310842_INSPECTIONS_20171231

NUH I H GAHULINA
Department of Environmental Qual

I imi (C4I
Type of Visit: B Co lance Inspection U Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: L / J1 3�J Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �j Title: Phone:
j
Onsite Representative: ✓ n �I f C/ Integrator:
Certified Operator: Certification Number: 1 7 �I Z
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
an to Finish
Wean to Feeder 1 7[, 0 I D0 0
Wet Poultry
E La er
I INon-Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Csarrent
Pop.
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult
Layers
Non -Layers
Pullets
Design
Ca aci
Current
Po
I
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
E NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: kLIZ Date of Inspection: /3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'sue' - ❑ 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes WN!
❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes hlo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes , ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 rwo❑
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ONo
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 E '� ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No NA NE
Paige 2 of 3 21412015 Continued

Facility umber: jDate of Inspection:
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea"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 F7 rNA ❑ 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:
❑ Yes E2r�oONA ❑ NE
❑ Yes No ❑ 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
NC❑ NA ❑ NE
to ❑ NA ❑ NE
FI-No ❑ NA D NE
Reviewer/Inspector Signatui
Page 3 of 3
713,
21412015
8

Type of visit: tq ZRoutine
pliance Inspection U operation Review U structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint () Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number: 1-73 1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design Current
Capacity Pop.
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P,ouItr,
ILayers
Design Current
-a acit P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ I�iO ❑ NA ❑ NE
❑ Yes uf ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 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: jkl l6ftj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. 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 U No ❑ NA
❑ NE
waste management or closure plan?
al threat, notify DWR
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ9No
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 [ 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 [;3/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 ZNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesV
�o
❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
INo
❑ 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
�VNo
D NA
❑ NE
Page 2 of 3
214,12015 Continued

1F'acili Number: - Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? 0 Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo ❑ 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 <o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 aNa ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes C3 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YNoYes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other_ comments. ,
Use drawings of facility to better explain situations (use additional pages as necessary):..:,
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
CgsPhone:
Date: c3
21412015

Date of Visit: Arrival Time: 3-0 1 Departure Time: ! i3 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Y-73 1_
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. Ploul
I ILayers
Design
Ca aci
Current
Ro .
Dry Cow
Non -Dairy
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
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 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 ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No ❑ NA ❑ NE.
❑ Yes o [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

FaciliNumber: e5l - T Date of Inspection:
Waste Collection & Treatment
4. js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 EeNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:)Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El"No ❑ NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -
[:j4(o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
01<0
❑ 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 ET
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes F3'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 ErNo
❑ 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 ag
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �f/No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes/X
25.als the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes�zo ❑ 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?
24. 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.
34. 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 ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [3 N ❑ 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
No ❑ NA ❑ NE
�❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES'answers and/or, any additional recommendations or any'other comfhents." I
Use.drawinu of facility to. better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phon 1(� q
Date: 1 1 1 I s-
U

Type of Visit: la VRoutine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
isit:
Reason for VO Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time:Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
r
Onsite Representative: tJ AT��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I -7 31 Z-
Certification Number:
Longitude:
Swine
Wean to Finish
Design C+urrent
Capacity Pop.
Design Current
Wet Poultay Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
6
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P�oul_ , Ca aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
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)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes ❑ N ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes , fo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Vacility Number: - Date of Inspection: S1
Waste Collection & Treatment
�No
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 [3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
, ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, 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 N
I_El _I
❑ 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
Zl�,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ 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
N
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 VNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Fdcllity Number: jDate of inspection: 3 j
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2!�N o ❑ NA ❑ NE
25' Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ 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 ] 1No ❑ 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 [<o ❑ NA ❑ NE
❑ Yes e No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes PA10 [DNA ❑ 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
jj'No ❑ NA ❑ NE
Ej No ❑ NA ❑ NE
Vo❑NA ONE
Comments (refer to question ft Explain any YES answers andlor any additional. recommendations or any other comments.
drawings of facility to better -explain lain situations (use additional pages" Use d' p as. necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
91b)W_�3
4

A
Type of Visit: 4D Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: (Routine Q Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: q County: 1.SP(J�J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: JQ6JQ7TU4C i (V1�11 L {L Integrator:
Certified Operator:
Certification Number: 113 a,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
In
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
4 b O
Non -Layer
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
I)r. P.oultr Ca_ aci
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[—]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
2fNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
ENo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
ENo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
t.nccirsrj
3r7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff 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
C No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
LdNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ "'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? �Ej Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�(No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes E� No 0 NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3"'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:Vl�To
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ZNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MINo ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [2&o ❑ NA ❑ NE
[—]Yes r2"No ❑ NA ❑ NE
❑ Yes [:]/lGo ❑ NA ❑ NE
❑ Yes E2"Ko ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
[—]Yes E]"No ❑ NA ❑ NE
❑ Yes ['�10
❑ Yes [fNo
❑ Yes [3''io
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
k* C.-0Ep ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone Q1ZO
Date: g
21412011

3
Type of Visit: (JCompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: O//Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 TiQ Departure Time: Z6S County: DAtZkj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: k5o";rrHAA ffmgz& Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: i73 i L
Certification Number:
Longitude:
Design @urrent
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design Current
Capacity Pop.
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
!`7 b0
Z.&d
Non -La er
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr= P,ault .
Layers
Design Current
Ca aci P,a
D Cow
Non-Dairy
Beef Stocker
E1
Gilts
I
Non -Layers
Beef Feeder
Boars
I
Pullets
Turke s
Turkey Poults
Beef Brood Cow
Other
Other F10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ 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 I of 3 21412011 Continued

Facility dumber: 31 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D'1Vo ❑ 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): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑—yes-1
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[3 Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
�TNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E�YNoo
❑ 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 �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 WNoo ❑ NA NE
Page 2 of 3 21412011 Continued

FaciliNumber: - tLf I IDate of Inspection: 7 1241,-V
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check CD Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
ElYes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
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
❑ Yes
❑ Yes
❑ Yes
No
❑ NA
Io
❑ NA
N
❑ NA
No
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
(Comments (refer to question #): Explain any YES.answers and/or any, additional. recommendations or anyFother comments. I
Use drawings of facility to better explain situations (use additional pages As necessary).
Reviewer/Inspector Name:
.j6N r,1 FA 2N6,LL_ Phone: OIL) 7Y[;
Reviewer/Inspector Signature:
Date: 17/A4/i1__1/
Page 3 of 3 1 21412011

Type of Visit: C3 C pliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other, _0 DJ enied Access
,�,
Date of Visit: g Arrival Time: I i70 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ( Title:
Onsite Representative: �� d m ATH AN W131 _C &(L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
1 owl
Wet Poultry
Non -La er
Design
Capacity
I I
Current
Pop.
Design Current
11 rcW]D_acity Pop.
airy Cow
Wean to Feeder
6 6
ai Calf
airy Heifer
lDrvCow
Feeder to Finish
Dr. P,oul_
Layers
Design
Ca aci
P,o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C No NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No❑ NA ❑ NE
❑ Yes YNo
❑ NA [] NE
❑Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 -L'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir nmeXtahreat, notify
7. Do improvement? Yes
DWQ
any of the structures need maintenance or
I ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Q No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z_No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes kNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ro❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
a<o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Ko ❑ 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
o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 t] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes d�N
❑ NA ❑ NE
75. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ 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:
0 Yes Ld o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes P(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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.other comments ..Y: ­�: :. e:
Use drawings of facility to better explain situations (use additional pages as necessary).
0 a r1 ASS e,+��c rL �F 3'ACK._5jp C 9J__ KAAL .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: A
21412011

Division of Water Quality �,-
FaCtltty�Numb`er . - O'•Dtviston of Sail and Water"Conservatiod
Other -Agency
Type of Visit (n Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitWRRouutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: E 9 / Arrival Time: Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ C.i dl�//� t Itz„ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 01 = « Longitude: = ° 0 6 = «
l-'^..
Design
Current",�: Design Current
Design Current
Swore
Capacity Population Wet Poultry .Capacity Population
Cattle `Ca ac Pt elationMt
❑ La er
❑ DairyCow
❑ Non -Layer
❑ DairyCalf
17
�a k
❑ DairyHeifer
-'
:Dry 1?oultry
❑ D Cow
_ _., ..
: ❑Non-Dai
❑ Layers
❑ Beef Stocker
;: ❑ Non -Layers
Feeder
❑ Pullets❑Beef
❑ Beef Brood Cowl
❑
Turkeys
Other Turkey Points
.. _
�.
.<
❑Other
❑ Other
hlitmber=Sinictures '
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
rod
� �6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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?
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 1 of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El No
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes hd'No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: —'NyjjDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
IA iJ
Identifier: 6aJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O No ❑ NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ElNA ElNE
S. Do any of the stuctures lack adequate markers as required by the permit? ElZo
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 YJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L/1 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
iQ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
U4es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or anyrecommendations bran mments 4 " �*e
Use drawings of facility to better explain situations (use, additional pages as necessary) s
pr) Ivb tP UMIVL C_r& J
Reviewer/inspector Name �%
Phone: %t) g [' — 6
Reviewer/Inspector Signature:
Date: b
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection i/ a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 04110 ❑ 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 FeNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E Nc ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L No ❑ NA ❑ NE
26, Did the facility fail to have an actively certified operator in charge? ❑ Yes CK ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
Q<o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R<o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
ElE Yes
��
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
!✓I N ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings: "
Page 3 of 3 12128104

Type of Visit 0,C,00 pliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: {{ Title:
jWPrAy'
Onsite Representative -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = « Longitude: = o = 4
Design
Current
Design
Current Design Current
Swine
C►apacity
Population
Wet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
iEx Cow
Wean to Feeder
bD
❑ Non -Layer
iry Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
❑ Pullets
❑ Beef Feeder
❑Beef Brood Cow
EEI Boars
❑ Turkeys
Other
❑ Other
urke Poults
NEIther
Number of Structures: l
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
El NE
❑Yes
El No
❑ Yes
I�Jo
[3 NA
[I NE
❑ Yes
U "NNo
❑ NA
❑ NE
Page] of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21 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
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
environmental7at, notify DWQ
7. Do any of the structures need maintenance or improvement?
El
❑ NA [I NE
�No
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
EI/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
�
10. Are there any required buffers, setbacks, or compliance alternatives that need
El((N Yes
,
o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[�, o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Co✓Gt s mments (refer tU gUeshon`�) EXpIAIn any YES_anSwers andlOr afiymlllen�reCpdatiOAS-w�'or aMny.,othercomments
Usedrawmgs of facility to better explam situations (use "additional" pages as necessary) ��.- s�
��..�.. -.�.: '�� w .w mr �;`.- .:n �.a• ..:ate- .,.: ... ..� .:.., .r^ , .ag-....e�- .. ..; _' .�r� . �' �.. .:.«;� ,c-. Feti"-�a.s.+'`"re.�.,�.._a' ir. acar�.��,.
Reviewer/Inspector Named V Phone: 6 716 �%3 3 d
Reviewer/tnspector Signature: Date: ^i 0
PO00 7 of, 7 12128104 C'nndnued

Facility Number: 31 Date of inspection
Rewired 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. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EfAo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �VNo El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
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?
Y
Additional Comments and/or Drawings:;.
❑ Yes ICJ No ❑ NA ❑ NE
❑ Yes 13 No ❑ NA ❑ NE
No
❑ Yes
_[Z
❑ NA
❑ NE
❑ Yes
E;V<o
❑ NA
❑ NE
❑ Yes
2/No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
E
❑ NA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit (ff^CoLmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: °i Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,� Title:
Onsite Representative: Ud�—V\
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 c =' = Longitude: = ° =' =
Design
Current
Design Current Design Current
Population Wet Poultry
Capacity Population Cattle Capacity Populat
r;XinCapacity
Finish
❑ La er
Feeder %
❑Non -La Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
Gilts
P_1Boars
❑ Pullets
JEJ Beef Brood Co
ElTurke s
Other
❑Turke Poults
I 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)
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 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
C1N El NA
El NE
El Yes
❑Yes
N El NA
❑NE
El Yes
No ❑ NA
❑ NE
12128104 Continued

Ifacility Number: 3) L
Date of Inspection 6
riWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
IN Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
Structure 4
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes EI 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 B No ❑ NA ❑ NE
through a waste management or closure plan? ,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes IN ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YN ❑ 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 El Yes No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 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?
❑l Yes
ld No
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
Ef Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,❑o
] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
❑ NA
El NE
18. is there a lack of properly operating waste application equipment?
El Yes
[ o
❑ NA
❑ NE
r S�) a"&W ygVS 116ErU 5744rO 1 / 0" _('1V 5AA1 Ictc.10 NOF Ntu wUf)
5v096 W .i4L49S /-,4V( u/T Pxc_t16*1 1wrfbf.
Reviewer/Inspector Name 6 Phoue: 6 7g
Reviewer/Inspector Signature: Date: A910k

Facility Number: — Date of Inspection G
._Required
l9.
Records & Documents
Did the facility fail to have Certificate of Coverage & Permit
readily available?
❑ Yes
11 No
NA
[INE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropiate box.
❑ WUP El Checklists [I Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,�
04o
❑ 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 El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ j No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ yes
❑'1 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C, oo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
D o
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ/-16
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
CI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
y'"1*'o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
4j
Additional C©tnments and/or Drawings:-
Page 3 of 3 12128104

' Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation /
Q Other Agency r�
Type of Visit
Co fiance 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: f 6 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:.��.�Q.lY�7^� /►'I�Z �-�C�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 6 = 4f Longitude: 0 o =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
D ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
El Dairy Heifei
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cold
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?
M
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&
❑ NA
❑ NE
❑ Yes 2 No ❑ NA Cl NE
12128104 Continued

Facility Number: 3 — Date of Inspection r o
• 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
Structu 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No ❑ NA
❑ NE
(ic/ Iarge 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? El Yes LdNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PfNo ❑ 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 21'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
UNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1�0 o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
NJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Sa �BF� Fi�xLvRE� Qi'SL �D
}2ie,1011CtO
Ak &Y4f. W6 , wy1f(+r NEXT CjUf NAP PjQAI
Reviewer/Inspector Name (� Phone
Reviewer/Inspector Signature: 44 Date: 1Z// v
121281011 CanYin Lied

Facility Number: — Date of Inspection 1 i
• 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ld 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes F�No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
DNo
❑ NA
❑ NE
❑ Yes
E2 &o
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[-io
NA
❑ NE
ElYes
ElNo
,❑l
LJ NA
❑ NE
❑ Yes [;Pl�o ❑ NA ❑ NE
❑ Yes D'No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes
LYNo
❑ NA
❑ NE
❑ Yes
eo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
El NE
12128104

Type of Visit .0-Compliance 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: 4";
rrival Time: : sJ Q
Departure Time: County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6wal
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [::] o =' = Longitude: = o E_-1 ' =
Design
Current
Design Current Design
Current
Swine C+opacity
Population Wet Poultry
Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ Layer ❑ Daia Cow
❑ Wean to Feeder
ILI Non -Layer I I ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Laers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets ❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
ther INumber of Structures:
❑ 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)
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 l of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
❑No
[3 NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 77
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):
e A,10 CKd'P C/on04
j e Y" P, pw;,-
0 n ' W/
CP IWcl -6 '/'0:1
J
Reviewer/Inspector Mame l� ' Phone `�10—
Reviewer/Inspector Signature: Date:
Page 2 of .3 12128104 Continued

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Accesss%%pper�
Date of Visit: Arrival Time: 4 Departure Time: ��County. &ZAi Region:
Farm Name: /5 fY _ Owner Email:
Owner Name:. - 7f(77D� Phone:
Mailing Address:
Physical Address:
Facility Contact: ,Q Title:
Onsite Representative: ' ! ��'�.;� r�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 I = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other - -
Dry Poultry
❑ Layer
❑ Non -La ers
❑ Pultets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
EFDry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Dyes 0No ❑NA ❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑Yes ❑No
❑NA
ONE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes )XNo
❑ NA
❑ NE
❑ Yes ;dNo
❑ NA
❑ NE
12128104 Continued

1V . X_
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�1No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S cture 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 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No El 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /2fNo ❑ 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) `"'t�.�yGf/¢r✓j __ _ —.._
13. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes e No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
IV"No
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/P�No
❑ NA
❑ NE
UsAdrawtngs of facdtty to better explain si#uahons (use additional pages as,nece`ssary):�
.
�} Nof �'2D w:�uTf Z� sP,�, Crl4,}, Coo
1I�P
Reviewer/ Inspector Name �, � � . Phone: wo 3 5ma
ReviewertInspector Signature: Date: - 9
I2128104 Continued

F, Y
Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? 10 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
the approprrate box.
❑ WUP El Checklists El Design El Maps El Other to
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 ACrop Yield 0 120 Minute Inspections ❑ Monthly and I" Rain Inspections JZ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;XNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El NA
El NE
If yes, contact a regional Air Quality representative immediately
IX
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
ElNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 0 1
Routine Complaint fp Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number / bate of Visit:
Permitted © Certified 13 Condininally Certified 0 Registered
Farm Name: �— ,
Owner Name:
Mailing Address:
Time:
Date Last Operated bove Threshold: _
County: — &lG_
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: so Tm ©LOWQ t�� tegrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' L� " Longitude
Design Current Design Ctirreat Design Current
Swine :. - :Capacity Po rotation Pouttrv:Ca�acitr �Po uLation _ Catttee ulstion� Ci acitr :. Po
Wean to Feeder ;_''� ❑ La er ❑ Dairy
Feeder to Finish Non -Dairy
Non -Dal
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design :aCapaGity
❑ Gilts
❑ Boars Total -sk"
:Number of Lagoons �` ❑Subsurface Drains Present ❑ Lagoon Area ra w ❑ S y Field Area
Holda4g Por�is:l Solid Trips'
�, ❑ No Liquid Waste Management Svstem
Discharees & 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 R 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 ZrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

t
b iC
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 ❑ No
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 El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T 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
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ANo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2pNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
2J No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (referto:questiQ #)..'E:plairi,siny l'1! S'anstvera'_and/os any recummesdsttotts.or suV other:c omraeiits. _
Use dratngs of facihty to`betcer,explacn situations. (apse ad<lraoiial pages as necessary) Field Cony Final Notes
_ - - a
Fc)/2
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: 6-Z—
O5103101 1 Continued

t
An
Facility lumber: — Date of Inspection D
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
Additional Comments an ofDrawings:
IJD i K- ol-COW •- P I%ie�sI T A-)OUe7r,0
JQ f) -re 4) T\)0� �\oo -)�--rE(,t\ lo t,)o-rep ©N 0—omVvmk6r--
105VECT-COO') p©aF- D� 01rt�02
pw>JFR- 4--' 67AQT6r7 (p� �r�"�L���BaP�.p ��{�D2r• 5.
rJwNF-R 4 fl�S KFtj WK �5rZ A'Mva: �As�
�OAL� 5z5 Q�--(fFp f 1 /01,ogg. !��OZI- �.sy-V-ORi D+47-jF.D
121�1°2 PE POR-rF-P) rtf PEP Foy �,`� �o Lzm� /ac,
GfPFRR-L- PEeJ--V\7-r LA�<tf
�EDRos'
w o FR A -5 © C -5 a tj 4., - Z 9 rJ FVp_ rv,_ Le T
�\-No�{ �o �EN� �n�. ©wF2 �LA�� l� �AK�
Cou25E Sao �E���E. 7�-t✓ ��F2�2��
ER 7o�w ©F (q E-
H E �4j/ 1 C c:c P opr �OD :i k2aA 7-0-
COULD ew E�
�F rfF G.0at)' WtJ
t� ��/ZFS 8 T
C /0 2
05103101

L
Type of Visit t Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Daie of visit: 0/ Time:
Not erational Below• Threshold
rPermitted © Certified © Conditionallv Certified Jj Registered Date Last Operated or Above Threshold:
Farm Name: 1_�County•L�I��d/►'
Owner Name: __ /Ji4 %p/t) Phone No:I�L2 52 "35653 iRT54W:L_.7T`T
Mailing Address:
Facility Contact: Title:
Onsite Representative.
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' 0• u Longitude
Somme Ca acrtw;-Pti uttaQon..,';_E'oultrs ..__ . =•Can Current Desrgn Carirent Uestgn , Current Des'
crtFPo utatioii m Cattle _. Ca acttv'Po Madan
Wean to Feeder I aL7 VIM Laver : n Dairy
LJ Farrow to Wean __ n
$; ❑ Other
❑ Farrow to Feeder {t
❑ Farrow to Finish Tot $I Design Capacity
❑ Gilts
❑ Boars T4ta1 Ssl
Number of Lagoons i ❑ Subsurface Drains Present ❑ La oon Area ❑ S rav Freld Area
Molding:ands/- hd:Traps , ❑ No Liquid Waste Management System `
DiischaEM & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes Y(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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
ALL
Freeboard (inches):
05103101 Continued

Facility Number: 2> 1 -8
Date of Inspection tD�=
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponddiing ❑ PAN ❑ Hydraulic Overload
12. Croptype ]fJ�1�Er41?5 �mRu. I�_-RA-Tnl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required_Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the'Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge? -
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes yrNo
0 Yes ❑ No
❑ Yes
oety
�No /d/z� L
El Yes
oNcOee-
/O� ryd'L
El�/
Yes
�e�NoGC
/D/�rjoa
❑ Yes
X No
ElYes
VNo
Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes ❑ No
Xy es.
ElNo
❑ Yes
VfNo
ZzYes
❑ No
❑ Yes
ZNo
Yes
❑ No
❑ Yes
o f� N�ay
//❑
OYes
No
PfYes
❑ No
❑ Yes
XNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conimen is{refer: to; ueStlon # . £7[ laEn an YE3`answe'sand/or;any re�;ammsndaiions ar any other-conn�iAaents. _ ' . -
Use drawings of facilx#y.to„better expla►n s#uaho�is: (ttse:addttipnal pages'ss as°cessaryj ❑Field Cop, 0 Final Notes
_s
ev,68) 114o 1 �Ce.�rYfo /� �,gLG W�.✓c r—+�nI G ©,AD.Q �orrt
U/Q�S�c GS, /;D Na
���5 i%a�GC' A. ��rJr✓F� i�5 �C/�f},� AVle
Reviewer/Inspector Name
Reviewer/Inspector Signature: -a. 4wdkDate: p /
05103101 [11-f V�7 / / Continued

Facility \umber: 3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes /in 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 X No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Cornments; and/or Drawings:.
to T F->� �A2 s � b +� ��is��i►�� _ _ yRx,�p d �,� - - � - D�
OF lffF Ls}Qnv.�, TJ�s Nf�,os a �J.E �Q�N���z�,o.
�D PqIAA PC cON57F_
LDS T5 S o c,6F A,-5 A PlO F4}7 1 rJ cF P[.!}fk)
LA G--ZV E 5 00 R aT�,
FPRr, 0 Ern R AcPE-
Ar3o `PUL-LS RPCE CLE-KV-Lq Lpw�r-,o,
15 ) TT. Ia�P IiARl RT (14+4 Say BC�AFvs �4t'eDE_gj slKl
4owa-, 9 e:F'o dR_fvrJ--1 Co. 56y-�Na' 0 me
A �F
!ri P,, CrR-rzrzcA--r& Co JF.� r �IC ERA
fF'ie�-r t.00,, 4
N V� PA,60 .�
05103101

1A
1 N a N,
z ti
CL
VN
R �4�Q��y�
Fr
cc
N N 2

tivision of Water Qnahty.
ivision of Soil and Water Coni erwation
I Q Other'Agency
Type of Visit Ycompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number a Date of Visit: ® Time: I= Printed on: 10/26/2000
Q Not O erational 0 Below Threshold
*Permitted O(Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold
FarmName: ......�V� �t... ............................ ..... County:....b �\......................................................
Owner Name:................................................................... .... Phone No: WC 10 �`�� _C.. Qr-10 -.(i7Lf
.......................................... a
Facility Contact:
......................................... Title:....................
Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ...........
�l [L
Onsite Representative: !�'+e��.. [tL .. SC ........ Integrator......�„G,}._ 4T..
........ ...........................................
Certified Operator: .......................... ........................ ... .......................................................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 '1
wl
Longitude �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry___ Capacity Population Cattle Capacity Population
Wean to Feeder Q ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑Nan -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
Farrow
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream 1m acts
1. Is any discharge observed from any part of the operation?
❑ Yes
ro
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. li' 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
D(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes X�Vo
Structure I Su-uclure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................................................................ ...............................................................................................................................................
Freeboard (inches): 3
5100
Continued on back

Facility.Number: Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 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 It 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 NNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes j(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? WYes ❑ 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 P(No
12. Crop type (EV S-CJ vhe_4-L�
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?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
kNo
16.
Is there a lack of adequate waste application equipment?
Yes
❑ No
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑
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
gNo
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 NfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes D(No
24. Does facility require a follow-up visit by same agency? ❑ Yes RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Zlo
.. .. yi.... r.. defeieuctcs were poled dirr>Eng �his:visit; yoji will t0d*e tno furthgr
:: • carrespo deiz ' 'albOu. this visit` ::: :
Comments (refer to.question'#): F,,*ain any YES answers and/or any recommendations orany other eoaunents''=^
Use drawings of facility to _better.egplain siiivations (etse additional pages as iecessar9).
r)
LV Alo A�r S Ak\,r, kal_�k
N-xn—k'6 1­3 S b�� mod . ��$i.� �� � t s CL
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: (0 • 0 5100

Facility Number: — a Date of inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes /D(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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the lagoon? ❑ Yes DZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes L;No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
Additional Comments and/or Drawings:... -
aA)
01
s �
�[.�- �..-,,,..`�,e.t� �, i �e � � ►tee-e�' -�:
5
C"s':'--1 L,-.
pL`[lr
CA, rc�\ I�
Aw�a
'��O Gzc- &'� Gel- terse
5� • � � ,31'TC.
9'5 117-�f�LZ-5 -L, )-P
ck
w
�. j
5/00

,j
(] Division of Soil and":Waater-Conservatton Operation Review
z ` 0 Division of Soil and-WaterCanservabton Compliance Irispection
- :�
&=Agene�'.
onter. al€ity Compliance l;nspecuon
OperationRevtew _ T
Routine Q Com laint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Z Date of Inspection CAP
Time of Inspection 24 hr. (hh:mm)
Permitted Certified © Conditionally Certified Q Registered Not O erational Date Last Operated:
FarmName: ........ .0 ' Z......... ............ �j'1 ................ County: ---....---........................... ........
Owner Name:..........l.-... .GxIUI..� � .. Phone No:...........................................................................
Facility Contact: ................................................. .. Title: . Phone No:
MailingAddress: ............................................................................................................ ..........................
OnsiteRepresentative:........................................................................................................... Integrator:..............................................................
Certified Operator..............��./.. �Cd. `?�...................... Operator Certification Number:..........................................
Location of Farm:
E--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I �J
Latitude �� �•° Longitude • �' �"
Swine
_= Design Current: Design Current_
Capacity Population. - 'poultry Capacity Population . . Cattle
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts t
❑ Boars
Design. Current
`.a acity Population
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Feld Area
-,Holding.Pands/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes OrNo
Discharge originated at: [ILagoon ❑ Spray Field ElOther'
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" _ -4te
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 D(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.
................................................... Freeboard (inches): ............... ............................................-.-......-............................................................
........ ...............
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

'K-1.ti
Facility Number: Date of Inspection ' !v
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
RfNo
(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
ANO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
bNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
12. Crop type S Vv 5
JKNo
13. Do the receiving crops 4iffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
nNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
R—No
b) Does the facility need a wettable acre determination?
❑ Yes
R10
c) This "facility is pended for a wettable acre determination?
❑ Yes
OID
15. Does the receiving crop need improvement?
❑ Yes
((No
16. Is there a lack of adequate waste application equipment?
❑ Yes
PNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
[%Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XYes
❑ No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
pwes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
` 610-
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
9Yes
❑ No
24. Does facility require a follow-up visit by same agency?
KYes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;I(No
0: Io *....cjris:.. deficiencies vt�re izofea• jlo ;i ig �bis:visit; • Y;oif will •reeeiye Rio further;
cor'resporideni & abvtit: this visit:. ....... • . ' . • . ' •
- ,2 -
Cor iments (refer to question #) Explahviiny YES:answers and/or any recommenilahons or any other comments:
Use drawings of facility to-better,exl lam situations (use additional pages as,necessa_ry)
rr L
(C?,eer- OU)4l) CCis,,.e bGGfL -6 6-6-,�eoo -fo A.
140-W j,- . +o re v; e w. J Yi r'. k" Z,JdYL's o C7 {�fv�
0_0 "t Id "-f! mre 4- w� � � m.. sift/ �rn�e- t/�,r iu d rc�{ ��
9^�"•��+..t ik s G h� 0 k- - �,�„ . � r►,1 l )w C SC ►vS 5►�RJ �s�1-t ��,� �. r.•�
w4 - ?Uly f
w -rr"" ik�)wql
t -�d ,r c o C cl
t 4
_.,
Reviewer/Ins ecto ame r_��✓ L / . ^ Y . r.jaw
Reviewer/Inspector Signature �,� 1/f/%,% ter` p Date: /0 M, ���[

*" .... 4.
[3 Division of Soffand W C Operation.Review
ater- -qnservati6n eview
;Fj [3 Division of Soil afi&WaterlConservation -'CompIiafice.1nspecti6n%-
ivision
of W4ter_Quality.; Compliance Inspection
13 Other Agency ',Opir-atio&Review---
0 Routine 0 Complaint Follow-u of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Z Date of Inspection 3
Time of Inspection 8 s3 O 24 hr. (hh:mm)
13 Permitted RrCertified (3 Conditionally Certified [3 Registered 10 Not O erational Date Last Operated: ..........................
Farm Name: ............ V.A.m.kP ....... ........................................................... County:........-......`.3? Upi
............................................ .......................
OwnerName. ................................................... ........................................................................ Phone No:
FacilityContact: .............................................................................. Title:............................... Phone No: ...................................................
MailingAddress: ..................................... .............................................................................. ..........................
PA-q
Onsite Representative: .......... 6144-04—.. integrator: ..... C-A..04X-Z..L.0.*-S ................................................
........ ......... ....... ....
Certified Operator: ........ W. t'. ........ L� .. .... AIAM141-- ............................ Operator Certification Number:...J-7 .. ............
Location of Farm:
............................................ ...................... . ....... . ....... . ...... . ............... . ..... . ..... . ...... . . ............. . . . ... . ...........
Latitude Longitude
Design -,Current Design Current
SwineDesign Current.' -
try. Capacity Populati Cattle Population
---- ---- Capacity Population on' C ttl Capacity
�Wean to Feeder_ o K[Layer El Dairy
Feeder to Finish I[] Non -Layer L I ❑ Non -Dairy I I
E] Farrow to Wean
Farrow to Feeder
-10 Other I
E] Farrow to Finish = Total Design Cap
acity
ty
❑ Gilts,
❑ Boars Total SSLW
Lagoon Area I0 Spray Field X-r�aj-
Number-.of Lagoons Subsurface Drains Present ❑
H Tofids JE1 No Liquid Management System
o I'd i�'n g Solid Traps -1
Discharges Sz Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon [] Spray Field El Other
a. If discharge is observed, was the conveyance man-made'?
K 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? 0 Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ........... I ....... .................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
Ej Yes ;No
El Yes El No
[-] Yes [] No
El Yes [I No
El Yes ZINO
[--] Yes ErNo
El Yes Ej`N*o
Structure 6
[3 Yes ;3"N'o
Continued on back
3/23/99

Facility Number: 3/ — 8 Z Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type t S• GW 4 Le
13. Do the receiving crops differ with those designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required_ Records & Documents
17- Fail to have Certificate of Coverage & General Permit readily available?
O/ s a.
I
nte wlanagement Plan (CAWMP)?
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: �Va-vioaaEmis:ot. defcienc p5. ..,ere nQteci during this:visit. - Y:oi ' ill•reeeiye lio further
corres orideitce: ahaut: this visit. . .
1
❑ Yes ;21No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZINO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
,eyes ❑ No
wyes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
'Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
0 Yes ❑ No
❑ Yes ❑ No
Comments (refer to question#): Explain any:.YF.S answers and/or.any recommendations or any'other_cominents.
. m. d
Use.drawings of faicility to betterae>rplain situations (tise.additiotial`pages as necessary}
c_ -
+�At;oa.d has See,•f r� Arreax;Mo,� ar4v-, T-ou'r SiWCFr LAST i_AfSfE.c_T.'n.J _
W'&JLA 4 04Vr,_ Q ZX.r.l M o,.+ E p M tAS T f L44 T' w :-rTrA c.a J ER_
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�4 Me— SAfr. eKEI XT q u i AAEOP w � TTu r,.r ILO 1 445 Ef AP L f t•rtTO N � 54
S• Z L. SA +Kf is S A-V-'-- '-c. Q%j, a tp A 0 n1 M�1..y . e6r QA;.tF PC. "t`'PA- - 1
�„t GS A rPLi �.fl fo J ►7 i8 t-j`s'ITo VajL_ S*. sOL . 4 &i( 'w6+T a F• Af f e.i C.Rr: " L4-,-We,.,j.
�. Sil+r..►o A,- "S axc.4 bEs-MzirLj Aet-�, Ly %t LAr--F-oC- A4p.rA<,y_,XV,4y
P6A4J 062- CAzlr MtitSr 3E. Q*446EA To fi'&r_LE.cs" JXUF_ TRap�&�-a.J A-r- +.-S CITE.
+r- •�
Reviewer/Inspector Name rj - p�}
Reviewer/Inspector Signature. 4; J,} fA Date: g1.13
v�r j e j- cl tL) 3?6 - _i7 ob t 3/23/99

Facility Number: —8y Date of Inspection 13
CJ " 1
t`ii $ Amp t�`►� rLE�S���FfGx-v�V�, �-�tGua.f D£S: 6nl ,r✓F�R..�I�Tio�I
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Ca i►�►rI-IL 1 E.fl 4&y M r+y ! , Z� MaS r PTM?S FCC
r
7/25/97

Facility Number E Date of inspection
Time of Inspection s 24 hr. (hh:mm)
© Permitted A Certified © Conditionally Certified [3Registered JE3 Not Operational I Date Last Operated:
Farm Name: 'D Count ptE rw
!�.:.......-- 5< �.. 'a c�I.......--- I ................................................ y ..........
Owner Name:
..............
Phone No:
Facility Contact: .............................................................. ... Title:........................ ........ Phone No: .....
Mailing Address:
...............``.....�........II............................................................................................................................................................
Onsite Representative:...( A... f.... . Integrator•
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude �` •� Longitude • �' �'=
"`Design
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Number oiLagoons...."-
Holding Ponds / SolidTraps
- --Total,-SSLW`
-" ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes �TNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes �4 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes DNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway XYes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: q
Freeboard(inches): .............. ............................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes P(No
seepage, etc.)
3/23/99 Continued on back

Facility Number: - B Date of Inspection�%7I
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or-7`-�-'--'
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 ,fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes J2'No
12. Crop type ?
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? 2 Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 2fNo
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes 2�No
15.
Does the receiving crop need improvement?
Z 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
12rNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
.0'''es
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No ?
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[X`No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
OYes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J9 No
.... .....................
. ...... ................. .......
�1o•vi Aatigns'or &ficWni! es *ere ngted- ditr>tYig thisMsit' . You Wiii •reeeiye do fukit or - ;
..... ........
correspondence. abii- tf this visit.
�Comments (i"eiFer to:questiot '#): Explain any YES answers and/or ah -recommendations or -,any of&er comments:"
Use,drawings of facility to;better explain situations (use additional pages as necessary) :-
W
1
�•Js; raE.. Arro caPC- t,.r S
V,V, CSC E- -Slrr rS
As 5-�•.t bsr+a►3
AU. off_
I tS� .to GoP a F ��t. cl . PL"t "aDAy `rwa-. 1 r &J� Eu� z=•.r� Cl;cP i ^! �hn r+: o
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dv .SM,4.V P�gASc C-u7%fG of r✓,`.�I % 9-1 E_ .Vz7-
tr6r� �4M 4AS'i .fiEffSa.rl Vr►r t20 �f l0 3�S-3yep 1W
Reviewer/Inspector Name
Reviewer/Inspector Signature: . �C ( �-�---- Date: q 7 -7 7w
3/23/99

r '
Facility Number: 3 l -- $ Z Date of Inspection 9 7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes A�!(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 J:J'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,0'�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 Q 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 EIo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Dll�o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �o
ittona omments an or rawmgs ' v
'o ) A FA,J G U 4" Z� u T JF tDL-4c-c , 'R07-Ar'P-w,` c E WO FE"'�;V rr FP -OS L E* S I A]
3123/99

Facility Number: — $yZ hate of Inspection
D4 0) 7 SuMv l /�54AW'
6) As I Jr . v-r�M 0 P9--z P>A G L-� i4its
GQ-7 ,"
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fr S T' SC!$vA U.r--,eD 'fAe—IL6 A 1-1 i S S� 5 r��.1�� A PF� 9,zelPrTv-D CAU-S
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f 4SP£.cro(z-- Ati7V S�7 AA-Vc.� To "AJE. i°c�tl "^'.f -Crf lk r.�S�CTJ�
;Afspc-c�&L- Gau.� �`c1�y Ar tb��o Czg� a�5�� 4 LET
ALL cA4 ze P\E1 F�u����� T� '-wK[,C
nil c.E of WQL.Ai % ter! F6F--
M L,. � �•.Jkrt_.� � c.}�•J f-� V � C'd `" � g�S �-� S � �f,rA � ✓2� o � r.JsPEu� � )
1r Fu 4e T- € — JAI F WLM i 1 \v J
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S! •'t�•1 �if.LO S Os.! �iE1`I � ��a` 4� Si p�'�' 1
7/25/97

j] Division of Soil and Water Conservation 0 Other Agency
ELDivision of Water Quality
Routine O Complaint O Follow-ue of DW2 inspection O Follow-up of IISWC review O Other
Date of Inspection (r)
Facility Number
Time of Inspection O =ba 24 hr. (hh:mm)
© Registered 0 Certified © Applied for Permit © Permitted 10 Not Operational Date Last Operated:.,,.,,...
.
Farm Name: ...........�A+f0.....�.���...... ..�``:Y..Y.ri...................................................... County: ....... cy...................................... .......................
Owner Name: ......................IM�.� jfn1 ...�o4V.1fl.........�� t-................... Phone No: L sz)SiL�� .101a4......�
FacilityContact:............................................................................... Title:................
Mailing Address:.. �........ s'L8—�iir "LV..... V.a.....................................
Onsite Representative: ....... .........Doy.i�...... ..........................................
Certified Operator. ..................................................
Location of Farm:
.. Phone No:
.............1 . e,� �>�^n+'.s+....``..................................2'Itm ...
Integrator:.......L.�� 1CYi��.i.S.......................................
.................
Operator Certification Number: .........................................
..............Qt .....c. s ....�k .....SJ..:.... �.....� z?.7......L...t�1.>.......... 5At�....... 4....i�...1�-,.,......................................................................._...........
...... .......... .......... ....................----............---.----------................ . -----
Latitude ' ' 0" Longitude 4 "
Design Current
a
"W Wean to Feeder /60 JLJ Layer JLJ Dairy
❑ Feeder to Finish 10 Non -Layer I JE1 Nan -Dairy
" ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars A Total:.SSLEE
Number of Lagoons THoldtt Ponds :. Subsurface Drains Present Lagoon Area Spray Field Area
r W.
V-S
No Liquid Waste Management System-, x
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notity DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
i'
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes O] No
❑ Yes EP No
❑ Yes
y No
❑ Yes
® No
1j
❑ Yes
No
❑ Yes
(] No
❑ Yes
No
❑ Yes
No
❑ Yes { No
❑ Yes No
El

Facility Number: 31 — N Z.
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes P9 No
Structures (Laeoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?' ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):........... 3...`L..........................
........................ ................................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Wo
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ( No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................. �..........:......r..........t................................................................4-...........CK.Y\......... !f►A..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? PlYes ❑ 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?
-PYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IF
No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes M No
[]-No.violationsor. deficiencieswere-noted-dtiring this:visit. Yo44'iII receive no,ftirth:er
correspondence atioitt this:visit.:: :
1(p. S�ra11 •�,rn�:n dry e ? � �cr.`tist_t� tti �Zt�r}S Cc}rn '''
}W � ZVWI�fl
j(h7t11� ��aulli �� 2� i �[ 111�trVw4u- cwrYWat tp,r 4f td i K'L kh 11
1= t v.-ei,
tQW OV 3vco GAllOKi ou7 _% A-4. "efr-
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Z t. 14LI t �' }.3 at I-L'rk OTn S 6m4.. 7/25/97
Reviewer/Ins p ector Name,
-
�..�,�lrri.�t��►�.
t
rti�`
Reviewer/Inspector Signature:
,,
Date: (G y.,
$

d�
-Division of Soil�andWater=Consetrvation t€
p,Dlvlslon of -Soil and.V4'ater Conservation "C
pbivlsimvi&Water Quktllty Compliance '
`p.Other Agency Operation Review
101111ne 0 (=nmplattu 0 1,01low-111) o1 I)N'Q inspection 01.(
Facility rN'riniber
p Registered 0 Certified p Applied for Permit p Permitted
Far•ni No-rnie: David.Sitthari..farm...................................................................
0%vi rr Nano°: William -David ................... S.uxton....................... ................
PhoneNo: 919-5b8-4A2.7...........................................................
Facility collIM't: .................... •.Title: ........ I'hone iNo:.............
ik9;liling Addrrss: MISeth..Turner-Rd............................................................................ Alberasan... NC....................................................... 285OR ..............
r.)n.iEr 12cl,rrsrntaEitic:Datvid.Suiton.............................................................................. In[c��r:rtor:Carxoll's..Ftarads..l[In.............................................
(;r rlificr! Ullr:rotor:wl�j,p1.L_.StLttOn............. ...................... OIrrratnr Ccrtificaliorr Nulnhcr:.............
....................................... ............................
Location of, Farm:
a e. wy,.. ..nark .am. snarasxx iirn.e k.on. ,..- urn.r� t.nn arm.is... .mies.on.t side ..........
L.alitudr. ©�®s © Lnngiturlc
Swine Capacity Population Poultry
® Weanto Feeder
❑ Feederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finis
❑ Gilts
❑ Boars
Capacity Population Cattle Capacity Population
❑ Dairy
❑ on -Dairy
p Layer "
❑ Non -Layer
❑ Other
Total Design Capacity 1,7
Total SSLW52,8!=
Number of Lagoons 1 Holding Ponds I
JE3
SubsurfaFe
Drains
Present 1113
Lagoon Area p Spray re rea
p
No
Liquid Waste
Management
System
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2. Is any discharge observed from any part of the operation?
❑ Yes
N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li'discharue is observed. was the conveyance man-made?
❑ Yes
0 No
b. Ifdischar'-c is observed. did it reach Surface Water? (lf vcs. notify DWQ)
❑ Yes
®No
C. I1'discharge is observed, what is the estimated Ilow in "al/ruin''
d. Dees dischargc bypass a lagoon system? (II'ves. notifv D\VQ)
❑Yes
®No
I Is there evidence of past discharge from any part of the operation?
❑ Yes
N No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
p Yes
IN No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
N No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

r.
aci ity Number: 31_842 1"0. 0 In,periimi
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
IN No
StrilC1ures loldin-, funds. blush fits. etc.-)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
® Yes
❑ No
lrirclurc 1 ti11'uclurC ? Clruclure = `1nIclIII-C d
tilruc;lurc tilrucluri.
6
fdi'r,tilicr ....................... ........ ...........................
I"�crlxr�ird i ll ►: 1
10. Is seepage observed from any of the structures?
p Yes
N No
I . Is erosion, or any other threats to the integrity of any of the structures observed?
[]Yes
® No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
1i�;istc �11,1ilic;iliun
14. Is there physical evidence of over application?
p Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type Coastal.Bermuda.Grass....... Srmll.Grain.( ...hrat_.Barley.........Co1n.(S1lage.&.Graim1........................... Soybzans....................
16.
Mi o, pats)
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?
H Yes
❑ No '
19.
is there a lack of available waste application equipment?
❑ Yes
Cl No
20.
Does facility require afollow-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?
N Yes
❑ No
Fiir CeiIi1'ictl air• I'ecrniIIU(1 F,rriIilies ()nl\'
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Permit?
p Yes
p No
Q . -o.vi(ytlons.orirenies.wer
e-note during t isvisit.. an. w.receive no:urt er ..
, , _• • c, b4yWtegebt.
................................ I.........................
-----------------------
Comments (refer to question*): Explain any"YES.answers and/or any recommendations or an other comments: _
s, y .
Use drawings of facility -to better ez lam situations. '(use additional, pages as necessary
9) Required to maintain minimum 19.5 inch freeboard, thus needs to pump as soon as suitable conditions will allow. Plenty of land
available and equipment at site thus should not have too much difficulty maintaining the adequate freeboard.
12) Need to mow on inside and outside lagoon walls. Outside wall has particularly heavy growth.
18) Wheat planted over coastal bermuda grass and over all remaining fields with a mix of rye. The wheat should be removed from
he bermuda field as soon as possible. Spacing appears to be such that bermuda is growing (sprigged about four years ago, and
stand appears adequate over most of the field).
FD) Reviewer will recheck lagoon level after 30 days. DWQ (Brian Wrenn) notified of high lagoon level.
2) No records to correspond with the pumping required to lower the the lagoon from Dec. `97 level = 0.4' (1.7Y in Oct.97). Only
o pumpings in records; March 1 &2 total = 77,400 gal. over 4 ac. about 401b.N/ac.
Reviewer/Inspector Name Joke N. Hutit -
IReviewer/Inspector Signature:
Date:

k '
��z❑ Dtviston of Soil and Water Conservation ❑Other Agency ��� � � �
Routine O Complaint 0 Follms-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection �-�-'�
Facility Number i��
Time of Inspection I— 24 hr. (hh:mm)
[3 Registered 10 Certified © Applied for Permit [3 Permitted [3 Not Opera Date Last Operated:
j� 11 ,
Farm Name: Ll titi{� s:� .............!rr ............................ County: bt101tn,..........................
.............. .......................
Owner Name: ......... P.atG.X1 .........Dakoj........... 5,)A6........................................... Phone No:...��...`a�i.'
Facility Cantact:... ; .... S.Iv4oxk......................................... Title:.........ate.M3........................................ Phone No:.. l.g.l �". . 'S.........
MailingAddress:..... . ...... S!.�.. 1?.l! u.......n...R....................................... .......i � C. G......,.................................... ` P .........
Onsite Representative: ..........
ff i S &t .. Integrator: ....... Cc .isX:6iEs................. ............................ I............
tifi Cered Operator :.......... W.I.S.LLiilx`......1! .......��.41ax...................................... Operator Certification Number, .........................................
Location of Farm:
x,oi. .......:. S.Y..i. �,hrn...... dn.....5 �SD.:....LLh`t�...G1t. ,�,:,....R..!�t�.:.......... A
lrr lt� ..----.5......� c...�......iaLt..lJ4 �....b.r...._.&I&............ ................. ..................................... ............................. ..... ...... ...................
....
Latitude 3 •LOl ' �" Longitude 0• ®� 2a �F
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
JZ No
2. Is any discharge observed from any part of the operation?
❑ Yes
(9 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 Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaVmin?P.J
14S
-d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
29 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
P No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E3 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
N No
7125/97 -
Continued
on hack

Facility Number: 3 — $'t{L
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laoons.Ilolding Ponds. Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard(ft): ..............-?i......................................................... .................
10. Is seepage observed from any of the structures?
❑ Yes ZI No
C6 Yes ❑ No
Structure 4 Structure 5 Structure 6
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)
....................................
❑ Yes id No
❑ Yes No
Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ® No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 6rtr,J& ....................3�1?^l� ��........�YN.A...................... Loin t�......... W44........... k.Aur.................................
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
ENO
22.
Does record keeping need improvement?
91 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
C,No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 -No. violations -or deficiencies. were noted iiuring this.visit.- You.wcill receive• n' 6-f4rilier
correspondence Ahout -this_visit'.- :.: . .
l- La300t V"- zhkllYAC ifEcx�ptir0• r c94r1 �r�6U e. �Viy1 Ot!)b)EL 1+B �r��lJ�r"o r'� 8T
�recboo.rt� �rh,re,�ta•�r Srro.l[ �►it�yv Slna,��0 bQ Pion- `�`j j�.C` �i T�t�e '�-�.►�. ,y� .r-
[Z- C�[�C e Q�tY ati W��[ �G�oaiti silati�i� �t? tr+bfx;� OV Str� 4e '6­��ii
_ U� S�as1Jd be ,m_ vvtl S�r;rlq 419 . Snug srtkN sk,,U ` bO e �10W*ej , w
Z2. ��,1 j4-GJ0.S�c Sarn a-'ta yxes s6u1j 6- 000-Fid. �r recorh S
7/25/97
Reviewer/Inspector Name U5yam."
Reviewer/Inspector Signature: XA I"X J. _ Pate:

Site Requires Immediate Attention: MJ
Facility No��
DIVISION OF ENVIRONMENTAL MANAGEMENT
�_- ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g 3 a , 1995
Time: 11 �S
r..
Farm Name/Owner: i7flV tD S TFW _
Mailing Address: W A (La^ W Z�39
County: 17U PC LtJ R
Integrator: C_ A-fL a b-( k c _ Phone:
On Site Representative: IV Phone: _
Physical- Address/Location: -1S0 1 p . S w-t iFY�.. ..-,�:�g,• ,�
Type of Operation: Swine ✓ Poultry Cattle
Design .Capacity: 1-1 �,o Number of Animals on Site: 11 b 0 ­
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -3 1; " _CA :S ,, Longitude: '11 - Sp ' _" 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) es r No Actual Freeboard: _A_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or @)V
as any erosion observed? Yes o
Is adequate land available for spray? (Yes Pr No - is the cover crop adequate? Yes or No
Crop(s) being utilized: rA I x ¢ v c— & sS
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or i
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain..
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
West
Inspector Name
Signature
cc: Facility AssessmentUnit
Use Attachments if Needed.