310844_INSPECTIONS_20171231

�Vn
NORTH CAROLINA .�
Department of Environmental Qual

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O<outine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region: {!U
Farm Name: ",, CVI l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t 1 Ct �'�� l `VY Integrator:
Certified Operator: Certification Number:
�3? 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine C*apacity
Wean to Finish
Current
Pop.
I
Design Current
Wet Poultry Capacity Pop.
I Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I
INon-Layer
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish I
Design Current
Dr, P,oul F C•_a aci_
La ers I
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turke s
Oth—PRE urke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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 ❑ N
❑ Yes rNo
El Yes
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412015 Continued

FacilityNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�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 environments reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesrN ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
c ❑ 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
❑ ❑ 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
N ❑ 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 0 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 ❑ Siudge Survey
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 VNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facdi Number: -L±j Date of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Vj No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑I<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:)Yes
No ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
rNA
❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
][�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over-application)-
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo❑ NA ❑ NE
Comments (refer to question, #) _ Explain any YES answers: andlor, any- additional recommendations or;any other comments :.-
Use drawings of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
`4X " , 1 V,3 ,/l,( 1
e2 Phone: l 71?30Y
Date: 7
21412015

Type of Visit: QCompHance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (Lid /1/T` ��[..( �/� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: /73��
Certification Number:
Longitude:
Design Current
inePop.
Wean to Finish
Layer
Desig%n@urrent
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
DrJ P,oult ,
Design
Ca acit
Current
P,a ,
—DairyHeifer
D Gow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
11
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 6 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes EyNo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 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?
❑ Yes
2No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fb&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
2/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
6Rio ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L Q O ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�,/1V
I """ ] o ❑ 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 ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Eq'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VN
❑ 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
0 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?
❑ YesPf'No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

F'acili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo
(o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo
❑ Yes CZ/No
❑ Yes O/No
❑ Yes E o
❑ Yes o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any, additional recommendations or any other comments...
Use drawings of facility to better explain situations (use additional paRes.as.necessary)..,.
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date.
2/4/20B
--�3

Type of Visit: Q 7Routine
fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: L.l�.Z.J Departure Time: County: L Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: "
Onsite Representative: f +� Integrator:
Phone:
Certified Operator: Certification Number:
Bach -up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Design
Capacity
Current
Pop,
Design Current
Poultry Capacity Pop.
Design Current
Cat#le Capacity Pop.
Wean to Finish
La er
D ' Cow
Wean to Feeder
EOWet
Non -La er
D ' Calf
Feeder to Finish
Design Current
Di. Pin_al 4 Ca a_c_i P■o ,INon-Dairy
Heifer
jDryCow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Turke s
T irke Poults
Other
10ther
Discharses 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
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ICJyNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of inspection: d
Waste Collection & Treatment
4r.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify 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 ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
Q 1VNo
❑ 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
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes C3
❑ 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 o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ NA ❑ NE
❑ Yes 6VXOO
25As the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes U "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 E31No ❑ 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 E ,, ❑ 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 0 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 [✓]K. ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes ❑ NA ❑ NE
❑ r
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of.facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone 4M6 "? 3 vp
D D
Date:
15

(Type of Visit: O Coyfipliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j G jJAT14fik
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dairy Cow
Design Curre It
Capacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
M 10
293 6
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
©. P,ouI Ca hy acPao , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [�Noo ❑ NA ❑ NE
❑ Yes Fj-K/o NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of ins ection: l
Waste Collection & Treatment
ti 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:_IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�/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
2NNo
❑ 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 U/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�?o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E(No
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;�c ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6/No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
�I
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ 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 WNo ❑ 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 VNo
❑ 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 <0
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes M No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes �No
❑ NA
❑ NE
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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.).
Reviewer/Inspector Name: i U
Phon�
IFL
Reviewer/Inspector Signature:
Date:
'3
Page 3 of 3
V2 14

Type of Visit: Q Com fiance Inspection U Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: 7Routine 0 Complaint Q Follow-up 0 Referral Q Emergency 0 Other Q Denied Access
Date of Visit:, Arrival Time: Departure Time: IZ , County:JRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: n z
Certification Number:
Longitude:
Design
Current
Design Current Design Current
Swine Capacity
Pop.
Wet Poultry Capacity Pop. C•attte Capacity P.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -La er Dairy Calf
Dairy Heifer
X
Feeder to Finish
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D , P,oult , C+_a aci_ P,o , Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -La ers Beef Feeder
Boars
Pullets
Beef Brood Cow
11
Turke s
Other
rke Poults
Other
Roer
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o
❑ Yes o
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

I 1
111,
Facility Number; -
jDate of Inspection:
Waste Collection & Treatment
ZNo
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L .,3 L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
zNo
❑ 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
allo
❑ 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
[fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes do
❑ 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 ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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?
[3Yes❑
FN
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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes 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 E5No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield [1120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to instal] and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes u No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

�' l
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ET<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D40
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
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
Erhio
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
dNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN 0
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z] _No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2"/No
❑NA [:3 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑JNE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: � 6H tJ FAaAX Phone: C�r� r)
Reviewer/Inspector Signature: Date: LaA 13
Page 3 of 3 21412011

(Type of Visit: Q 2outine
liance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access ll
Date of Visit: Arrival Time: Q 2 '= Departure Time: I! I S •� County: _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative:—JoA'A'TN AtJ PAsA uc. JL _ Integrator:
Certified Operator: Certification Number: j & G 13
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C«urrent Design KC.urrent
Swine Capacity Pop. Wet PouItry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Da' Calf
Feeder to Finish Z.b
306
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MILD Current
D . P.oult . Ga aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impact
Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection: 7/
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:
Structure
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
21"No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F2No ❑ 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 [DNA ❑ 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 [r o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [2�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ZNo
❑ 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 5o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 214,12011 Continued

/J
lFacHity Number: 31- jDate of Inspection: j/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes o ❑ NA ❑ NE
25.7Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesWo❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[:]/No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Cl/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 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
L"J;o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E(> o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: AII
Page 3 of 3 214,411

Type of Visit: &Co fiance Inspection (--)Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 7utine O Complaint Q Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: �� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �Title: y�
Onsite Representative:�-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Ploul , G I) ,a aci_ P,o P.
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther.
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? C] Yes No ❑ NA ❑ NE
. a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier: ( 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes YNo
❑ 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 EZ/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes ONo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ff 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 rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
WNo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ 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
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
rNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
%
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[:]No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ]� ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes LCJ No ❑ 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),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 1
e—IL
Date: `t
2141201.1

❑ Layer ❑ Dairy Cow
ElNon-La er 4 ❑ Dai Calf
' ❑ Dairy Heifer
Non-L,
Pullets
Facility Number „11 gq4
Division of Water.Qhaltty
Q Division of Soil and,Water. Conservation M_
0, Other-
Agency r
Type of Visit rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
JZNAr140�,_) 0.TA_C C-0 -
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = c = t a 1{
Design Current Design4; :.Current•' r' Desig Ctirre f
Same _ Capacity Population Wet E©ultry Capacity Population Y ACattle w� . aciI
❑ Wean to Finish
[--]Wean to Feeder
Rj Feeder to Finish
6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El
Boars
Other I I fi.-j" Other
❑ Dry Cow
Non -Dairy
❑ Beef Stocker
s ; ❑ Beef Feeder
❑ Beef Brood
Poults
Dischames & 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 No [DNA ❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
[INE
❑ Yes
❑ No
❑ Yes
ET/No
El NA
El NE
El Yes
R'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

f
Facility Number:
Date of Inspection 0
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 J, Structure 2 Structure 3 Structure 4
Identifier: LACs�� C7�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (0 Q
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 JZI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes VNo ❑ 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 0No ❑ 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 ApplleatiOR
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dvo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 7No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o
dFNo
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments (refer to question #):..Explain any YES,answers and/or any recommendateons orany other comments
Userdrawi©gs.of factlity.to better explain situations(use addihonal pages as necessary}
Reviewerllnspector Name (d - ,Qldlll �,� . r
Phone: 9� `i
Reviewer/Inspector Signature:
Date: D
Page 2 of 3 1 1 12128104 Condnued

lop
Facility Number: 3 — Date of Inspection I U
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
,(No
2 No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ao
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3"NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U<
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
L o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
20
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
El"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Vo
❑ 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
VNo
❑ 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
WINo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
W�j
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit zRoutine
pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: l I _ I Arrival Time: ® Departure Time: County: CVPL Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ryry�� Title:
Onsite Representative: °N,1�-1�AV AM A—tA - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = [= t [= Longitude: F] ° = g = is
Design
Swine Capacity
Current
Population Wet Poultry
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
Pullets
❑ Turke s
❑ Turkey Pouets
❑ Other
Design
Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ DairyCow
❑ Wean to Feeder
❑ DairyCalf
Feeder to Finish
3$'
❑ Da' Heifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
f
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 'eVNo
El NA El NE
El Yes ❑ NA ❑ NE
12128104 Continued

,Facility Number: 5t —{L4 Date of Inspection ` + l l
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: LA G6P#—)
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 environmenta�reat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
dNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
V 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Z 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 [TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,..l,�d, Noo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0.1410
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
0 Yes �
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
fAIJ TwsCE. .i'J cX_of ���Ti� ar.Jb
Reviewer/InspectorName f,Jlt� rtiJe�Ll. Phone: p % 3S1s
Reviewer/Inspector Signature: Date: 6 6
Page 2 of 3 1L/l6/W uonunuea

e
Ji Faciiity Number: l — Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑�es %O No ❑ NA ❑ NE
20. Does the facility fail to hatUP
components of the CAWMP readily available? If s, check Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ Checklists ❑ Design El Maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ILl No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
64)
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
I_I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
h✓J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
��.f/
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
IJ No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
;No
❑ NA
❑ NE
12128104

Type of Visit OjCo Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �] �Lktaiff Arrival Time: O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ` " t" AT 4 '►, .
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = c [� ' = Longitude: a ° =1
Current Design
Design Current "Ciapacity
Current
Swine Capacity Population Wet Poultryopulation Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turkeys
Qtber
❑ Turkey Poults
❑ Other
I ❑ Other
I
NU nber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
❑Yes
WNo
❑NA
❑NE
12128104 Continued

Facility Number: Date of Inspection
1.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
,�
I" "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): �a y
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
notify DWQ
environmentalth
Do any of the structures need maintenance or improvement?
El7. Yes
Elat,
NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
Zo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�
YJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3N
❑ 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
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
Yes
ElZo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name I 14 - Phone: Q 7 3 KK
Reviewer/inspector Signature: Date: p
Pnoo 7 of 2 12/2R/0� ntttinuod

i
Facility Number: 3f -$ y Date of Inspection
Repaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3 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?
El Yes
N
ElNA
ElNE
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
N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
0
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
11J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14VN
C
❑ NA
[I 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
❑ 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
[ J/ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�
U;7No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional=Comments andfdr Drawings: r
�mm X
Page 3 of 3 12128104

Facility Number 3
V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q i � Arrival Time: Departure Time: County: MZ LV' Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 � = I 0 " Longitude: = o =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ can to Feeder
Feeder to Finish
7A
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population`-:,_
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F
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 C "o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
NA
ElNE
❑ Yes
ElYes
rN NA
❑ NE
ElYes
NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
tructurp 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 EJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed El0
Yes , o ❑ 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 -ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) El"
9. Does any part of the waste management system other than the waste structures require ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
WasteAI)plication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E_T1Vo ❑ 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 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
ErNo
❑ 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
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
ElL_✓� Yes
�
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
u� �noCUV& A�i L G T' I✓ ,
Reviewer/inspector Name r/D//V Phone: A& Irk- /J
Reviewer/Inspector Signature: Date: 'r/G
12128104 Continued

I.Facility Number: -- $ Date of Inspection
Reauired Records & Documents ,�,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L'� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1=i'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ,��
21. Does record keeping need improvement? If yes, check the appropriate box below. Lr Yes ❑ No ❑ NA ❑ NE
❑ Waste Applicat' ❑ Weekly Freeboard [I Waste Analysis El Soil Analysis ❑ Waste Transfers ❑..Alinual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Wcather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ" o ❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q <❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
01, o�❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
04<0 NA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
o ❑ 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 L44 Ll NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑-N'6- ❑ 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
DN6
❑ 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
QNo
❑ 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
❑ f No
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

%if] of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
0 Other Agency -
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0"Region: LI
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
3wHne
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars JL
Other
M ❑ Other
Owner Email:
Phone:
Phone No•
Integrator• Al
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = & = « Longitude: = ° = 6 ❑ «
Current; ,Design Current, Design - C6rren.t
y Population Wet Poultry -;..Capacity Population Cattle Capacity fopulation'"_-1
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge -originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
�}
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
\ Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: —�
Date of Inspection U+a
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
Stru e l Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop indo//w ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) >�t°rll�,t� /�i� t!'LJS s*41
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 ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):,AL
Reviewer/Inspector Name d Gam/, Phone: —
/ 12 /!h
Reviewer/Inspector Signature: Date: tv 7
Page 2 of-3 12128104 Continued

Facility Number: 31 Date of Inspection aT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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?
Additional Comments and/or Drawings:
j'6Q 'J ari° V"w lC
N
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes El No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA El NE
Page 3 of 3 12128104

U rr--i
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 U Arrival Time: 325 Departure Time: f S p0 County: QUiIPLUr-� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: GEN)o k-Wom-Le
Certified Operator: A.. 13 S%n=u�_
Back-up Operator:T-01a SM---VrA
Owner Email:
Phone:
Phone No:
Integrator: ml)Rewe
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= c = = i! Longitude: = o =' = «
1111 Design Current
Design Current
Design Current
Swine
Capacity Population
iVet Poultry Capacity Popul"anon
Cattle . Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La et
❑ Daia Calf
Feeder to Finish
ZC7
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
ElLayers
El Beef Stocker
❑ Gilts
❑on -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turkeys
Other
❑I urkey Poults
❑ Other
I
ID Other
Number of Structures:
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E(No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: 31 Date of Inspection 1 Ol
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: LA6ocs�) f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
d o
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat,
notify DWQ
7. Do any of the structures need maintenance or improvement? El
N
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L'J 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
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenanceli mprovement?
VNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below, El Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) i�E&Y10M (. 1 J) 05,1W
13. Soil type(s) Rob pAG�, aoq
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dN�
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,o
o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
,L��J/N�
Ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
El
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I No
❑ NA
❑ NE
;�1.) Taus rL RAC wo LA G,6" (f_UC.L,5 To ►. c:ta �oq_Ar 5. Zx):LT-rAL l�
Reviewer/Inspector Name � A � a `j Phone: C�io) 31S - 35 oa x Z0I
Reviewer/Inspector Signature: � r. Date: 21'Ls-
12128104 Continued

Facility Number: 3 j — gib Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [I Waste Transfers El Annual Certification
❑ Rainfall El El Crop Yield El120 Minute Inspections J Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes La No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �/No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [XNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ftEl
o El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes NA ❑ NE
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes
dN o
❑ NA
❑ NE
❑ Yes
J No
irLWN
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
[2 NNo
ElNA
ElNE
❑ Yes
dNo
❑ NA
❑ NE
12128104

_ - - - ' "'1 � " - —�. 'c =•�'� -cars'=sL---r-.��_r_ �. :.--? s-..� ` _ _..- .. - � i�c - �`'
- +( ��.. - _4 _ 'Tiv�.. Y.rij-sM'+4�. _ _ ti..'�_ -,.. r -A- K'.�- -� �-rJ- � .. . w-�....a - - �•:
Type Of Visit (&Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Faciliry Number tf Datr of visit: Z 6 Time:L 0� U
rO Not Operational Below Threshold-1
IN Permitted IS Certified 0 ConditionaH37 C'ertified� [Registered Date Last Operated or Above Threshold:
Farm Name: �lcron .5m;g L/�}4W F',"MJ\County: t
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Title-
No:
&a,,/Integrator:
/Phone
On site Representative:
or on
Certified Operator:
Operator Certification Number:
Location of Farm:
1
❑ Swine ❑ Poultry
❑ Cattle ❑ Horse Latitude �'
�• 0 Longitude
Design`. Current
Design Current ; - Design Cur> got. '
Swine"= .
Capacity "Po- wslltion Poiiitry == ' .- .:Capacity
.Po elation -! Cattle :Ca aci ' _Po tilation:
ElWean to Feeder
❑ La er
❑ Daily
Feeder to Finish
I sq7z> JE1 Non -laver
❑ Non -Dairy
Farrow to Wean
A
❑ Farrow to Feeder
❑Other
�r t
—�
Farrow to Finish
Total DQSigil_CainClty t
a ❑ Gilts
. }. 3 r.
T'Totai: '§t 4}
❑ Boars
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ®,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is 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? (Yves, notify DWQ) ❑Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes M 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 R No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard (inches): 3Z
05103101 Continued c

Facility Number: —g Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes MNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
dl"osure plan? ❑ Yes �No
(It 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 maintcnance/improvement? ❑ Yes W o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes $2 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes EZ No
12. Crop type ¢. G
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 N No
b) Does the facility need a wettable acre determination? ❑ Yes BNo
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? ❑ Yes O.NO
16. is there a lack of adequate waste application equipment? ❑ Yes igNo
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes (R.No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ V", checklists, design, maps, etc.) ❑ Yes ED No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes QNo
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Z No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes IgNo
22. Fail to notify regional DWQ of emergency situations as required by General Perrmit?
(ie/ discharge, freeboard problems, over application) ❑ Yes nNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes tZ No
24. Does facility require a follow-up visit by same agency? ❑ Yes I No
25. Were any additional problems noted which cause noncompliance of the Certified AWN1P? ❑ Yes RNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence. about this visit.
Reviewer/Inspector Name to
Reviewer/Inspector Signature:
O5103101
❑ Field Copy ❑ Final Notes
Date:
Continued

Facility Number: I — Date of inspection `''S`'!"�"'
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 9No
❑ Yes MNo
❑ Yes Z No
❑ Yes P9 No
❑ Yes ® No
❑ Yes EKNo
❑ Yes �R No
05103101

P,

Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
-#Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or
Above Threshold:
Farm Name: ..... ' ...'^ �.. Cj....1................ County: ......L�L \............. ..I..... .... ..... ........ .._ . ^ ....
OwnerName: ........................................... . ...... ........................................................................ Phone No: .......................... ................................. .......... ....._..... _.....
FacilityContact: ............................................................................... Title:................................................................ Phone No:
Mailing Address: ........................................../..............................
/..------........---.........--••-•--•-----........................................................................................ .........................
Onsite Representative: Qt!..L.......rti'"� Integrator:11`,�3...................................................
Certified Operator: ................................................... ............................ ................................ Operator Certification Number:...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 L1 Longitude • 4 66
Desig1k Cuirent ' - Design. Current Destgn-_ C rremt
Swme .Ca aci - 'Po ulatiori Poaltry =..Ca aci -..Population. Cattle. •, Ca aci j Po latlom: _
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Totai Design Capacity
- Gilts -
❑ Boars Tatai;SSLW,
Nwnber:af,Lagooas ❑ Subsurface Drains Present ©moon Area . ❑Spray Field Area
..
Holding Ponds 1 Solid T>"sps.. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J4 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 DW Q) ❑ 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 allo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,5rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 191 No
Structure l Structure 2 Structure 3- Structure 4 Structure 5 'Structure 6
Identifier: ............................................................................................................................ .....
Freeboard (inches): i` L
5/00 Continued on hack

Facility Number:-'] — pl Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )ONO
(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 ONO
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 EfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11, Is there evidenceofover application?1 Y ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes � No
12. Crop type i7h , Sq , C 1--j Ida _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes V 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 ❑ No
15. Does the receiving crop need improvement? ❑ Yes Zf No
16. Is there a lack of adequate waste application equipment? ❑ Yes O No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O(No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
(gNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IgNo
4fiQl Wds:o�- deficiencies #ft pole~ dw�x°i>r�g �his:v�s�t� • Y;oO ' 01-tee iye too
correspo Bence about this :visit: ' • • '
Comments (refer to=question #) yExplatn any_YFS answers and/or any recommendations or any other comments.
Use draiwings of facility io: better eacplain situations..
{use additional pages as necessary}
_
on
�� 5�� Ql. C+-•� GAL\ aC�1��. i^=��"1'-1 � �i.,,�i-,. Cam, �--, �'�`�[e�1s .
eL
Reviewer/Inspector Name `� a
Reviewer/Inspector Signature: Date: r]—Q slop

Facility Number: — Date of Inspection a d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes C�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 D�No
28. Is there any evidence of wind drift during land application? (i.e. residue on'neighboring vegetation, asphalt, ❑ Yes b(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 KNo
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 WNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes &No
Additional,Comments an or rawuigs:.-
v::�) . ��,. v� 5aA fl
e,
5100

� - 13 Division of Soand �Water'Consei4ation 'Operation Re ilview
- ;
�._
T_` D Division of Soil and Water°Conservation_, Compliance Inspection^ _
iVisio74-
n of Water Quality Col►ance linspec ... mp
Other Agency. Operahotr Rev,Eew v
IGLRoutine p Com faint Q Follow-up ofDWQ inspection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection 5 -j7—CJ
Time of Inspection 24 hr. (hh:mm)
[] Permitted [] Certified [] Conditionally Certified [] Registered 113 Not O erational Date Last Operated:
Farm Name: f V� i�l! �An�Wt. County . ............. 1�11............................ .........
!1�-....�...............................�
Owner Name:............. :...... ........... .:.. Phone No:...................... .
Facility Contact: .................•--.......:.....---------------------------.................. Title:
Phone No:
Mailing Address: ............. ..........................
Onsite Representative: ,!Q, .-...... !. .. Integrator:.... ...........................................
............................. l ....
Certified Operator:................................................................................................................ Operator Certification Number:.................. I.......................
Location of Farm:
a
.................................................................... ........................................... ....... ..... ...... ............... •
I. -
Latitude ' 4 •1 Longitude • �"
_Design Current.; Design Current ,- . r Design Current,
Swine — y' 'Ca Capacity Population Poultry Ca acity Population - Cattle Capacity Population '
"❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 3 s ;, ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
[] ❑ Other
Farrow to Feeder - •
❑ Farrow to Finish Total Design Capacity
_ El Gilts
77
❑ Boars = - - Total LW
Number 'f Lagoons ❑ en Subsurface Drains Prest ❑Lagoon Area I0 Spray Feld Area
Holden Ponds /Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes l❑ No
c. If discharge is observed. what is the estimated flow in gal/min? —J^
d. Discs 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 T;TNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ^^��
Freeboard(inches): ........... J.U..+.�......................................... ...............................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 70
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — Date of Inspection - / % .O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes No
4 seepage, etc.) '
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(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 1500
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 'MNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes gNo
Waste A1212lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes NUO
IL Is there evidence of over application? ❑ Ponding ❑ Nitrogen El Yes No
12. Crop type e v
................ ............................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ► rNo
14. Does the facility lack wettable acreage for land application? (footprint) ElYes [ONo
15.
Does the receiving crop need improvement?
[Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
j (No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9N0
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
*lb'
19.
Does record keeping need improvement`? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
I;No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
-,No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes
1UNo
[P440
viWations:or. deficiencies were noted during this -visit;. You will nar further
IPW
- ebrrespgridefiee: abbot: this visit.: :: : :
Comments (refer to question #)-. Explain any YES answers and/or any recommendations or any other comments. -
Use drawings of facility to better explain situations. use additional pages, as-'nece`ssa "4.
4(/; _4"'__Zdk� �Opj - (
Reviewer/Inspe to Name �� •�/ r�
Reviewer/Inspector Signature: �~ t , `��`,� , ��% Date:
1 /6199

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes pill
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 21No
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
30. Were any major maintenance problems witB the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNp
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 111Do
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 1No
3123/99

Facility Number Date of Evaluation
Time of Evaluation �� 24 hr. (bh:rrmm)
*_,6=1tte,d [] Certified [3 Registered ❑ Non -Registered ❑ Inactive Facility ate Last Operated:
Farm Name: 3!i! .... ._.» ..»»»_». _ County:,
Owner Name:.. -------- Prone No:Facility Contact: Contact: -Phone No:
Mailing Address:
Onsite Representative: ------- Integrator:
Location of Farm:
Z
Discharges & Stream
1. Is any discharge observed from any lagoon? ❑ Yes
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 estimared flow in gailrttin? ./Y _ V
2. Is there evidence of past discharge from any lagoon? ❑ Yes 5No
'VV2ste Collection & Treatment
3. Estimate Freeboard Level: Spillway ❑Yes No
Structure i Struewre 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ._ ...» ...__.._ . �____ -- - --. ._._ »__ .___ _.. .».•._.» ._.-...._.----_. ---
• `�t:::.L1 sr`--iwWr.»• ;X,�.ia •i':1..-•_•-^:•r- - - - - 71
Ret�ewer/inspecror Name ���_ Y rry1� ..�=�e.- -- t—'s�aa y sr^a �rrr ma's _.-r1 X
Reviewerf1uspector Signature 3 Date: 1
YLEi
1/1J00 1

Water Quality Active Lagoon Ranking
Draft
Central Office Criteria
1, Was facility constructed before 1993 MRCS Standards or there is no verification of standard? i✓a ! f
2. Plant Available Nitrogen (PAN) Deficit < 500 r per year or F 1, F3 or F4 Wettable Acre Determination
Flags
F 1 Lack of Acreage resulted in over application in last two yearsr-
Fa Obvious field limitations ditches, buffers irregular shape
F4 Application acreage in excess of 75% of total acreage
3. Lagoon Capacity greater than 1,000,000 cubic feet
4. Was there a discharge from waste system in last five years?
Central Office Criteria available after new verified GIS data is gathered from field GPS Units
5. Distance from Lagoon to Water of the State (WOS) > 300'?. 3 ,
6. Is lagoon in 100 year flood plain? IV6
Field Inspector Criteria
7. Modif}- Question 44 from current inspection. add choice box: Is high freeboard due to storm Nvater or
management? 'Zko'{ F�
S. Modif - Question' 5 from current inspection form (take immediate out) and define in form instructions:
Current question: Are there immediate threats to the integritY of any of the structures observed? (trees,
erosion)
9. Add question on effective embankment Height > 10'
2/3/00

+, lw cuuu +{• •� 3ty-113-wo4u Did© NON DISCHARGE BR PAGE 84/08
Inactive Lagoon Field Data Sheet
Facility Number: Ell-�
Latitude F1 . F-1 ' E
4. Waste Last Added (mm/yy)
Inactive Lagoon Number:
Longitude E] E " P PS ❑ Map
❑ Owner ❑ Estimated
5. Estimate of lagoon surface area (acres) L ;2- x 3 0 D
6. Effective height'of embankment (feet) ` .
7. Distance to Blue Line or Intermittent Stream (feet)
❑ Determined From Field Measurement ❑ Map
8. Down Gradient Well
a. Is there a down gradient well located within 250 feet! ' ❑ Yes o
b. Is an intervening stream not located between any part of the lagoon and the.nearest well? []No
9. Distance to WS waters or HQW (mi.) < 5 ❑ 5 - 10 ❑ > 10
10. Does the representative know of overtopping from outside waters? ❑ Yes FLNu ❑ Unlaiown
1 I . Appearance of Lagoon Liquid
a. Sludge Near Surface
b. Lagoon Liquid Dark, Discolored
c. Lagoon Liquid Clear(k
12. Embankment Condition
a. Poorly Built, Large Trees, Erosion, Burrows, Slumping, Seepage, Tile Drains, etc.
b. Construction Specification Unknown But Dam Appears in Good Condition
c_ Constructed and Maintained to Current MRCS Standards
13. Outside Drainage Area
a. poorly Maintained Diversions or Large Drainage Area not Addressed in Design
b. Has Drainage Area Which is Addressed in Lagoon Design
c. No Drainage Area or Diversions Well Maintained
14. Liner Status
M
a. High Potential for Leaking, No Liner, Sy-idy Soil, Rock Outcrops present, etc. — [�
b. No Liner, Soil Appears to Have Low Permeability ❑
c. Meets NRCS Liner Requirements"
15. Application Equipment and/or Sprayf eld Not Available ❑ Yes 0,No ❑ Unknown
16. Contact could not be made with on -site representative 10 Yes No
ILFDS
1/12100 2

Groundwater Rating
The following questions will be incorporated into the current inspection form or answered at the
central office.
Rating Questions for Groundwater
YE
UNKNOW
IN
S
O
N
1
Has the lagoon/sprayfield been in use for 5 years or more?
2
Is there a water supply well within 250' of the potential
pollution source (lagoon or sprayfield) with no intervening
groundwater discharge?
3
Is the predominant soil drainage classification well drained
to excessively drained?
w
4
Are rock outcrops present?
5
Are either of the following true?
• The lagoon was constructed before 1993 NRCS**
Pill/�
standards
• There is no verification of adherence to the 1993
NRCS standards
6
Have groundwater standards been exceeded at this site
based on existing monitoring records?
7
Was groundwater encountered during construction of any
lagoon?
Depth to Groundwater . (feet below land surface)
*Generally unknown, but if this data is available is should be recorded.
**Natural Resources Conservation Service
Responses to the questions will be entered into a computerized version of the scoring table on the
following page to determ-Ine the rating
1

v f x
r 13 Division of Soiland Water Conservation Operation Review
; -13 Division of Sail and Water`Conservation -Compliance Inspectioh r
Division of Water QeeInspection
Other Agency Operation Review
ISMoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection I '] `tT
Time of Inspection I 11%.Z6 24 hr. (hh:mm)
Permitted ©Cert/i�fied O Conditionally Certified Q Registered r] Not O erational Date Last Operated:
Farm Name: ............... (- G.V.u........ .... County:...... 41vyx_...................
Owner Name: ...............f
...�.Y.Q�(1......................�.YY.►A.�!�r-:....................-..................... Phone No:................
.......................................................................
FacilityContact: .............................................................. Title:................................................................ Phone No:...................................................
Mailing Address
3�s-.........N.lw:....f.l.`i6 .........................................................................................'.......
Onsite Representative: G....�ln{CJ�(. Integrator: ..................................................
Certified Operator:
Location of Farm:
Operator Certification Number:,,,,,,,_ ...................
................................................. ..................
Latitude
......... I ............ I...........................................................................................................................................
Longitude
�
;,..' Design Current__-- _ _ Design;
Current �:
Design Cu�r,ent-
SCapacity Population
- Poeilfry "
Capacity
. Po ..ulation Cattle
Capacity Population
❑ Wean to Feeder
_
[I Layer
❑ Dairy
Feeder to Finish
3-S-"-
❑ Non- Layer-,
❑Non -Dairy
Farrow to Wean
- - :.
:..,.
❑ Farrow to Feeder
❑ Other
ID Farrow to Finish
ToAal Design Capacity
�3S-Zp
❑ Gilts
❑ Boars
= -
`,:To taI-SSLW
Nnaiber:of:Lagoons l ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holdiiig Ponds / Solid Traps ' ❑ No Liquid Waste Management System
Dischar>res & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: &4
Freeboard(inches): � ........ :............................ .................................... ............. ........... ........... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
❑ Yes 0 No
❑ Yes [] No
❑ Yes No
❑ Yes ® No
❑ Yes W No
❑ Yes [j No
Structure 6
El Yes Vj No
Continued on back
3/23/99

Facility Number: j - Date ofinspection 7 $ R
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
[3No
(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?
N 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
In No
Waste Al2plication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VrNo
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN
El Yes
0 No
12. Crop type � !!
�k, �4 6rr`_�iA3%u0.�1 Smt1P2�.•.— Srnc. 1 a M i V,
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
t
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Jallo
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
j9 No
15. Does the receiving crop need improvement?
❑ Yes
56 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[$ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
tRNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) I
❑ Yes
R)No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
M Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IR No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [; No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes f1p No
24. Does facility require a follow-up visit by same agency? ❑ Yes [P No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
0: Rio yiolafigns.. deficiencies were noted ...... phis.visit. . . .will .. * . . �...... ; ;
correspondence a�oulk this visit. .. . .:. : .:. . ....:. .. . ...:.... : .. .
Comments -(refer to question #f): Explainany_YES`aswers and/or any recommendations or any otlier^comutents:
Use drawings of facility to better explain`situatiions. (use additional pages as necessary):
1. t. e rove_ C-11Y-G v K is V }4. 0, vt 6-s; 0 ti-, Ka..
& &_)(tr, Skot1) V bu Will 15L yoUr�t1 1�
r Ptlzt�"
t ►`� � � Yt.in. ,
13. 1 Y-uel( cT
-,hoLA3 1a. a.�
`eI� �t (AJUg.
1 q . ��r-te�haa }_vc` 5 Siva vj c! cairfk� GJ e�-�
R
Reviewer/Inspector Name
Reviewer/Inspector Signature. Date: -x 7 O `4 `i
3/23/99

FaciJity Number: —
1)atc of Inspection C]
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 and/or -'Drawings:
3/23/99

Y
0 Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine '0 Cam faint 0 Follow-u 'of DW2 inspection 0 Follow-up (if DSWC review 0 Other
Date of Inspection
Facility Number +�
Time of Inspection / ! 24 hr. (hh:mm)
0 Registered JA Certified 13 Applied for Permit' © Permitted JE3 Not Operational Date Last Operated:
Farm Name:......... v.,a ....... . Ffa:fC.Y.h-- ................... County: ...... 1 bwpli-K ..................................... .......
Owner Name: .......... .-04 Yt9 r^........................... � .I?1� Clr ...................................... Phone No: �� q�.. SZo�!�. �(a..ir ?.................................
a . .....
Facility Contact:.... ..................... .:................ Title: ........ Phone No:
Mailing Address: ..?aw........ N......... N.( .............. :................... ...... l��Y 3r-...1..................................... ..2 �.. ...
Onsite Representative: .........�..dd....... .... .......... Integrator: ........... Cr,..V.,r0 ... a`5 ......... ......................
Certified Operator:-W-D•U {.a^ ................ <'"!............................._...... Operator Certification Number:-.j 1.1�.---"................
Location of Farm:
..si .:...�....:....1dx,t....Il�.�tQ3.�...fQ.:.!#...rollt�....xuzr........a.:...SIK...f.SIS:.................................................................................:...
........................---.------........... ............. .---- .. w
Latitude ®•_®� S� 't Longitude ©• �' ®
;, = Design, . =,Current
s" Design . Current Design ,. Currents.
Swine Capacity Population
Poultry
_.
Capacity Population Cattle
Capacity Poptlation
t
❑ Wean to Feeder
J❑ Layer
❑ Dairy
Feeder to Finish
3
❑Non -Layer
❑ Non -Dairy
El
Farrow, to Wean
i❑
❑Farrow to Feeder
❑ Other
❑ Farrow to Finish
dial Design Capacity"' '3Z5<D
❑ Gilts
El Boars
Total SSLW ,
Number of Lagoons / Holding Ponds
Subsurface Drains Present ❑Lagoon Area
Spray Feld Area
❑ No Liquid Waste Management System
£a
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes . W No
2. Is any discharge observed from any part of the operation? ❑ Yes CP No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [ANo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [] No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes W No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes EA No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes El No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number: 3 — t#4
8. Are there lagoons or storage ponds on site which need to be properly closed? Cl Yes M No
J
Structures.fl.i,00m.Iioiding Ponds, Flush fits, et(.)
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 (fl) ........... .....................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
1 l . 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
CK 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 ......k......................................... Oct—\ .....��.c�t........-`-$Y. t,h......--..................:................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
El Yes
MNo
17.
Does the facility have a lack of adequate acreage for land application?
y
❑ Yes
';A No
18.
Does the receiving crop need improvement?
QYes
0 No
19.
Is there a lack of available waste application equipment?
❑ Yes
14 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
.f
Does record keeping need improvement?
❑ Yes]
No
For Certified or Perntitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes V 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'? ❑ Yes � No
0 No violations or de#iciei cie's.were-note'd during this. visit. You will receive no further
correspondence about this.visit..
Commenfs (refer to question#): Explairt any YES answers and/or any recommendations -or any"other cornrnen s F.
Use /d�rawfings of fuct((litv�to.better explain situations.`(u'se additional pages,
I esas nLLecessarv)
l�� CGy.�s rw� C T rCN T S `* t_re�.c A-c (a5� 1 LL c x` I . F-yo s lor, 4- boC G *ca S V e
IT. Game z,P�k 6 1m�rrvt 142-rrhA, Gfo�_ becv. Y'�rzy"J,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: A;�� ��� �,� Date: 6 A/A2'

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
IG Routine 0 Complaint 0 Follow-up of DNVQ inspection 0 Follow-up of DSIVC review 0 Other
Date of Inspection 9
Facility Number
Time of Inspection ; p 24 hr. (hh:nun)
[3 Registered P Certified [3 Applied for Permit [3 Permitted [] Not Operational I Date Last Operated:
Earns Name kYnn..... .� 7Y]1 County. D
Owner Name: ........ .JoxalN........... ............ ... Phone No:.��.(°�. �a�:3fuu'��Z...................................
Facility Contact: .... C `
i�'�i�.Y.O;r�.................................. Title: ........ Q:k?Ate........................................ Phone No: .&1l.0)...
141ailing Address: ..... ,s&s1........ NC....l zjy.....jRi... ....:1(1 .. ......................•.. .... �►�ie1�Y !�.. j..N...:..i.................................. ,a'� 5..
Onsite Representative:.......... 1CLl ....... alxl.i`.................................................... Intel;rator:....... [C44.W.O.V5 .......
Certified Operator; .................................................. ............................................................. Operator Certification Number:..................
Location of Farm.
........... ...9R ...n ............ � ..... 4,ha,cosy,kl:,'I'VS.......... 1.4......61....... n...... ja..l.....
�nal s..
no. ,. a.f......5. ..� 4a...... an....
Latitude • I " Longitude • 6 �=
Design Current
Design Current
Design;" Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity. Population
❑ Wean to Feeder
JE1 Layer I
❑ Dairy
Feeder to Finish
❑Non -Layer
ElNan-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
3 SLp
❑ Gilts
Total SSLW
�f7S" apt]
❑ Boars
Number of Lagoons I Holding Ponds ' ❑ Subsurface Drains Present 1113 Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste IVianat;ement System
General
1. Are there any buffers that need maintenance/improve men t? ❑ Yes 1KNo
2. Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge orit mated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes O(No
b. If discharge is observed, did it reach Surface Water? (if yes, notify, DWQ) ❑ Yes UNo
c. If dischm-e is observed, what is the estimated flow in gal/rain?MIA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes [N 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 [A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number: ,I( — V w
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes fgNo
Structures (Lagoons.Halding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [A No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard (ft):D
10. Is seepage observed from any of the structures?
❑ Yes
El No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12. Do any of the structures need maintenance/improvement?
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
UNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
�9 No
(If in excess of WMP. or run+o-f-f waters of the State. notify DWQ) '
_entering
15. Crop type ......... QO.S61..... l��Y-MA...................... CCQ...................... ........................... ....... .............
................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
'F,No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
Yes
to No
19.
Is there a lack of available waste application equipment?
❑ Yes
U[No
20.
Does facility require a follow-up visit by same agency?
JAYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JXNo
22.
Does record keeping need improvement'? -
❑ Yes
[4No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
id No
25.
Were any additional problems noted which cause noncompliance of -the Permit?
❑ Yes
[ELNO
0• No.violations or deficiencies were noted during this.visit - You:will receive'ito ftiriher
correspondence about this.visit.•;
..
Con inents (refer to question #): Explaip any YES answers and/or any recommeridattons or"any other.comments.
Use drawings of faeitity to better explain situations.=(use additional pages as "necessary)
tt llx- 1 roSilm aYtGS Orgy e. tnrttwr btk �� G�c�Dof'� SGloju �C— Yf��G� a)i`C
fiC.52��t'� � �A�re- a�S Sy►ou�f] be, rc-St�racc�. ,
7/25/97
Reviewer/Inspector Name '
x
Reviewer/Inspector Signature: Date: VVI