670015_INSPECTIONS_20171231

NOHTH CAHQLINA
Department of Environmental Quai

�'i
• Divi`sion of�l'ater Resources
Facility Number ®- © +Division of Soil and Water Conservation
0 Other Agency ,
Type of Visit: V
Compliance Inspection 0
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit:
XRoutine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: Arrival Time: L_Wp ._I Departure Time: County: Z Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ( }YJ
6� w4m
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: ko p(n^r;
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design C*urrent
W,et Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Current Dry Cow
Dt;y Poultry Ga acity P,o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Wit
Other
Turke s
ey 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &� No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes &�No
[:)Yes NrNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - IS jDate of Inspection: Q,1 121 f1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Af 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 _KNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [*o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes IN 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes V 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 El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes�rg
No ❑ NA ❑ NE
El Waste Application El Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑ Wasteansfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Ins ection: 2' 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [yNo ❑ 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 9No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No WNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes blNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes MNo
❑ Yes b4 No
❑ Yes X No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
CojindWents (refer to que1.stion'#) Ezplafn a©y :YES answeri` and/a`r any i`ddrtio'ual'.recootinenditions o"r any ©ther comments:,
�_�-z
iw
Used wr©gs of facility, to betterq.explain situations (use additional pages
hYh� A&L `44
s .
L'W
Reviewer/Inspector Name: qL&t
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 640 ` i 9 (Q 7 3 fl
Date: V- I
21412015

Type of Visit: 0 Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: = County: (%j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: UQQL✓ W[--S,� 4 tj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
C►►opacity Pop.
Wet Poultry
C**opacity
Pop.
Cattle C•a Sell Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nan -La er
I
Dairy Calf
Feeder to Finish
3j7•b
Design
Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
1)�r P,oult ,
Layers
C•_a a_ci
P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke 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 �FN
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Fae'ili Number: - Date of Inspection:
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EdN o ❑ 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 Ca'N'o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes To ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ZfNo
❑ 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes No❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes /ONA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FneUity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes N ❑ NA ❑ NE
e
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] NA ❑ NE
Other Issues
28. Did the facility fail to property 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 No ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
VLJ lv ❑ NA ❑ NE
U ° ❑$ NA ❑N
No ❑ NA ❑ NE
(Comments (refer to:question #):.Explain any YES. answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use a'dditional.paRes as'necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone f Q 156
Date: la
2/ /2015

Type of Visit: ('Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: C)"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Cflr1 Arrival Time: Departure Time: 2D ti County: Region:
Farm Name: ���`�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. C►attle C+apacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
;p
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Design Current Dry Cow
ultr. Ca aci P,Non-Dai
ILayers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turke s
Turke Pouets
Other
Gilts
Boars
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ONO ❑ NA ❑ NE
[:]Yes F�/No ❑ NA ❑ NE
Page I of 3 21412015 Continued

1FAlity Ndtttber: jDate of Ins ection. /z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C2- o [] 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): 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes En'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 ZrNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej 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 E N' o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F:f"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F(No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
do
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
EfNo
❑ 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 f 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 E7(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [<o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

jFaXty N ber: - jDate 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
6/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
ETNo
❑ 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:
❑ Yes dNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
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 a410 ❑ NA CD NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F2/No ❑ NA ❑ NE
a�cvia.wa.�riunNww� imaiva . - I i IWIM. I I I / I y - I
Reviewer/Inspector Signature: ^^�' -��/ _ Date: zYLf
Page 3 of 3 214,12015

r7
Type of Visit: Qj Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:*0 Arrival Time: _. = Departure Time: ® County: CKXR.DW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: me �A4mjod _ _ _ _ Integrator:
Certification Number: lt3tq65
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
I
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Z,b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr.. P■oultr.
C•_a aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
U.tber
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ 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 rN
❑ NA ❑ NE
❑Yes
❑NA ❑NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili .Number: - Date of Ins ection:
V4dste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier: LAtsC,,tJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 6o
2/No ❑ NA ❑ NE
❑No DNA ONE
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 hTo ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6/0 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes q o ❑ 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 12 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): 11
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �..d o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 io
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes C3'N ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes To ❑ 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 ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

LFacift Number: T77 t7 Date of inspection:
;4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yesgoo
N❑ 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 to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Epee El 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 ❑ Nip -
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo❑ NA ❑ NE
Comments (refer to question ff): 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
Pho�
Dater
21412011

1]
(Type of Visit: V Co 'Hance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint p Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: © County: a Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ��ps
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
X
Feeder to Finish
Farrow to Wean
Zo
Design Current
Dr, foul Ga aci P,o
Layers I
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
M.-,th
er
Turke s
e Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes VN9
❑ Yes
[:]Yes
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑ NE
Page I of 3 21412011 Continued

Fir-iti Number: - $ Date of Inspection::3/gE-7113
Waste Collection & Treatment
dNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L l7..,6j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ]n ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �rNa ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Y/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes °
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes YNO
0 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 YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMi' readily available? If yes, check ❑ Yes E(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 eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes rNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑NA ❑NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast 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 C3/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:
[:]Yes [1To ❑ NA ❑ NE
❑ Yes [�J/No ❑ NA ❑ NE
[:]Yes I_l No ❑ NA ❑ NE
[—]Yes 2j/No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
r[:]
NA ❑ NE
NA ❑NE
NA [] NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. `I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6 6 ~ 3
Date: , 3L2L
l/41 11

r.�
S
(Type of Visit: UJ Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance 1
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0, J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ?(► 6 6`e (ACYTO 0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: i Ub S
Certification Number:
Longitude:
Design Current Design Iurrenn
Swine Caacity PoWet Poultry CapacityPop. Cattte
Wean to Finish La er Dai Cow
Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
'7..b
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
D , Paul_ Ca a_city P,4 Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef 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?
❑ Yes
2fNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[—]Yes
W]�A❑
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

r
Fa; Number: - Date of Inspection: Z
f•
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ) ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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
[3 NE
15. Does the receiving crop and/or land application site need improvement?
[3 YesVNo
❑ 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 2f
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
yNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Oth r:
21. Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ YesVNo
❑ 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
61<0
❑ 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
L 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
[3/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?
❑ YesFNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any otber comments {.'
Use drawings of facility to better explain situations (use additional pages as necessary).- _�,_ y
AAJAiY-C-rX rb Jwj�? t4�E
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r
Phone[ f f —7 ao
Date: 3 / Z
21412011

Type of Visit: a Co pliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
sit: l,�i/
Reason for Vi]Routine 0 Complaint Q Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Z 135 Departure Time: County: NAAW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
&68 ws&� - .
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current.
ne Capacity Pop.
Wean to Finish
�—esign C•nrrent Design Current
Wet Poultry Cacity Pop. Cattle Capacity Pop.
Layer Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
Dr, P,oultr, Ca aci_ P■o , Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets I lBeef Brood Cow
Turkeys
Turkey Poults
Other
Gilts
Boars
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Yes
No
NA
NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Yes
No
NA
NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
No
NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
� o
NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
WNNo
NA
NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facifi Number: - I = Date of inspection:
WastWollection & Treatment
4. Is sAage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): 4
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 environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesWo❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buf ers, 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 E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Wo
❑ Yeso
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes [-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
o
❑ Yes dfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required, Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box belo ��Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1LJ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 3
24. Dill, the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
r�
25. Is t1l facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
Wo
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
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
- permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[J'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 [XINo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P,No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ENo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date
4ba/
2/4/ il1

L
L
f Visit (�Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
for Visit Routine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ,j D Arrival Time: Departure Time: County:yrfG6W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: j TTitle:
Onsite Representative: 1�6C3�7�.f 701✓ _" _
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = = Longitude: = o = i =
fir
Design
Current Design Current Design Current
Swine Capacity
Population Wet Poultry Capacity Population C►attle Capacity Population
to Finish
❑ La er
❑ Dai Cow
En
n to Feeder
❑ Non -Layer
El Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑Non -Layers
❑Beef Feeder
PBoars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Pouets
❑ Other I INumber of Structures:
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ N
❑ Yes
5No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

$acility Number: — Date of Inspection
•.
,,Waste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA �•r6?fN
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 [yNo ❑ 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 ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need El M 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 ] 0 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
3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W1, o
ElNA
ElNE
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
�
El NA
El NE
18. is there a lack of properly operating waste application equipment?
El Yes
7Noo
❑ NA
❑ NE
Comments (refer to. questroriW#) ,Egpla�n any YES answers and/or any recommendations or anJ otherzcomments
Use drawEngs'of facility to better egplam situations. (use add�ho` nal pages as necessary):.„ ,.
Reviewer/Inspector Name i .: 6 j (; F .. 54�- I Phone: 'y!O
Reviewer/Inspector Signature: Date: ,0 17.
12128104

Facility Number: b-r--�y Date of Inspection
,Y
Required Records & Documents
%. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ \VUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes U/No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
es
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
�Kes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L7 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes R Vo ❑ NA ❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P4
❑ NA
❑ NE
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ 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
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4C No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

E
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit ( Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: GNt(C� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: (6060`l Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = ` =" Longitude: = ° "
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Populati
Ilesign Current
rp Me i KyA Population
El Wean to Finish
ElLa er
[I Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
91 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
3.57-o
2,a6a
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Gilts
PEE1113oars
Other
❑ Other
!Number of Structures:
❑Turke Poults
❑Other
Discharees & Stream Im2aacts
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
[/� ❑ NA
❑ NE
❑ Yes
I� �O ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — j Date of inspection 94n
l
Witste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA 6oa1J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qO
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 property addressed and/or managed
❑ Yes L2/No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes Zo
o [INA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ 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 Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
11 m.j intenancehmprovement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
,ao
L 4
❑ NA
❑ NE
Comments (r�eferFto gnestton #) Explain an3 Y.ES answe�rrs an_d/o na y recommendations or4any other comments.
Useawings of facility Eo better explain s t ahons (useiadtlrtronaMpages as necessa.rv}
Reviewer/Inspector Name ~� Phone: 910 226. ` 7,Joo
Reviewer/Inspector Signature: QW, L Date: Z 69
1lSC L V1 J arr G, V/VT t.VVasr•sacs

i
Facility Number: (,r1 — 5
Date of inspection 9
Reduired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
dljo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,/
!/ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Ell� Yes
,/❑
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O� No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
1VN
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
Li No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[
[I NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
7NQo
❑ 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
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

r
F
ype of Visit Co liance Inspection Q Operation Review Q Structure Evaluation Q Technics! Assistance
eason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: d Arrival Time: Departure Time: County: _ 61AJS1 % Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: (P� - I Title: Phone No:
Onsite Representative: 90 66, / E S11N Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 ❑ i ❑ « Longitude: = o = 1 = «
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
IEJ Layer
I
I
❑ Dairy Cow
Wean to Feeder
IEJ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[2 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
0 N
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: '1 — Date of Inspection o
s'L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EJNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes ETNo
❑ 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
El NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,Q�
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
]�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
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? El Yes rNo
El NA El NE
15. Does the receiving crop and/or land application site need improvement? [3 Yes []NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes fNo ❑ 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 64o ❑ NA ❑ NE
Comment (refer�to�quuestion•#) mh-xpla_, iiFany�S nswe and/oriany recommendations or any other comments.
�.
Use lirawtngs apfacEl>ty toIbett6feiplatn�sttuattans (ttse addit!on appages as necessary):
Reviewerllnspector Name -- Phone:( V/4013
Reviewer/Inspector Signature: Zj—Date: G a
Page 2 of 3 12128104 Continued

Facility Number: - S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
zxo
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rNo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Id No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E: No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ld No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
dN
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El
L/I No
❑ NA
❑ NE
Additional Comments and/or Drawings: m ,
Page 3 of 3 12128104

6Division of Water Quality
Facility Number l�f 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit &70utine
Hance 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: v/t1 Region:
Farm Name: -jL ; [ , }7 _ .� _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j , Title:
Onsite Representative: &G,f/+'= _ &S Iy a,"J
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [—] o [�J ' 0 Longitude: 0 ° a ` = "
Design Current Design Current Destgn ° Current
Swine Capacity Population Wet Poultry '. Capacity .Population Cattle pac�tyk Po ulat�oq y C a ,p
❑ Wean toLayer
: - _:...
- Finish f��' ❑ La er -
❑ Wean to Feeder JE1 Non -Layer
Feeder to Finish I
Farrow to Wean Dry poultry z .
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
a Other
0
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poufts
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: T❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
4
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? N
Page I of 3 G�
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
6<9"'EINA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: — %5' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I A 4, 6
Spillway?:
Designed Freeboard (in): Z.O
Observed Freeboard (in): 3 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 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 Z<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Zo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CI'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lhs ❑ 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? El Yes El No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'No ❑ NA ❑ NE
[No ❑ NA ❑ NE
El NA El NE
l�fo ❑ 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):
yu✓ST Aj trb Um 4j(-jC(✓L)qL fjLjtL Z.(­& "6AI 4fPLjZ—P tJ ra;%/ C"f `
(Oaat-S 4 6)UdSY MAI 447E fix— C1,4JO U&L L .
Reviewer/Inspector Name I ® I Phoned[ ' 1( - / it
Reviewer/Inspector Signature: a ,_ Date: y I lb7
Page 2 of3
12128104 'Continued

V "I
Facility Number: — [ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
E,111�o
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Do s record keeping need improvement? If yes, check the appropriate box below.
dyes
El No
El NA
[I NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
0N0
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1,2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[TNo
❑ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ,
❑ Yes
0"NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ll No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,/
Id No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0_ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes""
es`
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Eldo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Oopipliance 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: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: niru is y _ wwro d Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c ❑ & = u Longitude: [� ° = A ❑
Swine
Design Current
C►apacity Popnlation
Design Current
Wet Poultry Capacity Population
Design C►urrent
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish 3r7A
❑ DairyHeifer
❑ Farrow to Wean
Dry poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-La ers❑El
Beef Feeder
PEj Boars
Pullets
❑ Beef Brood Co l i
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures: a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E No ❑ NA ❑ NE
i
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ilk No ❑ NA ❑ NE
❑ Yes [P10 ❑ NA ❑ NE
12128104 Continued

Farjlity Number: — l,r Date of Inspection
Waste Collection & Treatment
4AIs 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: ZA600A)
Spillway?:
Designed Freeboard (in): U
Observed Freeboard (in): +39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V(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
[2'No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
o
❑ 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
Ld No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DINo
❑ NA
[:1 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 ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) cilij ACL.•
13. Soil type(s) �ja e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Zo ❑ NA [I NE
15. Does the receiving crop and/or land application site need improvement? El Yes L�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [rNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes EXo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations .or any other. comments -
Use drawings of facility to better explain situations. (use additional pages as necessary):
� c.6n.105 L4Z d
ReviewerlInspectorName �oy� �� Phone:
Reviewerlinspector Signature: Date: 5� 66
Page 2 of 3 1 12/28/04 Continued

❑ Yes 2(No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
[Facility Number: -� — 5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
d
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain
inspections Weather
Code
�❑
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 o ❑ NA
❑ NE
"
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FNo❑ 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
C, o ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
� o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91�
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:1 Yes
L.d o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
.�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit t3'zRoutine
pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S aL o5' Arrival Time: 1 t 3� Departure Time: County: CNA40 N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
On site Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° = 4
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 3S ?4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other ----
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Coyd
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L_1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
12128104 Continued

FacilityrNumber: — (s Date of Inspection
r
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 Structure 2 Structure 3
Identifier: [A�� 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C d
Structure 4
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ko ❑ 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 L' ! No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes No El 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 Widow ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) V"'13A.&
13. Soil type(s) d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D<, ❑ 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 Lef'No ❑ NA ❑ NE
Lc--Uo Fp_w\s
Reviewer/Inspector Name ��� 1 (, � Phone: / 76 — 72 6 Y
Reviewer/Inspector Signature: Date: S
12128104 Continued

Facility Number: G) — is Date of inspection ub
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El other
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
dyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly reeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
El 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
D<o
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElE Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eli
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L'7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ET<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EINo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] Yes
�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
Q o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ET&o
❑ 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
9'1�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
.e� MMM
AddeEioinal Comments and/©rrDrawings "4� ;�20
12128104
12128104

A
F Dayssion o Waterali Quty '
_ D:
Dinsion of Soil and Water Conservation
O Othec'Agency =� a -
_
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit /Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: f O Time:
Facility Number
O Not Operational O Below Threshold
Permitted 13 Certified 13 Conditio y Ce�rttifiie�d,, 0 Registered Date Last Operated or Above Threshold:
Farm Name: Ld! .. .. --.' �!.11'�' y _ ._.. �W ....... County: WLI . ....
.�
OwnerName: ........ Phone No :..................... �............ ...... ....... ......SUN . ........._..........._.....................�--------�_..�..................._...
MailingAddress:...................._.............................................
Facility Contact: ..._............... _....... Title:.._ .... ...... ..............._.e N._..
o:_..._._............................. ...
_... ....
Onsite Representative: --_ �7_ .L/�C�t„��'...... Integrator: ,
Certified Operator._..... �......._ �_._.. _ .. _.m .__ . _ ... W ......_ Operator Certification Number:
Loration of Farm:
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� �" Longitude ' 4 cc
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? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? /yX-%o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JKNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;;(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier -._.... ......... .....
Freeboard (inches):
12112103 Continued

I
JVac&.dumber:
Date of InspectionI
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceJimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes Jrlo
❑ Yes P"No
❑ Yes 2(No
❑ Yes ONO
❑ Yes ONo
❑ Yes PrNo
❑ Yes R(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes j2fNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ;244o
b) Does the facility need a wettable acre determination?
❑ Yes QfNo
c) This facility is pended for a wettable acre determination?
❑ Yes $No
15. Does the receiving crop need improvement?
❑ Yes yNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes grNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes to No
Air Quality representative immediately.
�Coifi e s (refer to questtan #) 16gplarn any YE&answers andfor any r+eco�ons or ang er commer►ts.
Use drawings of ­77facthty to better eacQlam sytuatro s. (use additional pageSas necessary} ❑Field Coy ❑ Final Notes
2 r�K oA�z.►A6ado-L.�rT�n� y f vrDc�
C41kvE•e7 111v
Cn��G T7 rzOr� 7 All /41V
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /
12112103 Continued

0,
acility Number: Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes )9 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes VrNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes PNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JgNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes )� No
28, Does facility require a follow-up visit by same agency? ❑ Yes ?(No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) JdYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes V*0
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Ao
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes X10
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit ;er-Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified [3 Conditionally Certified [3 Registered
Farm Name: 5D
Owner Name: J a 6 t 1y! &V a4 d r'v
Mailing Address:
Time -
Date Last Operated or Above Threshold:
County: a n11'riv
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: j3a k b �, Oe-54 o:-, Integrator: n's es'p Cq rd at j ✓ZCt�
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 14 Longitude o 4
Design
Current Design Current Design Current
Swine
Ca acity
P,o ulation Poultry Ca achy P,o ulafson Cattle Ca aci P,o utation
❑ Wean to Feeder
10 Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer
❑ Non-lbiry
❑ Farrow to Wean
❑Other
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Total Design Capacity
❑ Boars
Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present 110 Lagoon Area
10 Spray Fiel Area
olding Ponds l Solid Traps ❑ No Li uid Waste Mana ement S stem
HNManagementd
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lap-oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,ErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: If
Freeboard (inches): 43
05103101 Continued

f�
Facility Number: % —1.S Date of Inspection 2 O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type CiO,-rt 1 14ken i , SOy beori-s, TObaGc.o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes'ONo
❑ Yes O'No
❑ Yes tfNo
❑ Yes J�No
❑ Yes AE�rNo
❑ Yes ,Ej'�No
❑ Yes )2No
❑ Yes 4!1'No
❑ Yes ONO
❑ Yes �No
❑ Yes �No
❑ Yes 01%
❑ Yes ,ifrNo
❑ Yes,-El"No
❑ Yes )7jNo
.eyes ❑ No
❑ Yes ❑ No
❑ Yes -�No
❑ Yes ,ErNo
❑ Yes '21'No
❑ Yes ❑ No
❑ Yes ❑ No
!� No violations or deficiencies were noted during this visit.. You will receive further correspondence about this visit.
l4nYo¢
+attai 4,k Ft�'. �'+W. .. -�-=Ii -- tF '�.�
Commentsp(refer to question,# ,Explain any YES answers.and/or any recommendations or an} other comments:.
Us`e di awtngs of facility to better situations {use as_necessary)e
egplam addrbonal;pages
[] Field Copy ❑ Frnal Notes
1�• ta�owa• I)Qed5- fo be so-ee -Ao hnve or w.qs -e J:s Ao4edw;A;n
(g0 plat 3 Or o f / GGr4ieit eyes? �S . 0"vwE✓ of%a neec! Ae VSe a
(n/AS� e. C.rndy1; 5 da4e-d by-4Wn 60 pigAe
T12IZ-- Z '0W hI&'A4;o'1 ,nezdmds 4,9 Ga l'ea'w e Ae :-�� p9�� ap�1►tea( .
n'M� . We govl s;t;d lie 46mj1j+ -1l)e re h td �eetn q ceVle W wis4c
anal S;s e'41 IvA7C—h ije LVgr ld-0lcih1e*0 jaCq ed1�/in i�'IS L-��Q�t.
Le
Reviewer/Inspector Name �.. 4rti�ti✓S.� .,. , r
Reviewer/Inspector Signature: Date: M 4 Z
05103101 Continued

Facility Number: 7 — II Date of Inspection
dor Issaes
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 ❑ No
❑ Yes
�No
❑ Yes Z"No
❑ Yes,,No
❑ Yes .,r N' 0
❑ Yes -,ETNo
❑ Yes_,O'No
Additional Comments and/or Drawings: .
Ioq.�C onq;VI L"eai) ae sure]7
&j 1 J o t-v st rx c2 F'^ am T e evio f 4 rc GCS �i- kv i s4a (4l 1 `M V
�A? 41,e -1Ko 2— Ye1, qre L'-veren.r'J /25�s�rv+-1
-f)-,,e 4ld poIn n , j
O-41,c►- - iict,-. eo -(ed q ba ve" 44, elo c". 1 a Md GAO'rS
a ,-e n eat 1 ke71 .
05103101

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 3Q 24 hr. (hh:mm)
;31Permitted [3 Certified ❑ Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
Farm Name V`� �'� County; ....... �."..� 9..................................................
Owner Name:
Facility Contact:
............................ Phone No:.........................
Title: ................................................................ Phone No. -
MailingAddress: ..............................................................................................................................................................................G ....
Onsite Representative :w±— Integrator: \\e��
Certified Operator:
Location of Farm:
Latitude ' =' =11
LL Design,.-_; Current.
Swine Caoacily .Poiiiib ition
❑ Wean to Feeder
Weeder to Finish
5-Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Operator Certification Number:
................................. .............
Longitude
Design
„Current = = ` Design ;Current :.
Poultry Capacity Population Cattle Ca actty ' Po uEation -
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy -
❑ Other
Total Design:.Capactyr:
Discharg.es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes bNo
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? (Il' yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systczn? (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):........................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23199 Continued on back

acir-* Number: — Date of Inspection 0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes NrNo
(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 WNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ONO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
; No
11. Is there evidence of ove application?( ❑ Excessive Ponding ❑ PAN
❑ Yes
allo
12. Crop type C
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
allo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
tZNo
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17.- Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONO
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
5eYes
❑ No
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
tRrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JgNo
24. Does facility require a follow-up visit by same agency? ❑ Yes NrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes C9`No
Nd-yioiafiotis;o d hcieni ies �i�ere noted dix'ing fbii. s;visit, - ." will-teeeiye oo futthgr
correspondence. about. this visit_ .. . ..
Use,drawings of fa_cahty tobetter explain sit�tahons (use addihona! pages assneressay) -_
,
y�
0
41A
V
��JMA 12�__CCJA�p {
�c74` Y�pG
dlQ��c-1 � �u21` M`Y t�-"���•�, j li `j r 4��' Ly �`� cad
L
Reviewer/Inspector Name
Reviewer/Inspector Signature: � i� Lj Date: -5— F7 __Q a

,' FaeAty Numberc-) — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
VYes
❑ 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
1 Ao
es' r1No
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
P(No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
J'No
tli%113 amme�tsan or rawrn r4a� r.;� a.m.
r .... =..�� 'ire„ -�'.�°-. �'Ts°--�--'�.'.sw'r -^."'"'fir-.i
7

•r
1\
iitvt816n of Water Q alrty a
Q Iirvrsign of soil and Water Conservation --ice
Type of Visit Compliance Inspection p Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Date of Visit: ®Time: ® Printed on: 7/21/2000
Facility Number
O Not O erational Q Below Threshold
Permitted J3 Certified [3 Conditionally Certified © Registered Date Last Operated or above Threshold: .......................
Farm Name: ............................. ....
.................. ..................................
Owner Name:
Phone No:
FacilityContact: .............................................................................. Title:.......................................................
... Phone No: ..........................
MailingAddress:.....................................................................................................................
Onsite Representative: 3� Q-✓S ................................................ ........
..................................................................................... ..........................
Integrator: -.--_ ,,,,,,,,,,,,,,
Certified Operator: .........................
, Operator Certification Number:,,,,,,,,,,,,,,,,,
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 L Longitude • C�` "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ID Layer I I d ❑ Dairy
Feeder to Finish 35')40JE1 Non -Layer I 1 103 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurrace Drains Present ❑ Lag--n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Iml2acts
1. is any discharge observed from any part of the operation? ❑ Yes XNo
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, nolifv DWQ) ❑Yes ❑ No
c. If dischar,e is observed. what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
St1'UC1urC I Structure. 2 Structure ; Structure 4 Structure 5
Identifier: .................................... ............... ...................... ................................... ........ --.......................... ...........
Freeboard (inches): 77
5/00
❑ Yes ❑ No
❑ Yes J (No
❑ Yes kTNo
❑ Yes N No
Structure 6
Continued on back

+I
Faculty Number: 777= Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes JqNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
RNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
�rNo
elevation markings?
❑
Waste A uplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes
M No
12. Crap type IL__i v
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
JVNo
b) Does the facility need a wettable acre determination?
❑ Yes
W No
c) This facility is pended for a wettable acre determination?
❑ Yes
4 No
15. Does the receiving crop need improvement?
❑ Yes
J�f No
16. is there a lack of adequate waste application equipment?
❑ Yes
t�rNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�rNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
Oe/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
t<No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[RrNo
21.' Did the facility fail to have a actively certified operator in charge?
❑ Yes
tgrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes NfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [�5No
:: No-yiolatiois.
:or deficiencies were noted di Whig this.visit'. • Y:©u will•reeeiye iio ]further -
correspondence. about this visit.. .
Commen&-(refer to gnestion 4): 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):
{ � C� �ti'�.sZ � {W�\1 � t,.r SG.�+nw�e5 �T 1�c�c� �1iR►r A.
Ve
Reviewer/Inspector Name VJ �'�tA Q
Reviewer/Inspector Signature:SLI Date: `�- ��G~O S 5100

ty Number: — .S Date of Inspection �; G Printed on: 1>*9/2001 ci'li
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 f�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes r }�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 qNo
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 1VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes F�rNo
lAdditional-Conunents,andtor,,Dr-awings= W- 7 , _
5100

�J
1 [ Division of Soil and Water Cveservatrvn Operation Re
view 13 Division of Soil and4ateriConsery
ation _Coniplia ns nee I pection
Division of Water Quality "Coiripliance Inspection
_ — ©-Other Agency,-Uperapon Review.:
_ .._ . - .-
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number (Q ' ] j 5 Date of Inspection f / 14 qg
Time of Inspection I 1,R ; O!I 124 hr. (hh:mm)
JaPermitted CiC/ ertified 13 Conditionally Certified 0
.cRegistered E3 Not O erational Date Last Operated: ` l
Farm Name: ..Y '5rpl!i..._./.Ip<: --...1.iem................................... County:... . S e vk�i.................................V.311. .Q...
......................... .
Owner Name: ..... B.Q&f .V.... W..i.5S10.r4 ........................ Phone No:............ ............ _... _
Facility Contact. ��.!3g..Y.----- 5.!. ............. Title:................................................................ Phone No: ..._...............................................
Mailing Address: ....Z�.�.... �..=...r�.YGc?�2......�D...................... .. �.IGhft_A-tJbS t JG..
OnsiteRepresentative:........................................................................................................... Integrator:.....
Certified Operator:,,,t3eflbd.... WC S r -0 Operator Certification Number: fo Z -S'
Location of Farm:
........ I`i.... ll.!!rE.... �RP..�...i�.TE�SEGTrnnf aF.._/fwY.:z��.........l�n�D... SR...Az35.... iAX... Col. y.... f�U �
-S.s...zpw...LF—ar!r�..t�9...s�..���5 ta,e,`t Q�._.�2T---lp�AA'z" 1�...�24..,:
Latitude F-3q-1 • FTj37` ©.4 Longitude © • 38 ` '°
=_ .. Design Current_ _ Design ."'Current =; Design Current `_
Point Cattle
Swine Ca achy Po ulation i Y.. Capacity Population Capacity Populahon r;.
❑ Wean to Feeder
Feeder to Finish
Z o
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Number:of Lagoons- ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area
Holding Ponds / S61id Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes � No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other '
a. If discharge is observed, was the conveyance man-made? []Yes: ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ?RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IV No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .............................................................................................................................................................................••-....._...................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes gNo
seepage, etc.) `' ��
3/23/99 Continued on back

Im

t
,_ Facility Number: ' — 15 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: i -6WA,64) is:or• d hgenci:es were itgte4 during this:visit: • You wiil r' eeeiye tnti iutiher
..........
coriesp&idenke abauf this visit:::::.: :
❑ Yes jtVNo
❑ Yes XNo
❑ Yes '�Vo
❑ Yes o
❑ Yes �&No
❑ Yes \1"No
❑ Yes RNo
❑ Yes �,KNo
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes NqNo
❑ Yes ONO
❑ Yes �No
❑ Yes VNo
❑ Yes iRrNo
❑ Yes WO
❑ Yes R110
❑ Yes MAON
❑ Yes WO
❑ Yes ;No
❑ Yes '(No
Comments (refer to uestion # ~E lain any YFS answers and/or any recoRiinendati6_&: any other comments: —
q, _ ) _-.
Use,drawings of facility to better gplarn.`situations {use addifianal pages as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: —&hi:, 91�
3/23/99

• � �
e

Fdcility Number: `r— Date of Inspection
•1 Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,I�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 ,�i'�T0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 110
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 ANo
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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? Cl YesXNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes t(&—o
3/23199

i - ; . I . I I , f

Revised ApzU 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 1�-
Farm Name:..- god -
On -Site. Representative:_
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
Annual farm. PAN deficit: JUq pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility itern(s) F1 F2 F3 F4
V Operation not required to secure WA
determination at this time based on
exemption F1 ,E2 (Ur ,E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation Systems) - circle #:g turd -hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; a. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
.z
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP,
E_4 75% rule exemption as verified in Part Ill. (NO T E:75 % exemnption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
cnecklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART If. 75% Rule Z-Iigibility Checklist and .Documentation of WA Determination
Requirements. WA Determination .required because, operation rails -one of the -eligibiiity
requirements listedlelow.
_F1 Lack.of:acr--aoe:whichT--suitedin:over-ppiicafon:Df_wasi-3water�(PAN) owspray-
7ield(s) :2ccordinaio7arm'sdast two yearsmfdrngaiionaemDJs.-.
F2 Unclear,Jllegibfe,--or lack of-information/map.
F3 Obvious--T-jeld-limitatii)ns-(numemus:ditches;failurazo:deductu-equired:ti_.
bufierlsetback:acrcage;-:or25%':oftotalacreageidentifi6-d:ir�--CAWMP::iricludes_
small, irregularly-shaped#ields�fields:less-1han5:acres�r.tmvelers-orJessinan
2 acres-For:stationarysprinklers).
F ^ WA determination required because CAWMP credits - leld(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised Ag'1 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE of TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER'S IRRIGATION ACRES ACRES %
] SYSTEM
{
I
1
FIELD NUMBER'- hydrant, pull, zone, or:point numbers -may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross-morefttan one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination sor exemption, -otherwise operation will be subject to WA determination.
FIELD NUMBEFe-- - must be clearly delineated onTnap.
COMMENTS' - back-up fields with CAWMP acmage_exceeding'75% of its totaf:acras and having received less than 5()%
of i*.s annual PAN as -documented irLthefarm'sprevious_two years' (1 a97 & '1998) of irrigauonTacords,-cannot serve -as -the
sole basisio;- requiring a WA Determ_inarion:�.Back-upfields -must-be-noted in the-commentzectiomandmustbe accessible
by irrigation -system.
Part IV. Pending WA'Determinations -
P1 Plan:Iacks:followinginf ation:
P2 Plan Tevision -may-7.5% rule based on adequate over-all PAN deficit and. by
adjusting -all field :acreage#o-below 75% use -rate _
P3 Other (ielin process of installing new irrigation system):

Lagoon Dike Inspection Report
b
Name of Farm/Facility
Location ofFarm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection / Names of Inspectors
Lbw + ,
Structural Height, Feet Freeboard, Feet
Lagoon Surface Area, Acres —3. Top Width, Feet
Upstream S1ope,xH: IV 2 42:1 Downstream Slope, xH:I V
Embankment Sliding? Yes -No -
(Check One, Describe if Yes)
Seepage? Yes X-- No
(Check One, Describe if Yes)
Erosion? Yes ?C No
(Check One, Describe if Yes) - -
Condition of V'-
el 624�Z-
Vegetative Cover -
(Grass, Trees)
Did Dike Overtop? Yes _� No If Yes, Depth of Overtopping, Feet
Follow Up Inspection Needed? Yes ^ No
Engineering Study Needed? Yes _ C No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

[3 Division of Soil and Water Conservation ❑ Other Agency
` E3 Division of Water Quality �f
f .
10 Routine O Complaint O Follow-up of D«'O inspection O Follow-up of DSWC review~' O Other
Facility Number
EKeeistered (a Certified 0 Applied for Permit Permitted
�,`CM4 rx
Farm Name: 0 YX..'. 1....../..�...........� .. �Oom
Date of Inspection
Time of Inspection 124 hr. (hh:mm)
0 Not Operational Date Last Operated:
County
Owner Name: ...8.26.8..y..... WC�.T_614_1 ..................................... ............... Phone No: /o.. ..a..
Facility Contact: ........t��..fl$: 1.......:.W .r To P.`.'............... Title: ................................................................ Phone No: ........ ............ I..............................
n D �J
114ailingAddress:. .. ......!"i. .... �J....h.D............. l�.�G�l����.r.,N.�...... 6..5 J��,(74................ ..........................
Onsite Representative: ...... Q¢............ Lr�l................. Integratrir:.......... rti9rQt .........................................
Certified Operator:..5 Y.....VJ.a.`..L...........................:..........................I...... Operator Certification Number, ...... 1.Z6? .........
[vocation of Farm: 0 F COV 4.4- 0► ZW
.. ......................................................................................... .. ...... ...
Latitude ®•=1'="
Design c Curi
u S�vitie'Capacity Poptil:
❑ Wean to Feeder
[KFeeder to Finish
- 15d0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1'. Are there any buffers that need maintenance/improvement? ❑ Yes P,No
2. Is any discharge observed from any part of the operation? ❑ Yes I�INo
Discharge originated at: [:]Lagoon* ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what`is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
RNo
❑ Yes
RN0
❑ Yes
K10
❑ Yes
No
0 Yes
No
Continued
on back

s,•
Facility Number:
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures (Lagoon0folding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
Cl Yes No
❑ Yes ❑ No
Structure 5 Structure G
Identifier:
Freeboard(fU .........5....................................................................................................................................
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type 1CO2e1 605r 14-4,W �.....1!v!�E'4T �...�o.V s...p....TD�ACo...
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
23. Wer ny addtrtonat promems noted wntcn cause noncompuance or the Permit:
No.violations or deficienCie's were note'd-during' this.'visit. - .You.will receive no further
eorrespandence Ei out this:visit:
❑ Yes N0
❑ Yes NINO
Yes ❑ No
❑ Yes �10
❑ Yes'.
❑ Yes Wo
❑ Yes 1KNo
❑ Yes ONO
❑ Yes RNIo
❑ Yes Rt `o
Cl Yes �`o
❑ Yes *0
Cl Yes I'No
❑ Yes �&No
❑ Yes j<No
Comments€(refer to question #) `:Expiaitt any ES answers and/or any recommendations or any other eomments
Use $rawrngs of #acttify. to better explain situations, (use additional pages as necessary) _ E
f- -
i{Z, AL�.-d i o Mo%,r Lns tom.: AA-5 a-c [as y
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
Q "

Spa
;� ❑DSWC Anlmal Feedlot O erat oa Review ;�
P �
®DW Animal FeedlotOperatian 51te'InspectlonM ;z
10 Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Date of Inspection !0 1
Facility Number Time of InspectionEL�E]24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted I or Ins ection includes travel andprocessing)
❑ Not Operational Date Last Operated: .. ... — ... _ ..........��.. ...... ...__.... .... ..........
Farm h'anne:...... �r"i_ .....'(2..............._..........---............ County: ... »....
Qln..fa,,..l��...»......._._.... __.........._ .
Land Owner Name:..W...�D� ... _. 5 __. Phone
Facility Conctact:. .k¢ --V.A _. itle: Q �'` Phone No: Z •3 5�13 37�7
Mailing Address: Zg �?...,�.: .."L�.! al�....R .... _._.....-........ ....._ .... ' .1. e�
Onsite Representative: h h w+'". Integrator: edL�.v� t. _ ......_...... ....__.
2....._....... _...`� .....__._.._ _ .....
Certified Operator: T>�? w �" ' 'J Operator Certification Number: t.*0 5
.f....»......_........»»........ ....... ....._....._ .. __.... ..... ..
Location of Farm: 1
Latitude S 4 J5 Longitude
Tvae of Operation and Design Capacity
s Design Ctirrent `, �I?esignj� Cnn enter x!`D ign x Current
Swine ,� Ca aci Po elation -Ca' aci Po a ation� Cii aci Po ulahon
,_.. :; , �t Poul Cattle
❑Wean to Feeder , �❑ ❑ Dairy
Feeder to Finish is ❑ Non La er42 ❑ Non Da
. f
El Farrow to Wean">
10 Farrow to Feeder Tt)tai Des><gn Capacity , a`�
Farrow to Finish tk
»TotaItSSLWk ,�x
E� �<
gq
NU%%ffmber of Lagoons /Holding Ponds
❑ Subsurface Drains Present
❑ Lagoon Area, ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ig-No'
2. 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 [j'No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EM
c. If discharge is observed, what is the estimated flow in gal/irun?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑.N'0�
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0--90
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes UNO
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 1;K0
4/30/97 maintenance/improvement? Continued on back
2i `:�4o -

Facility Number:... -I......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Q-No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [}Igo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [TNo
Structures Lagoons at}d/or Holding fonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ErNo
Freeboard (ft): Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
». ..... ...... . .... ---- ._ .... ............................ .......... ....._ .... ...... .... .....
10. Is seepage observed from any of the structures? ❑ Yes QNo
I I. Is erosion, or any other threats to the integrity of any of the structures observed? B<s ❑ No
12. Do any of the structures need maintenance/improvement? B'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 O-To
Waste Application
14. Is there physical evidence of over application? ❑ Yes Duo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type (,.lz.1. ..... ......... ........... ... �,1:.. :...- ....................... 5'.. I� !! ........ ........ TO ';A A ce- o......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Mo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes B'Ro
18. Does the receiving crop need improvement? ❑ Yes B'No
19. Is there a lack of available waste application equipment? ❑ Yes 19'No
20. Does facility require a follow-up visit by same agency? ❑ Yes M-No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Ewo
1grS�rtifed Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes &NO
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes allo
24. Does record keeping need improvement? O- Yes ❑ No
Comments (refer to ques on ExpWri any YES'answers andlor,gpy rccammendatzons or any other comments: s r
Use drawings of facihty to'lietter explain situations.` (use additional pages as necessary}
et'C.0r-•9-5 -I c "C e^c. k .. vS e__c., - . M �2, 4
L
Reviewer/Inspector Name
Reviewer/Inspector Signature:
I -
Date:-7L—"
y
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECOM
DATE: a I995
Time:
4��
Farm Name/Owner...
Mailing Address: _
County: Op 5 L
1IJE57-0a% iVO,-S —
.M
Integrator.
On Site Re resentsve: G-0I
A,D +7*Us 6n d_ig IZ7 � t
Prhysical Address/Locanonff:.�/,
de LA;-tf
Type of Operation, Swine 1
Design Capacity: 3 G
DEM Certifcaaon Number: At
Latitude: '3 SZ 170
Does the Animal Waste Lagoon hi
(approximately I Foot } 7 incises)
• Was any seepage observed from ti
Is adequate land available for spra
Crop(s) being utilized:}
Does the fatuity meet SCS minion
Is the animal waste stockpiled wit
Is animal waste land applied or sp:
Is animal waste discharged into w;
Similar manmade devices? Y
Does the facility maintain adequat
spray irrigated on specific acre
Additional Comments:
Inspector Name
cc: Faciliry Assessment Unit
LTO'39Jd
Phone:
o r, Phone: q i J 3 a4 = /
toe' R- %u... t'p' 470 GtirT �:
Poultry Cattle
Number of Animals on -Site: 3-
DEM Certification Number: ACNEW
Longitude: 77 - 3? ' US-?" Elevation: -_ � Feet
Circle Yes or No
e sufficient freeboard of 1 Foot + 25 year 24 hour storm event
f No Actual Freeboard: cP- Ft- Inches
lagoon(s)? Yes o`aWas any erasion observed? Yes o
! e`s r No Is the cover crop adequate Or Na
I3 5eibaL'1£ CritCria? 200 Feet from- DWC1l1It2s7 -
�IOr .No `
100 Feet from Wells? ,�e or No
a 100 Feet of USGS Blue Line Stream? Yes or ,, .
y irrigated within 25 Feet of a USGS Map Blue Line? Yes o is
,rs of the state by mast -made ditch, flushing system, or other
or No If Yes, Please Explain.
waste management records (volumes of manure, land applied,
ie with cover crop)? Yes yr -
.I
At Ir JL
SiaT1ature
Use Attachments if Nceded_
=:�hJ 311di111i�'=`i� ! HH3 110d3 S T SG 4 CqnH

OPERATIONS BRANCH - WO Fax:[phone] Jul 24 '96 18:07 P.14/18
Site Requires immediate Attention elo
U
•
•
Facility Number: G 7- / s-
SITE VISITATION RECORD
DATE: _ r4�x - 1995
Owner: 43inld k ��tr ti p w Farrn Name: OVI x,75 1v
County: 0rvrA,9W - -
Agent Visiting Site: _ 1 -Phone: _( ��L sr VkPA
Operator: _ •Bv ja yt�. i o-•� _ _ Phone: •
On Site Representative: &!�4.d k_tv:t lTd.v _ Phone:
Physical Address: A10-11 iv i=•r a ri' s4r iY -n',f -4- , s'
Mailing Address:
Type of Operation: Swine ✓
Design Capacity: J.' ZA
Latitude: 0. t
' "
Type of Inspection: Ground
Poultry Cattle
Number of Animals on Site: ?s Z
Longitude: 0 "
Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot +8 inches) (a or No Actual Freeboard: 7- Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed frorn the lagoon(s)? Yes ok�Vas there erosion of the dam?:<Or No
:e Is adequate Iand available for land application? r No Is the cover crop adequate? es)5r No
Additional Comments: _Cevtov 4,9.4od
Fax to [phone]
Si2i lure of Axat