time: County: DLRGZW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
_ OA►J Nla L1,k Z-
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 9 = Longitude: = o = 6 = {I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
10 Feeder to Finishi Q ±a6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Othcr
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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
El
-Dry Cow
❑
Non-Dai
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of. Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence 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
No El NA
El NE
❑ Yes
El Yes
,❑
CJio❑ NA
El NE
El Yes
L+❑NA
❑ NE
12128104 Continued

F2lcility Number: — Date of Inspection v
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: io
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q Z
❑ Yes QNo ❑ NA ❑ NE
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
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 Y No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9f 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 E NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ✓u 01 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,[_
L� 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
❑ 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):
z!� wjwri' Am4 LYrZ5 I6 w— 161b4 -1zl6 6 Ai6(-, J TO 0 C oUt6 P.
as/ sLUn6� fWWY kkos 7v An 01W6. 6,vtx A10'-i1zj,j2 Eyemrib✓.
Reviewer/inspector Name i ` Phone: 9/a q —7 3
Reviewer/Inspector Signature: Date: z6h,
•�i �. vi vT 4vF/+•H�u

F
Facility Number: — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. LJ 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 L' I 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? ❑ 'Ye
s No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? Yes ❑ N ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes No ❑ A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ❑ No J_/J NA ❑ NE
❑ Yes fNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
ElI2
�,�
'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`y
[I 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
L No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z No
❑ NA
[:1 NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Revi ewer/] nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El
ba No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit Gedompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Qloutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Thee) '+ �Q Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
PhnneXo..
Integrator
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = I = Longitude: = ° = d =
gl
Design Current Design C►urrent Design Current
Swine C►apacity Population MOP, Capacity Population Cattle Capacity Population
❑ Wean to Finish
ID Layer
I
❑ Daia Cow
❑ Wean to Feeder
1 10 Non -Layer
I
1
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to FinishEl
El Layers
Beef Stocker
ElGiIts
❑Non -La Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
El Turkeys
❑ Turkey Pou Its
I❑ Other
Number of Structures:
Other
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 l of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application �I Weel Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers [I Annual Certification
El Rainfall ElStocki Crop Yield 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
925Did the facility fail to calibrate waste application equipment as required by the permit?
Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Ga
yy
illy
Page 3 of 3 12/28/04

93*1
Type of Visit ;7Routine
pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: jI r� Departure'Time: y, County: QUA+ Region:
Farm Name: f3m(3f iW+r./y�C i� hA Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ,,` Title: Phone No:
Onsite Representative: �G �iJ Integrator:
Certified Operator: ____&86,�_b+eW�('fl Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = , 0 Longitude: = ° ❑, 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder_
Feeder to Finish
2 fi
a b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Puults
❑ Other
Discharees & 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
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: I
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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
G No
[I NA
El NE
El Yes
Coo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: JRK
Spillway?:
Designed Freeboard (in): c
Observed Freeboard (in): ar
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' No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ 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 tJtreat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ul No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application?. If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind Drifi El
rApplication Outside of Area
12. Crop type(s) W W &(21' V,0' i! ) 60
13. Soil type(s) ��d� N6,►q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z o ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes l-J No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes Zor
�< ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA [I NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
5) LA G-OW At jab rf CAW lea
2y
�1ARkcZL SCT 7a
!
I j -rW�' �j<n kE Ca a QS
A/e
0 241' A 6C-Ot,-ko jg6 V00A-r _,0 aR
CCU d' YZ6L.� l 04*J c6ur4s �U
Reviewer/Inspector Name
_, - _ ,,ai _Phone:
Reviewer/Inspector Signature:
OZ
Date: ZA
0 ,05
I2128104
Continued

FacilityNumber: Date of Inspection
Required Records 8c Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes OR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2f No
❑ NA
❑ NE
23.
1f selected, did the facility tail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
5 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
ZNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
D NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
ElYes
El1d No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
_f
L(J 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
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�Na
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
�(N o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit g Routine Q Complaint O Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number [lute of visit: Liu Time: // Nt
Not Operational Below Threshold
® Permitted ® Certified [3Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: �jn V zed.1117 e riICU �/.17 County:'42WAII
Owner Name:
Mailing Address:
Facility Contact: `_ / � Title:
Onsite Representative: _!�42 .16.11 /t.•i
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: :&ef'z
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 " Longitude 0 1 «
Design '� :Current
n)wme Ca
❑ Wean to Feeder
© Feeder to Finish Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Number of Lagoons
Design Current Design Current
Poultry Capacitv Population Cattle CaDflCitV Population
❑ Layer I I JE1 Dairy
❑ Non -La cr I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present IfLJ Lattoon Area
'I I' 1LJ No Liquid Waste Man
Discharges & Stream Imnacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facility Number: 31 -422 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El 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 El No
(If any of questions 4-6 was answered yes, and the situation poses an .
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Anniication
10: Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAX MP)?
❑ 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
&eguired
Records & Doguments
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notifi- regional DIXQ of emergency situations as required by General Permit?
(ie! discharge, freeboard problems. over application)
❑ Yes
❑ No
23.
Did ReviewerAnspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about tliis visit.
�`: i-,.4:.- --';�t:l•a;eik§`4 ,� - --. �w_ ~-' �y;s �.1-,:t+ii:vr4�1Ya64:_'t'+1iwv..�'k'sc1'LL3ai,yZnnw Lril�w . 8RF.:."_" .d- ,r }� {
6i it's (refer iEo gnestiaii . Eiplsin any4'YES a�tsweis.und/or any recommendations or„any+Fotiter tommAents� R¢
a.
Use drawrns of facility to better explain sittiattons: (use atldtEsonai pages as necessary) t a"r . ❑ Field Copy ❑Final Notes
rr�
ikD:,E.r_..:..'',`n`t°�aiG'.ikia'..1>,?:.+�.1�1�'d}�. :ter/«.� ..,.�.;,. _h;t 1:/_iyr�' �r��� ,'+d..at%",a.'i�r..: �u. ri:k..,_n«na..?4i�?9a�.�kF:.:..s.,:diF§,.�,ot�cek'R:.��:saw..._.,n.,,«--R.,c...�.•.--,,.-+�-,-r•---*,.�.-,g„.wr,..�-.�_�. �"`
JC�f Co��S d' �i'/r� L�O�I✓ (��9
•
ti� sv w. =fir ...... ,.
Reviewer/Ins ectorName ,nr
p
Reviewer/Inspector Signature: Date:
OS/03101 11­_ Continued

Facility number: 3 -W Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the sto'ragc pond or lagoon fail to discharge at/or bciou,
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i,e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. W'erc 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.)
+1. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? .
❑ Yes ❑ No
❑Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings:
A.
05103101

Type of Visit 0 Compliance Inspection 0 Operation Review QLoon Evaluation
Reason for Visit 01!rutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Date of Visit: Time:
N O erational Relaw Threshold
0 Permitted [] Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
In Farm Name: A }_ � /d? s, i l� 4 "7 _ County:
Owner Name: �l i�14 Lam, f"��CZF%WAx &V^ Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title: Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude 0' ' 0" Longitude 0a �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Poulatfon
❑ Wean to Feeder ❑ Layer ❑Dai I
El Feeder to Finish1. ❑ Non -Layer ❑ Non-Dai
❑ Farrow to Wean
�f ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ' Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
I , Number of Lagoons, : �_ JL.J Subsurface Drains Present �ILJ Lagoon Area 1LJ Spray Field Area
HoldingiPonds1. ISohd Traps 'a� ❑ No Li quid Waste Mana ement S stem �
Discharees & Stream Ininacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
n
Freeboard (inches):
05103101 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes I1Po
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application.) ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ 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 ElNo
16. is there a lack of adequate waste application equipment?
Required Records & DocUments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the faciliry fail to have a actively certified operator in charge?
22. Fail to notifi- regional DN Q 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q No Niolations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'E, .: �s .r.tiw'"�:..;:a� a za,�� �E + ;S
Comments.(refer to gttestton.:Ezplsin,any YES answcts,andlor,atiy recomuretadations or any otlhnsmlenta.��y_`�«; +� E,
Use drawings of facility to better explaua s1Wa'iions ' (use addidoaal-pages as necessary") s ❑ Field Copy ❑ Final Notes
k ,
.hew. %�+i.W.l.�n"wMuw..w..�u°1^ti.7.'i4��411�&'�srY..�,..5`.i.&.M1 e.- - �':.�I..�c.'.P9���,��I�.by-�N%7�:}!�WC� �:F1ti'�..g-..feaef%�wil.�`WFF3i..i�il13� ,.i!tRi.SKiv I�.hai['�%�"-I1(w��i)@Ptt�aaw'rs'Yiaa�;�..ee�w....�".vC-'�:ri'a'.w^`o+Irr+'.VPM�hM�• '•-}' �fl., i�.§NY'�R
©K� 6oH,,
Reviewer/Ins ectorName �' 7��
P l �g4r..n
& T d df� .iM C :7 :f4 .i 7..tzK R°JE I ,a?x3iR 'thhil a h::.:
Reviewer/Inspector Signature: Date: t
05103101 Continued

Type of Visit 1 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J6Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
D:
Facility Number ate of Visit
Permitted [3 Certified [3 Colak
ionally Certified [3 Registered
Farm Name: 8 �f �G
$ og v
Owner Name: 6MR
Mailing Address:
Time:
10 Not Operational 0 Below Threshold
Date Last Operated or Above Th1reshold:
County: , P1, �N-
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: t O �Ep ntegrator:s-y-� i=
Certified Operator:
Location of Farm:
Operator Certification Number:
)6 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0' '
Design Current
swine 1,apacsty Yo ulation
❑ can to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current
Poultry Capacity Population Cattle, Capacity Population
❑ Layer ❑ Dai I
❑ Non -La cr I ❑ Non -Dairy
❑ Other
Total Design Capacity
:. ❑ Soars Total SSLW j
IIIIYPIIIPIYY�III�-
>r
-.� . :#.,
„ a.Numbei� of Lagoons ❑ Subsurface Drams Present ❑ La oon Area ❑ Spray Field Area
� vw Pond�rc.. �- ilia
Holdidg s 1 Solid Traps ❑ No Liquid Waste Management System i
Discharees & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes/2fNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ko
❑ Yes
XNo
❑ Yes
XNo
Structure 6
Continued

Facility Number: 51 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
I No
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
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Cl Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
JVNo
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ArNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Hydrauli Overload
❑ Y , No
12. Crop type S
„�jj✓
rQ
13. Do the receiving crops differ with those de ' n ted in the Certified Animal Wa a Management an (CAWMP ?
❑ Yes
rN
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?
El Yes
/1
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Reaulred Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
ElYes
o
X']
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
X.
24. Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Conm ents;(r"efer to question_#t)Explain any YES:answers'and/lor4a ny�rco emm�endatians oranyo er�camment�s .. M }^'
Usedrawin s of facilit to better{ex' lain situations .use addttionall a es
g, yry (� `� as nee wary) Field Copy ❑SFinal Notesmaw
/v 13cow..� s r �,5
C 2 j- 5 Lz s��"r� �iJ ljl%l 1 "L f3/✓. �`�'2zG f}7Z o n�
�7—e7
ACD�yo 5.
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:
05103101 Looly
Continued

t
t
\ `�
i
�,�
e �. `�1
1

r
Facility Number: % — bate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�NO
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
. ,. .
,Additional Comments andlorrI)fawings �, ��. �F� , ;. ,,,•ram;• .
4 72f- A)x-g R-
1.o--FG L2 5iJX
05103101

C ,
1

Facility Number $' Date of Visit: '—t'•Z- Time:
Q Not Operational Q Below Threshold
Permitted E3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: ...... ....�__mlr. ' .�. .......................... County:............................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: .....................:........................................................ Title:.,.............................................................. Phone No:...................................................
Mailing Address:............................................................................................................. ............................. ...............
........ ........ ....... ........................ ..........................
..
Onsite Represent ative:... ����'?:.... ......�. 1.. ........................................... Integrator: ... :�.i........ .. 4................................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
o .'a
7
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 « Longitude • t 69
Design„' , Cuurrent Design Current ]
Swine Ga aci Po ulation Poultry Ca aci Po ulation Cattle C
Wean to Feeder
Feeder to Finish
�.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total bWgn Capacity, [
„ `T 'ta< ss wI E
esign Cuirrept
sc '6'ulation° P."
3;r
z Number of lra aons ❑Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Area;
�HoldingPonds I SoHd'Traps` ❑ No Liquid Waste Management System LL era
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes tj�-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: .................................... .................................... ................................... .................................... .................................... ....................................
Freeboard (inches): 3
5100 Continued on back

Facility Number: — Date of Inspection 0
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
closure plan? ❑Yes ,O'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? -.Wes ❑ No
8. Does any part of the waste management system other -than waste structures require maintenancelimprovement? ❑ Yes eNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JM No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type bh , <A , C ( V1 SthA
13. Do the receiving crops dirfer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ANo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
8'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
CR�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
kNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
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
KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
W(No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
,V No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0; Q yi�l iiq>t}s;o d#'fciei;cie� vt�re "004 dtrri>�g f t�s'v�s�t! Yo>j� wii� >reetiiye �}o #'u1-th r
:: ;corresparidence a)aulr this visit:: ::: . .
Comments (refer to:.gaestion`#) ' Ezplain any YF„S answers and/or any recoammendations or anyEotker comttienb. , , (a 8;a�, t , ��r �,� p,,
Use drawtnjo of facilityto better explaimsltuations: (use.additional pages`If r d
I
5��J�e L_
R
Reviewer/Inspector Name
r:
Reviewer/Inspector Signature: Date: 5/00

r r
Facility Number: Date of .Inspection' '� G
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j 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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )NTVo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Al No
ona omments an or Drawings:.
#
zk-
-
1
C � 1
5100

'jWD1 i,ion'
r otl hater Q4ahty
-and
Q Divtsiori'of $oily Water Coi►servation
PID'Other Agency;s, .
k
,M i;.' 'i, i �.,
F„ _ 1 iF_
,�.5
Sr _
Type of Visit )eCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Wcompiaint O Follow up O Emergency Notification O Other ❑ Denied Access
L- Facility Number ! 3 Date of Visit:
$(Permitted 0 Certified [3ConditionallyCertified [3 Registered
Farm Name:
�f ........................:.......................................
? Qd Time: 119 CIO 1 Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County:. V .. A!.".1.............................
Owner Name:...: ! /D� 6, 1C DY'►'1C J6 a (-`-,...................................... Phone No:.......................................................................................
... .........
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:...........................)............/..............................................................................................................Q..................)................................. ..........................
Onsite Representative: ... dbb ICdY�?p►} �1 Lj GB"!n kfh17CI� Intel;rator:...7 !,,..."CS7Fi�}
......................... J
Certified Operator: ................................................... ............ . ............................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 & Longitude �• �S «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE3 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gifts
❑ Soars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
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 ohserved. did it reach Water of the Stale? (If yes, notify DWQ) ❑ Yes ❑ No
c. Jl' discharge is observed. what is the estimated flow in galhtirin?
d. Does discharge bypass a lagoon system? (If'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Rfto
Su1Ucture I Striwttirc; 2 Structure 3 Structure 4 Structure 5 Structure G
IdentiFier:.............................................................................
Freeboard (inches): 36
5100 Continued on back

Facility Number: 3) —83`% Date of lnspection )j (A Printed on: 10/26/2000
w
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
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ 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
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination'?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;fNo
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
Vo yi0 a(i0os:or• d0cie 6bg i• rb hofpd• dt<rritig this;visit; • Yoot wiil•reeohy 06 f. thgr . .
. rorrespandeit& Aatit: this .visit..... .
CommenI.ts (refer to question.#} Explain any YES answers and/or any recommejidations,(r any othei commI.ents }, . < ¢`
;Use drawings,of facility to b3etter explain situations (use additional pages as necessary):
Kesp,)Iof;r,q IV ct Gnr"pi ;rd 00-, irr;c441oh acLuFrr ;j'1 T�C ralyl ay} •
s•�w no s;S�J o ry ands IF-ickar c eke.,--
1 �
�SgLs � 1,gll-.f,PrAyc aiy FvtZ IS eh iI/Zy%Od one( ,4-wkS ha�
rAIn�.��. Send urd4 e4 -s)e9-'Z stjd1_,;ny 44,,S evcn4 Iy )Zll�pO,
IV
Reviewer/Inspector Name yr r L"q 1 f M -� , r 07
Reviewer/Inspector signature: Date: if 5100

}-s. { + : s }s. ! sl 4r€ s E3 ! 3 s3s `I�tvtston OftiWater ualItVy
D�'1r1310t1i'sc
�
;kSr�IQr ofSoil'andWafierConservat�on„ qy �, aS §',!r
}�.-..j.'.,
a y r t a t .l,.` 's1f sii t� OrOtherAgen ey'+ E _i i4i 4j54 ss s� ki kt x er 1 i E f i �t vi
e§�..
y f fi 3 s 3s x§ 3 �° 1 1
2.
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine © Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 837 Date of Visit: 14123/Z044 Time: 14:30 Printed on: 10/23/2000
Q Not O perational Q Below Threshold
® Permitted [j Certified ® Conditionally Certified © Registered pate Last Operated or Above Threshold: ........- --
Farm Name:RRW.KOIrugay-Fam..................... ................... County: R.upaia.................................... ylIRO.-....
Owner Name:.HXttr.d.(i........................ Konggay-A................................. Phone No: 41�:k5.8.5 9 ............................................
Facility Contact: - -- •- -- -- -- -- -- •- -- -- -- -• -• - -- Title---- -- -- - -- -- -- „ - Phone No:............._ .. _...._ ._ ._
Mailing Address: 429—RaW.D.O.H.Ag.ad..........................................................
Onsite Representative: Mark.P�axs4Jq,--,
.... M-01in..NC....................................................... Z83.45......
... Integrator: Pr_VhtRgC. FarjM......................._._....
Certified Operator:,jgPl�t............ .. .. .... K4rJugay. -..... -. _....... _... Operator Certification Number: J9409 -- -- -- -- •- -- --
Location of Farm:
Vortheast of Calypso. On North side of SR 1559 approx. 0.25 mile Northwest of Hwy 403.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F 35 • Longitude 78 04 10
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry Capacity Population Cattle Capacity !Population
❑ Wean to Feeder
® Feeder to Finish
2480
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons �.. ® Subsurface Drains Present ❑Lagoon Area INSpray Field Area
Holding fonds / Solid Traps ❑ No Liquid Waste Management System
Discharl:es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. I................. ....................................................................... .........................................................................................................
Freeboard (inches): 32

5100 Continued on back
Facility Number: 31-837 1 Date of Inspection 1012312000 Printed on: 10/23/2000
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
closure plan? ❑ Yes ❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ 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 ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. hail 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?
❑ No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
refer to;questirin #) Explainany YES answers and/or,a�sy recommendat�ons�or any�other comments Cdinments (
Use drawings affac�lrt to'better ea lam_ situations use.additionalt a estas necessar '
g.. P g . Y) ,., x .,..... rrt 1 1 t j1 9 r. Y
Responding to a complaint that animal waste was sprayed on State Road 1559 by Mr. Kornegay's facility over the weekend. i
10. Stains on State Road 1559 show that animal waste was sprayed on and across SR 1559 from Mr. Kornegay's facility. Grower
needs to make modifications to spraying activities to prevent waste from being applied somewhere other than the sprayfield. Also,
grower has gun pulled out in back field. it appears that this gun may be able to shoot waste into the nearby ditch. Grower needs to
maintain sufficient buffer to prevent waste being applied to ditch.
u
_... .._ ....
Reviewer/inspector Name ,Stn ali,MathIs �' .� ,:,R �.�

Q(Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 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 late of Visit: �/ I a Time. : � Printed oft: 7/21/2000
0 Not Operational 0 Below Threshold
MFermitted 13 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
e6 SY ......... — A/.
Farm Name : ............... Count`.�.,�..... i............
Owner Name:
........................................................................................................................... Phone No:.......................................................................................
FacilityContact:........................................................................... ....l"itle:................................................................ Phone No:...................................................
MailingAddress: ...................................................... .......................... .............................
Onsite Rcprescntative:...........`Q. ....1�4... Integrator:....... �,..tL......................................
............ !?'
Certified Operator: ........................................... ..... Operator Certification Number
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�` ��° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish Z ❑ Non -Layer I I 1E] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Laggmn Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance; ratan -made?
h. ]f discharge is observed, did it reach Water of the State? (ll'yes, notify DWQ)
c. [['discharge is observed, what is the estimated flow in gal/ruin'?
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
1
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure II Structure 2 Structure 3 Structure 4
Identifier: ..................1.................................................................. .................................................
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
Ave'/
❑ Yes ❑ No
❑ Yes %RCNo
❑ Yes �No
❑ Yes ;SrNo
Structure 5 Structure G
............................. .....................
Frechoard (inches):
5100
Continued on back

Facility Number: — 3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obser ed. (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
RNo
\\
`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
12, Crop type CW
13, Do the receiving crops differ with those designated in he Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
jNo
^[�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
[KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[X-No
15. Does the receiving crop need improvement?
❑ Yes
1�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Mo
Required Records & Documents
17. Pail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
IkNo
22. Pail to notify regional DWQ of emergency situations as required by General Permit?
Ge/ discharge, freeboard problems, over application)
❑ Yes
kNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
COO
24. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
�'�TQ Yiol'a iprjs;o defic�er�cies r are naYe� iijWing �his,V14t; • y0i, will Tec�iye o; ruftittt; .
cor'res ondenC . a�otik this visit. • • • • • • • • • • .. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better ex ain situations. (use additional pages as necessary):
�L
Reviewer/Inspector Name y' e er Lille P, '9441--
Reviewer/Inspector Signature: Date:
Q�
5100

Facility Number: — 3 flute of lnspection Ib 3,o v
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
itiona omtnents'an or rAwrn s:. ,' " r, "
A
3/23/99

`! , s`' r. •� Division of Soil and'Water Conservtiition -'Operation Review pis , :e jsr 1;6
1 p }
Division of Soil and Water Conservation Coilipliance ectrOn
f n��SrR3 1 ~ €c�li " 1 ^ l0 ��k y { R x -! .r i I i 1 , i' j ,y �f z r is 9x•iiE�g, y '`1
Division of Water Quality ,EC4mii a nce Inspection„
f t9 I! . .
.Other Appency'
,ppeicatto�n=Review
6. -(iC
.Routine OComplaint 0 Follow-up of DWQ inspection 0 Follow-u of DSWC review 0 Other
Facility Number 3 Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
0 Permitted © Certified /© Conditionally Certified [3 Registered © Not Operationaall Date Last Operated:
jg,e
Farm Name. .............D........6.r...,........'........................ s 5 County'..�1!J��............................. ...............................
n
and
Owner Name G� r �t' Phone No
...........................................................
Facility Contact: ....................................................................... .. Title. Phone No
MailingAddress:........................................................................................................................
Onsite Representative:................... ... ..... r.. d�......... lntef;rator:.....l....re ..V............................I................. ..... y...................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
...................................................................................................................................................................... .......................... .....................................
Latitude =•=' =•L
o '!
Design Current"`
swine Ca p acit Po ulation '
1
1
❑ Wean to Feeder
[Z Feeder to Finish
2 Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts!
❑ Boars
Longitude 9°
<Desiign; Current Design Ca"rrent
. oult Cattle
,,
ry Ca' acit .Po •ulat�on Ca acit Po ulatiar
] Laver �"' ❑ Dairy
10 Non -Layer I I ! ` 10 Non -Dairy,
❑ Other
!
Total''SSLW
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of tllc 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: !
F b d(' h ) Zrl
❑ Yes 8 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [8 No
❑ Yes N No
❑ Yes J& No
Structure 6
— oar tnc es ............I.......................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes $ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 j — DatV of Inspection qj
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 No
(If any of questions 4-5 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 5d No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? PK Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type L2> S�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JgNo
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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
0: �o-061aiidiis :ot- lief ciendes were noted• dofift this.visit; • y0o will •r. eeeiye 00 fut�-tho
correspondenke. aboutk this .visit:
❑ Yes 19 No
❑ Yes XNo
❑ Yes ;SNo
❑ Yes ;j No
Yes ❑ No
❑ Yes $f No
[:]Yes PrNo
❑ Yes D5 No
❑ Yes ZNo
❑ Yes N No
❑ Yes `Z No
Comm'e, nts;(refer}to--question #) EkpIiid;any'YES answvers andlor'any recoin;nendations or,any other comments :j-; s
,Use drawings of facility to better4ezplam'situations '(use,additio al�pages as necessary)
Jo �� h yd r��ll1 c�11 o verloo
y
1R. New LvaS4e Av?q 17 s.'S heeWed - MAke. xilrc r vOrS 4;, PAN me ,ch
ton-4e P1.01 • C IT y J-/ 0q 044; v'e 4 a �,✓a 1�c la �► 1'r� rotor& .
�ggpd�l 1� S-41G1,01 look ao4 -
-- Ad p ,y4d — s�r►tcr s1or Sean f s �l rG G. Ft utrc Ljei 6ve44 '
Reviewer/inspector Name y
ti. .
".ena.w f q, ;I�
Reviewer/inspector Signature: Date:4fll -[
3/23199

Facility Number: 3 J — Date of hi.spection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
X 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
j No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
$ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken. fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
TANo
lttona ontments an or < rawin s: 1 t t
,. i` ci. 3Ii §.9J' y§i}, 'I'�Ir, li c. _Al
3/23/99

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Routine 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection OG ?A hr. (hh:mm)
13 Registered © Certified 13 Applied for Permit C1 Permitted 10 Not Operational Date Last Operated:
Farm Name:.. �. `'�2... County:..... . 11`ra.....................................................
QQ � GG
OwnerName:.....;VT......'`/......................................................... Phone No:................l........................................
Facility Contact: ....................... ............ Title:................. .. Phone No:
C� JQ [ rI
MailingAddress: ... .a'...1..................D►�......i `................. v .......................... ........................... ..........................
........... ........
Onsite .. Representative•.: ,__. .., g ........................
. � .................................................. Integrator
Certified Operator. .................................................. . Operator Certification Number ;.........................................
!a atin o Farm:
.I�,..e.........''' ..�........ ......... ........ ......................... .... .............. �. ............................ ........ �,'l... ..�
Latitude C]•4 " Longitude • �_ �4 41
.; w,
v Design Current, Design Current; Design Curren
.,mowt N
Swine Capacity Papulauon Poultry u h Capacity Population Cattle:, Capacity I'apulatom
❑ Wean to Feeder ILI Layer ❑Dairy
Feeder to Finish $VJ 10 Non -Layer JE3 Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑ Other F `
❑ Farrow to Finish Total DesiR Capacity
❑ Gilts
❑ Boars Tota13SSLW
�Nt#m er of Lugonns`I Haldmg Ponds ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Feld Area
yIS
R
L,I0 No Liquid Waste Management System k
General
i. Are there any buffers that need maintenance/improvement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Fd No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [%No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes NJ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7125197

Facility Number: 31 — nrj
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11oldin2 Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
..........//.................
Freeboard (ft).......... .rs .1(. a ...............
Structure 2 Structure 3 Structure 4 Structure 5
................................................................................................... .............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Annlication
❑ Yes tEfNo
❑ Yes 0 No
Structure 6
...............................
...............................
❑ Yes brNo
❑ Yes {5No
0 Yes ❑ No
❑ Yes 9 No
14. Is there physical evidence of over application? ❑ Yes `(No
(If in excess of WMP, or runoff entering waters off the State, notify DWQ)
15. Crop type .r..... ..f...... �.`...4 . e..N...45.�..............................................
I........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18.
Does the receiving crop need improvement?
❑ 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
($ No
22.
Does record keeping need improvement?
19Yes
❑ No
For Certified or Permitted Facilities Onl ,
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available`?
❑ Yes
[YNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0: No.violatiohs or. deficiencies: were; noted,during this:visit.- You:will recei've:no:flirit%er_ :
. cprrespOdehO i out this:visit:.
1) � �•►- e -�c r�.sQ�ve �`,w $�e,�-j] �-,�aLe�-- a+� -�-� �-att...�Q�-. p � �s� Gam, �cr`�.� �-
�Q11.. �-� `�s�- 7- `�CAeV v� '�v1 ��-. O[�C ►-��-r� �-"V. ���CA..,
<Zty �Q'C] `� `S 4�5_�Q� ln1G t A, CC"
►!e 11�t -het-ccL�—(- S''�ll I.v ��t _ 7/25/97

........
❑ DSWC Animal Feedlot Operation Review
E3 DWQ Animal Feedlot Operation Site Inspection
® Routine 0 Complaint 0 Folloiv-ue of MVQ inspection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection "I
_
Time of Inspection i 24 hr. (hh:mm)
Registered 0 Certified 0 Applied For Permit © Permitted JE3 Not Opera Date Last Operated:
Farm Name:.... L�.0.�....�/-iJ.FY�trst. ....i'VYY` 1...........................
(honer Name:.....p. ar�rx�l................pr���..
Facility Contact: ....................................................................U........ Pitle: ..........
Mailing Address:....` -2--1..,.,....�s:t .� .�,..in, .....�.v�,1..i.......R.a.................
Onsite Representative:..,,,
lI ��
Certified Operator;...,.c�...i..i...: ...,...........
Location of Farm:
........ County:...7u 1.................................... .01..�...
........ Phone No:.....,............... .............
.... ... .... I .............'.............. Phone No:...................................................
.......}..;:.wA.....1�1::...:.....................1...la...
Integrat ur:....P.ar..e..S..-.......................... I.....r.............
Operator Certification Number :.....LuLl... ( "71.....
.......
i?,►1..... r.a.r.t-!.e.ust.,....�.%.t.....,6.
{
i.,16
r.....ct�
...
�.. ra. ,.,ars..n . p....D.. .... ..[... k Jr
i
.............1�.....'...............................
............................ ....... .......................
LatitudeLongitude Ze ' I OO l` I ❑`°
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design i Current
Poultry Capacity, Population Cattle Capacity ,Population
❑ Layer 1== ID Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity =0
Total SSLW 139
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 13 No
2. Is any discharge observed from any part of the operation? ❑ Yes E"NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was`the conveyance man-made? ❑ Yes ®.No
b, if disci arc is observed, did it mach Surface Water" (If yes. notify DWQ) ❑Yes No
c. If diu:harge is observed, what is the estimated flow in :;al/[t1in? ►� f a�
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 KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0'No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 1K Yes ❑ No
mai ntenance/i nip rove ment?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 29 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes MNo
7/25/97 Continued on back

t AO
R1
Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed`? ❑ Yes IR,No
Structures (l,agoons.11olding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Structure l Structure 2 Structure 3 Structure 4 Structure Structure 6
Identifier:
Freeboard (ft): ...... 2-:...1s.�...........
10. Is seepage observed from any of the structures? ❑ Yes E3 No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes B. No
12. Do any of the structures need maintenance/improvement? KYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes R[ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....b.�rr.rr� ,t.A-A................... �6L.%t.t...ct.................... ..................... ..................................................
16. Do the receiving crops differ with those desigriated in the Animal Waste Management Plan (AWMP)? Cl Yes IN No
17. Does the facility have a lack of adequate acreage for land application'? ❑ Yes CR No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
(9 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
C9 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`?
❑ Yes
JR[No
22.
Does record keeping need improvement?
54 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
P.No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
C&No
No vialations or dericiencie's.were noted during this visit.- You;wi11 receiveno further
correspondence about this'.
C mfrients,(refer to question #} Explain,any YES answers and/or any reeornmendations or..:any other comments
LJse drawings of facility tci'better ezpla►ii situations (tiEse additii►nuE pages asznecessary) ,
:
t-t a-w 1 �Jao wu ! 4 _ Lo r r-1 �t al +rk v. �fw��-•-� h-o u 1 e. c u -..��
t) f
To -
Uri 0 v 0 V% L4 rr l�[.� `� � 1 va W �— ' ^1-�
N i fir,^ `r.+r. Ira t o .� ed ✓vw a t LL c-a. C w Lor {Aj ao t ¢-1, �t f c, �+ �1 0
s Y q ra �J t• a-e G 0 i w o,n�P_ c3� 1^ `-T sq t'� k. S . Z i V vt G R-4+�r
4 emv_}�r {�r]c 1 i Fr-t,- f t� . DS �-w S rLV'D t�
� P a
t,�� 'E` W j ' j o v 1w--a-'.t , + �^-a✓�.z a v-v P r. u cl- r w o-v� t w t H-ave
7/25/97
1aH -
Reviewer/Inspector Name r
Reviewer/Inspector Signature: (�, � - �� i 1 �n Date: j / 1-7 f 17

•
1 Site Requires Immediate Attention:
Facility No-'I2-
DIVISION OF ENVIRONMENTAL MANAGEMENT ++
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 6r2- , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representative:
Physical Address/Location:
Type of Operation: YKet
Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE . DEM Certification Number: ACNEW
Latitude: LU -227—" Longitude: ° QD ' -L- 5" Elevation: Feet
Circle Yes or No
Does the Animal, Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spra ? es r No Is the cover crop adequate? Yes ol(&o
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(S or No
100 Feet from Wells? d�s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Co)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes ordQ
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (vo mes of manure, land applied,
spray irrigated on specific acre e with cover crop)? Ye o
Additional Commis:
C/o��,r9-eV_
C 2836 r
T' Asp.
`} Inspector. Name
cc: Facility Assessment Unit
Use Attachments if Needed.