670019_INSPECTIONS_20171231

Z V
NUH I H UAHULI NA
Department of Environmental Qual

Type of Visit: 0 Co
ance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I Arrival Time: Departure Time: IT= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ?`c-yj co-Ixt C.HA5e Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 66
Certification Number:
Longitude:
Wean to Finish
I
I Layer
I
I Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
ti
Q
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , Poultr,
Ca aci_ Plo ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
,Other
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 DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Fdcili Number: Date of Inspection:
`Waste Collection & Treatment
4 'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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 �NoD ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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
D NA
❑ NE
15. Does the receiving crop and/or Iand application site need improvement?
❑ Yes
Fyo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
jNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Ficili Number: jDate of inspection: /1 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
MA f.;❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes LL]o El NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [;3/No ❑ NA ❑ NE
❑ Yes
❑ Yes
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
dPNo
NA
NE
❑
❑
No
❑ NA
❑ NE
V❑
NA
❑ NE
❑ NA
❑ NE
�No
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or any:4ther comments.',,'.",,
Use drawings of facility tobetier explain situations (use „additional pages'as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone ID 1 1 b J J V b
Date: I t
/4 015

(Type of Visit: U Coglpliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: L Ir I Arrival Time: Departure Time: County: dNI"IA) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: L3ILQ'i m Cuf)5C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 2 too
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Desigu Current
Wet Poultry Capacity Pap.
[Layer
C►attle
DairyCow
Design Current
Capacity Pop_
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P■■©ul Ca aci P,o ,
Cow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o ❑ NA ❑ NE
[:]Yes �No
o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of ins ection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I
Z��j
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): iA
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ,/ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require [::]Yes hio
❑ 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 Z
❑ 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
Zo
❑ 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
U<O
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
q401
❑ 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 El Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes WNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

+ Facili Number: - Date of Ins ection- f j
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
VNo❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
g'Na ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[34o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[/ ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
EZ"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
dNo ❑ 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 o ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations:or any'otber comments.
Use drawinus of facility to better explain situations (use additional Dap -es as necessarv).
CE rN (ta 12'i'v ol U)a h , S6r4 9 Ga f 1 A P61-/ W 11 f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l� Phonk R10 16 -:7319
o,&J"V Date: 1 (1, // s
14 014

Type of Visit: (y Cpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time:. bo o Departure Time: County:0/l1,JL,0A ✓ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: 9'ci. )oq c4yi se'_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2dj dD
Certification Number:
Longitude:
�MlgesiQJLU.-urrent Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
-
Non -La er
Design Current
P,oul.aci P,o
Layers
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[::]Yes ❑ ❑ NA ❑ NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes E,C_I No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili'Number: - Date of Inspection: 2
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
�1L! Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes �No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ 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 reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E
❑ 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):
l4. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes jVNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 1a
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [ o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ 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 L aZo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection: Iq
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �No
°NA ❑ NE
25. Is'the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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:
2b. 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. /
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
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?
❑ Yes [-No ❑ NA ❑ NE
❑ Yes �o
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [;YNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
N j C,- e-gNT� f,- �U�' SST AL t--GAP 2-5 ��,6t �D ,
9(--- Sua-C— -Flo PACE f4_W WUQ ?L,�F�W6- ,
ReviewerlInspector Name: t 114 k1 _
Reviewer/Inspector Signature:
Page 3 of 3
Phonq 0 / f�
Date:
2/4/2 ll

(Type of Visit: 0 zRoutine
Hance Inspection U Operation Review U Structure Evaluation Q Technical AssistanceReason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:op Arrival Time: ® Departure Time: © County: 6A%Si;.a IA/
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: CNASCS Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
2q800
Design -luir. en 11Design Current
Swine Capacity Pop- Wet Poultry-apacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
X
Feeder to Finish
Farrow to Wean
Farrow to Feeder
35
Design Q-ffr e
I) P.oult . C•.a aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
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 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 ❑ No ❑ NA ❑ NE
❑ Yes [,� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: f 'f - ! Date of inspection: [( 3
Waste Collection & Treatment
'--4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? —] YesEn No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure j Structure 2 Structure 3 Structure 4
L=6N
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen al 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 R No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes [/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 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
[A o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[-]Yes
f-Mo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Zo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

9
IFaciM Number: -Iq jDate of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ENo ❑ NA ❑ NE
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 6 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E�rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fjflo ❑ 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 the 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 [fNo ❑ NA ❑ NE
[—]Yes [/No [DNA ❑ NE
❑ Yes E24o ❑ NA ❑ NE
❑ Yes 0N ❑ NA ❑ NE
Yes
[No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or°any other'comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
19' �kE6Q6A&V ,n! 2A rz . 1�-P6w:T 16 W�7L_ R6 W�LTJA 21 2S.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -:23660
b
Date: q A 13
2/4 OI

Type of Visit: (J ReaZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
son for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t I Z Arrival Time: Departure Time: County: 61 kohl Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 3 Rkr1 QA C�HgSC Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: .10),(41_'dD
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►opacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
'ZA
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,oult F Ca aci P,o
Layers
Non -Dairy
Beef Stocker
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
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
❑
❑ NA
❑ WE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaciliNumber: - Date of Inspection: 3 t iZ
A
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
l�
2A
No ❑ NA ❑ NE
[3 No ❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes i4o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/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
,ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D I es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� 1V
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNoo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jNoo
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 El 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 o ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes �YN0 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: 311 Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7No
❑ NA [3 NE
25�: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[ ] Yes
VNo
❑ 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
� N
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Np
❑ NA
❑ NE
33. Did the Revicwer/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
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or, any additional recommendations or any other comments
Use.drawings of facility to better explain situations (use additional pages as necessary)..,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1
Date: ?�
2/4i2011

leffily, Numtier�
O;Division of Soil and`Water Conservation, `+
_
Other Agency -w .: .
Type of Visit dcoApliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:otj Arrival Time: l d d Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: BuN.pA CHASE Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c = ` = " Longitude: 0 ° "
=
n tDes� ri C DesiI; Curren
g .
urrent - ..3 Desi n Current
= g
Swine
Capae�ty�Population �;Wet Poultry Capacit}h Population: Cattle 7Capacity
,,,
Population
.
e
�, ❑ Layer
El Dairy Cow
❑ Non -Layer
El Dairy Calf
" ," " . El Dairy Heifer
❑ D Cow
WDry Poultryw=
„. r ; ..:_..,: ',, ElNon-Dairy
ElLayers
3 ❑ Beef Stocker
ElNon-Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cow
ElTurke s
❑ Turkey
❑ Other
Poults
❑Other
Numher of Structures
a
❑ Wean to Finish
�
Wean to Feeder
Feeder to Finish
��
9D
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E� No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes ❑ NN
❑ Yes o
❑ NA
El NE
El Yes YNo
❑ NA
❑ NE
12128104 Condnued

Facility Number: Date of Inspection !i
Waste Collection -& Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S�e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAW
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.) JNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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 rest, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ElYes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ld 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
o ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
to ❑ 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
o ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
"Comments (refer to question # Ex lain' an YES answers aiidlorin recommendati - ` '
9 )• P Y y ons or anyather comments«
Use drawings of facility to better explain situations (use additional pages as necessary)
Reviewer/ins ector Name � " w _
P d - ►Q'(l�;/C-� `. - Phone: 10
Reviewer/Inspector Signature Q42_jAA1VW1 Date: 9
'ape 2 of
I2128104 ' Continued

Facility Number: — Date of Inspection q
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 El Maps [I 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 ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
EJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
wx 0
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
-❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
El Yes
[I No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�,�
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�`Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:.'"
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit ("Compliance Inspection. 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit td Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r0 Arrival Time: Departure Time: County: OWL, L 61^L Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Q 9_— OA GNA SC Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number -
Back -up Certification Number:
Latitude: 0 0 [= i=« Longitude: = OFT � "
Design
Swine Capacity
Current Design
Population Wet Poultry Capacity
Current
Population
Design Current
Cattle Capacity Populati on
to Finish
❑ La er
DairyCow
[3der
Fan
an to Feeder
❑Non -La er
El Dairy Calf
to Finish 3SZO
El Farrow to Wean Dry Poultry
El Farrow to Feeder
El Farrow to Finish ❑ Layers
Gilts ❑Non -La Non -Layers
❑ Pullets
EBoars
El Turkeys
Other ❑ Turkey Poults
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Other ❑ Other
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes W
❑ NA
❑ NE
❑ Yes �Z40
❑ NA
❑ NE
Page l of 3 12128104 Continued

acility Number: Date of Inspection O
• aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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 CYVO J
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes . L7 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 0 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 OlNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �f
9. Does any part of the waste management system other than the waste structures require El Yes L7 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
[INA
[-INE
15. Does the receiving crop and/or land application site need improvement?
ElYes
LI No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[)/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0�, o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
0o
❑ NA
❑ NE
Comments;{refer'to question'#) Explain any YES answers and/or any recaminendations or'any other co meats ­' x
.... r
s Nonal pages -as -necessary):,.
Use drawings of facility;fo betterexplainsituations (use addttt
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: S
Page 2 of 3 12128104

r
Facility Number: �j"� — Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2(No ❑ NA ❑'NE
the appropriate box.
❑ WUP El Checklists ❑Design '• El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D 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
eNo
❑ 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
L2/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
yo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
rj No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector.fail to discuss review/inspection with an on -site representative?
❑ Yes
NZo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
L'I'N0
❑ NA
❑ NE
Additional Comments and/or Drawings:: a
Page 3 of 3 12/28/04

617
Type of Visit IC—Lpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: a9 Arrival Time: ® Departure Time: County: owk4j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q 42*" DA 04A5(o
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0 ' = « Longitude: [= o [= 6 = «
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
Current
Population
I
Design Current
Cattle Capacity Population
❑ Wean to Finish
Io Layer I❑
Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ D iry Calf
® Feeder to Finish 2.b
50
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dty Poultry
El Layers
❑Non -La Non -Layers
❑ Dry Cow
ElNon-Dairy
El Farrow to Finish
El Gilts
El Beef Stocker
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Turkeys
Other ❑Turke Poults
❑ Other Other
❑ Beef Brood Co
Number pf Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[I Yes MNo El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
o
ElYes
go
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: '] — j rj Date of Inspection 3 of
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: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
CNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
Rf/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
0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
En 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? Cl Yes [2/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 W-N o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18, is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
sLVOUe rZkVA vE.V 2,01 4 c.""'"j S-L+
Reviewer/Inspector Name o wj �aa c u_ Phone:
Reviewer/Inspector Signature: Date: 2 o
Pnan 2 of 1 12128104 Continued

• Facility Number: Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U(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
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
26 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
XNjo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YN o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[; No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
{�(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[]Yes
Cf 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
nNo
❑ 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
o
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
YNo
❑ NA
❑ NE
Additional Comments and/or Drawings: .
Page 3 of 3 12128104

I
Type of Visit (3 rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0AK"a1 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: e R.E-J SDP, CAASC Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = n ❑ I E__1 fl Longitude: = o = 4
�--@-
Swine Capacity
urrent Design Current Design Current
Population Wet Poultry Capacity Population Cattle C**opacity Population
10 Layer ❑ Dairy Cow
❑ Non -Layer ❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
S2o
3000 ❑ Dairy Heifer
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry El Dry Cow
El Non -Dairy
❑ La ers
El Beef Stocker
❑ Non -Layers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
J❑ Other Number of Structures:
Discharges & Stream Im acts
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 Q(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — j°j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
StructurejI Structure 2 Structure 3 Structure 4
Identifier: t A Cry
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 LJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 6 VNo
El NA ❑ NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 1� 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 W/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� N ❑ NA ❑ NE
maintenance/improvement?7
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LI ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Corumentst(refk r to_q es05d1 Egpla ,any YES answers and/or any recommendafions or any other comments.
F
�Use,drawmgs'of ficiliiy to betteVexplarn�s�tvatioris (use -additions[ pages as "necessary):
ReviewerlInspector Name �� Phone:( - /3
ReviewertInspector Signature: Date: yj D
/ -5. L Vf J 1 V/ VY-1...... . M

Facility Number: — p Date of Inspection e
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No
El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps gp ElOther
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 ;/No El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ N El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El
❑ NA El
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �7�NNO❑NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ,LEI No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1,�� NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
L� 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
.� 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��/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�/No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additi6nal Comments and/or Drawings:.
Page 3 of 3 12128104

S
Type of Visit ,C_,/omplionce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ly Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i 4 Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: Q46&C Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = [= A Longitude: 0 ° 0 ` =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I I
❑ Dairy Calf
® Feeder to Finish ST ZA 6
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
10Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
10 Other
Plumtrer of Structures:
Disci & 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
[I NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

1.
Facility Number: (o) — j °j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /X0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (, ffU
Spillway?: c _
Designed Freeboard (in): 1 ' S
Observed Freeboard (in): 9L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of.facility to better explain situations..(use additional pages as,necessary): ;
al) IVyvS NAVC_ sPz r
!.J.jtjDouCRL'L_.
a qcA L-1,0p �
tN a� orals A>J o 5Er-mac- 4�
pW �.
Reviewer/Inspector Name
Phone: ro _ 7
Reviewer/Inspector Signature:
Date: 3 0
Page 2 of 3 12128104 Continued

�j Facility Number: (� — Date of Inspection URtEj
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 El Other
21. D�oreecord keeping need improvement? If yes, check the appropriate box below.
aste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes VNo ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ 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 L < ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L_f<o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
Yes ❑ No
❑ Yes -dNo
❑ Yes LE]� N`o.
❑ Yes LI No
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
E3'No
❑ NA
❑ NE
❑ Yes
YJ No
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
ETNo,
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
YJ Division' of Water Quality - F`
0 Division of Soil and Water Conservation��
0 Other Agency
r
f Visit CCo�mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit -V-Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 900 Departure Time: County: Awtgox! Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AwAL.O Chris Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = ` = Longitude: = o "
Desi n
g
Current"
Design Current
Design Cprrent.k,
t, wine..Capacity
Population Wet Poultry
Capacity Populatioq> "."Cattle ` +
`Capacity Population
�: ..
❑ Layer
a ❑Dai Cow
El Wean to Feeder
�'- ❑ Non -Layer
= ❑ Da Calf
—
❑ Da Heifer
;
Dry Poultry'
❑ D Cow
El Non -Dairy
El Farrow to Finish
El Beef Stocker
i" Beef Feeder
El
Boars
El Layers
El Non -Layers
El Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
0 No
El NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
[I Yes
❑ No
El NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
[I No
El 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
[I No
El NA
El NE
2, Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,�o
(�No
❑ NA
El NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: Tj —/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;�TNo ❑ 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: '�A(jar,A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes E 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 [�o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Vo ❑ 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D/No ❑ NA ❑ NE
mai ntenancelimprovement?
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 l0 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) r f ? BN S6y
13, Soil type(s) retcf'cfu W." =W& -r. S 7A U-X-&� /
14, Do the receiving crops differ from those designated in the CAWMP? El Yes B 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 QNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [4o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 12No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
Z/,) MdST /'vr►�P z nl SAP j,�DJ�?cs+� APPG� C A T..E�rj 3 R. S&O &--WCT O c- APPf
try r11G- Ye -A . Cl�l�i�l6-6 Qt1E12 F*Ajr-1 0AIE )9AN PA7� (A16 OPLA. AFfZZCAA0
d+r RECO&W V4,4r-.Y r"M %Lkr, I ro allLY 31 Frei- Ckop
IReviewer/Inspector Name I T44w/Phone: (�110) % l (, .-
Reviewer/Inspector Signature: '- ,, , Date: C. %(,4 L
. ".S . j �

e
k-
IIFacility Number: Date of Inspection G p
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 El Checklists [I Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
IQ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑Yes wj'� ❑NA El NE
❑ Yes 7N. ❑ NA ❑ NE
Ia Yes ❑ No ❑ NA ❑ NE
❑ 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
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
O/No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
E Yfes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2fNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[" No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Cl/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U3 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
,�
L! No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L✓J 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,,��1�10
//
ER/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
241.J p CA,.,j r 1?E Q ja4k.(_S Y CAtL1.Y CA t,.VSRA7�a+✓ o f 4"K=,ArZ4t,l SOUZlor-6 t-
IwAw v ))Ac rj C_AfE SCN p GvPy -'o 1) jj4p SAP teargv✓ 3° CWV S
( _DV SPF
Page 3 of 3 12128104

Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: I ZO b Departure Time: County: 6/AMW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ndkp L H AS£
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 4 0 « Longitude: = o = & 0 1i
IrDesign,
. Current
Popula�tian�
Design Current
Wet Poaltiy Capaciiy' Population
Design C'pacity
'° Cattle �Capactty Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La et
Dry Poultry
Y
❑ Dairy Calf
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
® Feeder to Finish
1 35-Lb
1 3
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
❑ Gilts
❑ Boars
EllOther
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
JNo
❑ 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 D WQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
C3 No
[INA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Q—
Date of Inspection '!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: CA 6100 !
Spillway?: q
Designed Freeboard (in): r
Observed Freeboard (in): !i !-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ! No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes T-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 L,d No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEl Evidence of Wind Drifl /❑f { \Application Outside of Area
12. Crop type(s) I &S GL1 (1 �Jl 0E��yo-A 1 f � 1 &O _ --
13. Soil type(s) Gi6oci STAu_. &J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNQ
(El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ElYes I�i❑ NA ❑ NE
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 rNo ❑ NA ❑ NE
@omments (referto question#)Eaplam'anyYESyanswers,andJoranyArecommendatsons or any ather comments:
:Q4f Y k y..:n i•- )-i xi_3y l #�-- �`"` i' Y J�"�'.Y 3y .gYy. - -
tUse drawtngsaf facel�ty totbetter explatntsituahons {useFaddthonal pages as necessary}:
f �4-.� :`J• T� ts' Y,a.� �. +� .a � .n,�a< a � � . X:` ' s�>:'.`:S:E:�-•.:... _ �:.
FA P-JA
Reviewer/Inspector Name (j ` Phone: 9!0 — Jt�b x ZZy
Reviewer/Inspector Signature: A4 Date:
12128104 Continued

Facility Number: Date of Inspection 1
Re uiy-.,d Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI No ❑ 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.
❑ Yes
V 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
U(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
YNo
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
EYNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
EAo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [,-2,<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LEI 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
��
LI 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
LJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
114
❑ NA
❑ NE
Additional Comments and/or Drawings: -77
12128104

Type of Visit jo Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
A Permitted [3 Certified `© Conditionally Certified [3 Registered
Farm Name: ..... 11i.l...... _ _ ._.._...__... _..
Owner Name: ............ 4QC✓ +�............ . �----------
------
Mailing Address:
�--_vEv 0 Time:
Q Not Operational C Below Threshold
Date Last Operated or Above Threshold: .r W
County:
Phone No: ...........
W .�
Facility- Contact: Title:.. _. ._ .. P one No:
Onsite Representative: � ... Integrator:
Certified Operator: .. . ......... . .. WW ........ ........_.. _.. _......_..........._ ......... Operator Certification Number: ......... ......... _....
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude • 4 "
r
v)(r n CIIrrC[It ' De��I13 = Ct1r1C11t �)€3ieS�p wCnrrent
Swute zCa
LL
Watio�n Poultry nlatton Cattle ulatiion
aci
.eft _,Ca �;Po r Ca ap "Po
Wean to Feeder
[l Layer ❑Dairy
Feeder to Finish
❑ Non -Layer ❑Non -Dairy I-
Farrow to Wean
Farrow to Feeder
Other
-'C F `fig`' _"�--•- r _ 1
Farrow to Finish
F �
Oital \(.�r�yQE a�• yE
Gilts
6
Boars
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ZNo
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 gallmin?
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 12f o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P?<o
Structure I Structure 2 �N Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... _...,.._ ....... __ .. .. .. .
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
040
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
J20NO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes .'rTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
PoNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
❑ Yes
�^o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those de ' ated in the Certified Animal Waste Management Plan {CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[30No
b) Does the facility need a wettable acre determination?
❑ Yes
dNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ONo
15. Does the receiving crop need improvement?
❑ Yes
P1�0
16. Is there a lack of adequate waste application equipment?
❑ Yes
j2fio
Odor Issues Zr
No
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [I Yes Z1 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Rio
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �1Go
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 moo
Air Quality representative immediately. ✓❑
.Comments {refer to gamest boi #) , Uip, '_Y ariy YES answer's and/or any recommeadatrons or'aey o_meir comments.
:Use drawmngs of famuimty to better explain s�tuationsr{use additmonal pag s as necessary)• Final Not
n F� - s
❑ Field Copy
7 116d re G1je we-e Ca�1ro s` _ - a •
o ✓' apt/ it �
wQll
Ae77Nek&-- e57161 hay
H,
Reviewer/Inspector Name
ReviewerAnspector Signature: Date:
11/.U/(!3 Conanuea

Facility Number: R= Date of Inspection
R.ebuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;R'No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLiP, checklists, design, maps, etc.)
❑ Yes
L2'No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,0'No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
;kNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
jallo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,014o
28. Does facility require a follow-up visit by same agency?
❑ Yes
Ofio
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ER No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑Ies
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1200
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
Eno
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
EfNo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
PIN, 0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Peco.lvS ,-qv-1rlevel_111.
o ool sAe weld Qiy i� �
w
12112103

Type of Visit -0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 3 Time: ,�{=
Facility Number
rQNot Operational 0 Below Threshold
0 Permitted 0 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 1ti�2 �A A County:
Owner Name: O V.C, Phone No:
Mailing Address:
Facility Contact: J /I Title:
Onsite Representative: _/�'")_�t a-410I C ko"Se _
Certified Operator:
Location of Farm:
Phone No:
Integrator: M V Wh^
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ` 4
S_wi©e
Design
Ca aci
C*urrent
P,o ulation P©ultty
Design Current Design Current
Ca aci I'o ulation Catt[e Ca aci P,o ulation
❑ Wean to Feeder
La er
E[3 Non -Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area
..--....__................_...._...--------�_._.— ..—
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
❑ Spray Field Area
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches):
❑ Yes Yl 0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes,,E5 No
❑ Yes No
❑ Yes `eNo
Structure b
05103101 Continued

Facility Number: r% — Date of Inspection 3 Q
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 anv of the structures need maintenancefimprovement?
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?
❑ Yes VNO
❑ Yes ;?rNo
❑ Yes ZNo
❑ Yes ��O
❑ Yes ,ZNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes .ETNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ErNo
12_ Crop type Rer et o e(A HIPkS►-1.4 C�q !rl Fe<e- U'Q n S v/'e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIb'MP)? ❑ Yes O-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNo
b) Does the facility need a wettable acre determination? ❑ Yes _,PI�o
c) This facility is pended for a wettable acre determination? ❑ Yes 9NO
15. Does the receiving crop need improvement? ❑ Yes_,FzrNo
16. is there a lack of adequate waste application equipment? ❑ Yes�IZNo
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.) ❑ Yes , o
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports) ,12(Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes "R$lo
22. Fail to notify- regional DWQ of emergency situations as required by General Permit?
(ie.1 discharge. freeboard problems. over application) ❑Yes p,No
23. Did Reviewer,'Inspector fail to discuss review inspection with on -site representative? ❑ Yes .PTlo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? XYes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no farther correspondence abotii tkis visit.
-
Comments (refer to questioti s''Eiplaw';sity YES snswe andfor sny recommeniiattons: or anv other.commentk c ­ 4s
Use drawings of facility to better explain stttiatimm.(use add:donal pages its geressary) tl ❑Field Cotsv ❑Final Notes
_ s -_ -
t
1S Well ke f4-. —7—he b6r--1Vd1'AWeSCLA0 A►1O4
5.-►-�a�� �ra�►-► e^�ra ark w�l� �cc�il►'Jlied. �hC� IA-f)ee i ow��
, S vexMet,,
q e Well Met. rl � c_ vied , Dve� Gr p - {1�P retards a ✓r h ¢a4! y ke f4 ,
;-1 no x&1e 4e -'a►y/Q a►gal-rsis dot fed W;44%:n 6o deu73 cf'
a►�jv : r,44 •GtiL EVe44r 4kSU4 44GVr-4•eaj 0,-, �gn ld�(�� b�1J� 26d3,
Reviewer/Inspector Name = 9 _ JrQ�"
Reviewer/Inspector Signature: Date: 3 / 7 0-7
05103101 Continued

Facility Number: 62 —[ Date of Inspection I D3
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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.)
3 L 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 ZNo
❑ Yes )2Mo
❑ Yes f allo
❑ Yes,)21"No
❑ Yes ❑ No
Additional C66inentitand/or'Dea{wmgs `.-
13 e .sv to 4e have at inlet-s- e 5A,1101e da4en( c.. 'A,,tn
(06 do-TS o -{F'1/1 0.jri�J G(1'.�ip+'1 eveAl'b" �2�'l[.�Lir�C yo'q T4 e
ra r�Pl e s eve" I 1,0 1'tIQ
<- !7 `S a, -Jhe ee 15 %tQ S►vlQ�� C;f rct1^- C✓�
Pl An-� c 6t Orr, r, e 64 q o,�, A PLrfl Ca i ons 4o -1kt y 1^Tetd
o v1 Z,zt e 1 *,, Nov. ! ql 2pO L , � d oar zany 3 Qt., N a✓ • �ta�211� 2 .
M . EAh e ys -�kQ y �e Lam e old a� k--
let, jjet.eve,r1 �V�1'4t l � ^'✓t A
o ee --t -fie be pl4p4ad ' -1 -� h: s �; lai as c.✓e l7 at F-eld 5 a cC O"-d 1k119
40 S rrw 11 n 1, -}moo y'ON d e-A c 114 r n - e I-K WOLS �la�t � Allo r be s 01-e 4a
h 6-1 ec pe 1 y wet.4e o h q. -Pe I d Uh le" -4L1 e a fF Gr ; o S a/ne W 1 i;,-t
Ae 4,0vi e -rAome v✓)-}L, 4tne p,,e�ve� c�-m�o�o recet►rc
.�lqe a�ao-1 C a-�af vP¢ake :� -
1 A1-ce, -ht �,.1a� �ta� Gjlalws r�^ate more -#Lw, /bS ay,..
� '-f e s >". a 11 � ✓' a Iri', �B lit YtQ � � 'T � PCB S l/ /'� -�p sp / yr- -�'2l f
Wf r' Ca- �vr. w }, Idw w1 rzp ylo�� - t�t� 5� jI�7S �1t e)-�Y1C✓'
�Fr=,Q SE' -� • j5—06fobee w ["ddw
✓� a r G � � � -let0 t.,/ t,�., �'� Yt o re-t0 r'P C.-r � ��P Fe b f � a �.� -
4e bna- W'r-40ws , CV -1/1�
p�iY}� O-Ve►-41 i - P� ' A re-k- 1'5 well
so, s �l� ra;� w.11 be
05103101

(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 67 19 pate of Visit: 111 non ime: 14:2D
Q Not Operational Q Below Threshold
® Permitted ® Certified U Conditionally Certified 0 Registered Date Last Operated or Above Threshold:.........................
Farm Name: Clxase.Fa.T.m................................ .. County: 0mlow .............................................. WIRO.........
Owner Name: Djould.................................... Chas .. Phone No: 91.0-298.-4944..(M.29&5234..(.W)
Mailing Address: 111Q(.SQuI>*.lY.� 1� ...............
Facility Contact: .............................................................................. Title:..
cbinquapi n...lYG-------------------------------------------------- 2852.1------........
Phone No:
Onsite Representative: Doxiald.CUse............................................................................. Integrator: Uurp y..Br.Q7:1jL...............:....................................
Certified Operator: DQjUWd.Brj8R..................... CjhA$.0 ................................................ Operator Certification Number:152,29
.............................
Location of Farm:
South of Albert Ellis Airport. At end of SR 1210 (Futrell Rd.) on West side, 13 miles East of SR 1209.
® Shrine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 •F 48 ' 12 Longitude 77 • 38 48
Design Current Design Current Design
Swine Capacity Population,Poultry Ca aci Po ulation Cattle Ca aci
❑ Wean to Feeder
® Feeder to Finish
3520
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 3,520
Total SSLW 4751200
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? r ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes []No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........I ................ ................................... .................................... ................................... ......................................................................
Freeboard (inches): 36
05103101 Continued

Facilit4Number: 67 —19
Date of Inspection 11/7/2002
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 Coastal Bermuda (Hay) Fescue (Graze) Small Grain Overseed
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired 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 ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
;,. Y4' ,. r:'tl4 .. },;,,:,�-, a��[ 3t .. --z.t: :des €it 3 - gidU -eaten "Notes—
{referi�to gyestion #) E plain any_YES answ;e�andlor any recan� ndattuns or any atlier commentsUseidrawmgs of facility io better ex- li insituations (use�additional pages asnecessaryj:
,
❑FieldCopy ❑Finalu;%�i
RComments
p �[$ a, 3 €
�L:f�� 3§< } .$} k,o` 'S:. -{ a n.
This farm is very well kept. The swine house area and lagoon are neatly manicured. The fescue, bermuda, and small grain crop are well
intained and well established. The records are well kept also. Please be sure to use a waste analyis dated within 60 days of the
application events to calculate the nitrogen applied on the IRR-2's. Your efforts to maintain this farm in good order are evident and
appreciated.
Reviewer/Inspector Name Stonewall`Mathis
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 67-19 Date of inspection 1 11/7/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [:]-No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the aninlils feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
:A itiona . ommentslan or DrawingS ? '`
05103101

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: i! ? 1 7102- Time: 7U
10 Not Operational Q Below Threshold
0 Permitted �- ❑ C//e++rtified Q//--C��onditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: r, s e X, r ' ,_ -r County Q'xs l v LV
Owner Name: 'Dv na j Oi C k°tse Phone No:
Mailing Address:
Facility Contact: ^ Title: Phone No:
iA
Onsite Representative: D pY%_Akst-se Integrator: w
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑.Cattle ❑ Horse Latitude 1 ' 1 - I " Longitude 0' 0• F.
' ­Design';-_Cu_ went
Swine -Ga acit� Po ulatton
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish y'
❑ Gilts
❑ soars
reNunaber of Lagoons
Holdntg Ponds ! Solid Traps
:sign =Current
�" Total Design Capaeit
Total SS1W
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JZNo
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 ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )2-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .,ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 3 Structure b
Identifier: i
Freeboard (inches): 3
05103101 Continued

Facility Number: — a< q Date «f Inspection / 'T D Printed on: 7/21/2000
�5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .,.,ETNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 101No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes yNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes fi�No
12. Crop type GC'Y,,A,) P ty ! ,eSC,0e Vek 34tu / e , S►� all ��`�+�"� _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes 'P'No
15. Does the receiving crop need improvement! ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes )ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes Q�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /
(ie/ WUP, checklists, design, maps, etc-) ❑ Yes '7110
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ,�jNo
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'PeNo
21- Did the facility fail to have a actively certified operator in charge? ❑ Yes '[20No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? _ ❑ Yes /0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 2�No
TS,0.. i61a(idds'oi•- deficiencies •were n6ted. d&ihd this'visit.- Y;oii will-i,eeeiye ii6 furtWe
cor.. oridence:about :::: '
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):
ThA.
v �a ,�.� is Very we �� kela-l. T�,e Sw✓� �or�ts� arevt ��(
/ay011#1 ire ne,141y wIaYt;cvrea( TL1e esGve� fern-.vo(4)) q�_
are shed.
elr'f, well ke f l -1Isa . please be sure , a LA se q
e nnA 5
even-I"S �a �Z1Gu]��e 'fltP ),q,o etj �Ired 01, Ie
�ae.,r eF{crl~3 rtte +S°)aad o✓elPr cir'2 (i.ok1j) f
Reviewer/Inspector Name J PVa
Reviewer/Inspector Signature: - Date: /Z 5/00

t Facility Number: '] — 19 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
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 permanentitemporary cover?
Additional Comnments.andlor;Drawinas:
05103101
❑ Yes ❑ No
❑ Yes,ZNo
❑ Yes ONO
❑ Yes 0 No
❑ Yes ONo
❑ Yes 9No
❑ Yes ❑ No

1 Dtvtsion of Water Quality -
Q, Dwisian of Soil and Water Conservation.:
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: -QI Tirne-� Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
'Permitted ❑ Certified [3 Conditionally Certified 13 Registered hate Last Operated or Above Threshold:
Ci 1C�T�,� .. County :....CL.,
Farm Name:......................................................................................................................... _............_._.............._........._........-....
OwnerName....................................................................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No: ....................................
MailingAddress: ..................................................................................................................... .
Onsite Representative: -- V..... .................. Integrator:.�`?...!'Q�-
......................................._......._......
Certified Operator:................................................................................................................ Operator Certification Number: ....... ...................................
Location of Farm:
..
I IV
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� 0°= longitude • �° F--T{
Design Current Design Current. Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ID Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Total SSLW
Number of lagoons ❑ Subsurface Drains Present ❑ Lag—n Area I0 Spray Field Area
Holding Ponds / Solid Traps JE1 No liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance rnan-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State'? (If yes, nk tify D��Q) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal min`'
d. Defies 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 A�No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge.? ❑ Yes J� No
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Stl'WtUrc I Structure 2 Structure 1 Structure 4 Structure 5 Structure 6
Identifier: ..........................................................................
Freeboard (inches): a�
5100
Continued on back

aciliti;.Number: — 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 ENo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes &No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
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 1pPrr-,tkdg, �\ -39
h2SC ti�
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?
:: o violaiiq ....... a ...mere noted c�irrtng his;visit:... .. ... . e Rio; further
correspondence: about. this visiit'
❑ Yes NrNo
❑ Yes WNo
❑ Yes b�rNo
l
❑ Yes JNNo
❑ Yes WNo
El Yes 1PNO
7
❑ Yes N�No
❑ Yes 19 No
❑ Yes V No
❑ Yes ,gNo
❑ Yes tj No
❑ Yes )?fNo
❑ Yes )"No
❑ Yes )EfNo
❑ Yes �TNo
❑ Yes KNo
❑ Yes ONO
❑ Yes gNo
Comments (refer to question #)- Explain any YES answers and/or any.recommeridations:or.any;other eommeuts
Use drawings of.facility to better explain situations. (use additional pages as necessary) = _"
5
Reviewer/Inspector Name
Reviewer/Inspector Signature: q� t� Date: 5100

IFacilitq Number. (of) — �� I Date of Inspection d Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes tNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,&No
5100

- "I V-n-:-- k 0 k-
Revised April20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -_ \/ Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: cc Part 11 eligibility item(s) F1 ® F3
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP: (l
Annual farm PAN deficit: pounds
Operation not required to secure WA
determination at this time based on
exemption El E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s).- circle #:0hard-hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
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.
E4 75% rule exemption as verified in Part Ili. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational .table in Part lil).
PART If. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Detem�nation.required .because_operation .fails -one of the .eligibility
requirements listed below:
-F1 Lack .ofzcreag :whichTesuffedjnmver-pplicafion-mf--rvastewater�(PAN) on:spray_
fields)zccording-fofarm'sdasttwo-yearsmf rrigation7ecords:--
F2 Unclear, -illegible, -or lack of -information/map.
F3 Obviousfeld-fimitations-(numerous-rlitches;�ailure:-ta,deductTequired
bufferlsetbackzcreage;-iDr25%':ofiotal:acreageidenimed;in,CAWMP_-=iricludes _
small ;-irregulady-shaped fields-fields-less-ihan b�cresfor.. mvelersmr.less-than
2 acres-#or.:stationarysprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised April 20, 1999
Facility Number_-.
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBERt,2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
}
`I
FIELD NUMBER' - hydrant, pull, zone, or:point numbers maybe used in place of field numbers depending on CAWMP
and type of irrigation -system. If pulls, etc. cross more -than one field, insoectorlreviewer will have to combine fields to
calculate 75% field by field determination Tor exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated onmap.
COMMENTS'- back-up fields with CAWMP acreage exceeding =75% of its total:acres and having received less than 50%
of its annual PAN as docurnented in the farm's-previous_two years' (1997 & :1998) of irrigation -records, -cannot serve -as -the
sole basis -for reouirincz a WA Determination. hack -up fieldsmust-be-noted in the -commentaection-and must be accessible
by irrigation -system-
Part IV. Pending WA Determinations -
P1
Plan _lacks: following :information:
P2 Plan revision -maysatis y75% rule based on adequate overall PAN deficit -and by
adjusting -ail field :acreagelo-below 75% use rate
P3 Other (iefin process of installing new irrigation system):

- �:Dinsion of soil and Water Conservatson Operatiion Review 5 - G
r
D�vit of Soil and Water Conservation ' Compliance Inspection R� `
- z.. Vie, „:�: w
.,ADrvtsron of:Wate --Com fiance Ins iron _
—: r Quaitty p pee
s, OtherA enc _ O erahon°Revrew� , �-
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Ot
her
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
'Permitted (3 Certified 13 Conditionally Certified (] Registered 0-Not Operational Date Last Operated:
Farm Name: �.. ...... County: ................: .Sri...........................................................
Sri�r...
Owner Name:
Facility Contact:
Title:.......
Phone No:
Phone No:
MailingAddress: .....................................................................
1
Onsite Representative:.. ��...GHQ............................................... Integrator:.. ...................................................
Certified Operator:
Location of Farm:
Operator Certification Number:,,, -
Latitude Longitude
_ Des "Current
Design.- Current Design Current. gn
Swine
Capaci `Po elation Poultry Capacity: Po elation Cattle .Capac t i' Po` ulatton'
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 2� ❑Non -Layer Non -Dairy
❑ Farrow to Wean _
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish .-Total DeSign,Capacity �.
❑ Gilts
❑ soars A =.TOtI`SSLW
Number of i:agoons e; ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid -Traps ❑ No Liquid Waste Management System
__ r•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
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? (Ii' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes *0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes klrNo
Waste Collection & Treatment ``
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Struc[ure 3 Structure 4 Structure 5 Structure 6
Identifier: (k
Freeboard(inches):`.,\...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Af,Io
seepage, etc.)
3/23/99 Continued on back

Facilily Number: 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 level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenoaof ovenaoolication? ❑ 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?
B. 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?
��o Mola(ioiis ot- def eie d," -w•gre j of d(Wkig this'Asit: ;You will r' eceiye dd fuf fte . .
6resporide'about this :visit: - . -
❑ Yes VNo
WYesNo
❑ Yes gNo
KYes ❑ No
❑ Yes bdNo
❑ Yes XNo
❑ Yes �<No
❑ Yes 994o
WYes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes WNo
❑ Yes WNo
❑ Yes WNo
XYes ❑ No
[:]Yes ONO
❑ Yes �No
❑ Yes ❑ No
[:]Yes )d'No
❑ Yes ❑ No
Yes
❑ No
W
Continents (refer --to. 6esdor#) Explain any YES answers and/or any rec6mmendations or any other comments
Use:drawuigs of facility tb` tter;explain situatioins (use additional.pages,as necessary)
_
Al -In ffl-J
`�� `� � � �� ,,,� � � ►-��i �P , of T � ���
�.
Reviewer/Inspector Name `" • h `_,S IV
Reviewer/Inspector Signature: Date: �`�

Facility Number:, — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
KNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
11�No
28_
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
6(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
N0
r `kNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
�No
'AAditionall -omments`an or' ravings:
oY
r
>o �S ��LCt�, 14r2Cc�.-c�� t►tl
1eLy7-
`tom V --- -9 VV C11-- a--\- C ,
'�k� , A�
Wa L(d) 3Sa a-00LC,
Al- 'S
cv'3vi i.., ca _ ey�` c
� � . � cal
..
3/23/99

0 Division of Soil and Water Conservation`-'Operation•Review
F f _ [ Division of Soil and Water Cvnservatzon ,Complia`nce,Inspecdon-
aDivision of Water Quality ` ICIO fiance Inspection
0 ©ther Agency - 06eratian Review - _
w Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 7 Date of Inspection
Time of Inspection % / 24 hr. (hh:mm)
KPermitted JA Certified ❑ Conditionally Certified 0 Registered 113 Not O erational Date Last Operated; ,,,,,,,,,,,,,,,,
Farm Name: ............ cant�.... 14�i AfS....................... ........-.........---...----......... County: ..... �pN: w .......1...1................... W/. t ....
Owner Name:..._. .4..Nt4 .......C>............................. .......... ......................... Phone No:...a._/._t'..'. 7�� T-.................................._..
Facility Contact:._..`..........................................................................Title:.......
Mailing Address:..,(.f k.....r. r�T ....% C..II� ..............................
Onsitc Representative: ,6/e6- Dfr....;wq..6...............
Certified Operator:.,..,&/A/l ,_,_ ...................................
Location of Farm:
.................................. ... .. Phone No:
IN'�fll.........N....4........................5./...
..... Integrator:.... 5..1..
•.... Operator Certification Number: ,,,•, . �.4f
............................
Latitude a6 F7�Z7­ Longitude 77 ' 3Jr ` ®`.
Design Current _ 'Design Current _ Design Current
Swine - Capacity Po ulation Poultry - =Capacity .Population Cattle Capacity Population
❑ Wean to Feeder
weeder to Finish
(j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts.
❑ Boars
Number of Lagoons [] Subsurface Drains Present ❑ l,agaon Area ❑ Spray Field Area
_ HolthngPonds'lSolid Traps ❑ No Liquid Waste Management System
x
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No
Discharge originated at: [ILagoon ❑ 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 gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes � No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes L'No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes qNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........A
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �Io
seepage, etc.)
3/23/99 Continued on back

Fiarrlity Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 11�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes �No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes j4No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes �(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes 6(No
12. Crop type CD, _-1-- Q R" t r1ge'.—L Ski . -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 6�Vo
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes KNO
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
11-10
�'CC
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
gNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
a No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes15,Z40
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
}q No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0: No.. iolati6is:or defieie dO$ •mere noted dtwing 4his:visit: - Y;oir :Witt-e eeiye do furthgr
• corr4s 6fidehee. abaut. this .visit .
se drawings of facility to better explain situations
,Tome _ a s o�t� n s po5si b e
se additional, pages as ne
�O 4T je ups
�oco/t •-+or Wing .
ent§ -
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature: je
Date:
3/23/99

Facility Number:6 Z — Iq Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0
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] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �$�I0
roads, building structure, and/or public property) V ,
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 fah belts, missing or /
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes I/��-' No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes _XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
�... honah. omments ani oir awings:. - W _ --`71
rl
3/23/99

Lagoon Dike Inspection Report
Name of Farm / Facility Chase, Donald (Carrois) 67-1-9
Location of Farm / Facility _Sr 1210 2215
Owner's Name, Address
and Telephone Number
Date of Inspection 9128199 Names of Inspectors Patrick i&ogan
Janet Pai b
Structural Height, Feet 3.5' Freeboard, Feet l .4'
Lagoon Surface Area, Acres 2.0 Top Width, Feet 10'
Upstream Slope, %H:1V _ 2 to-] Downstream Slope, xH:1v 3 to _l
Embankment Sliding? Yes X No
( Check One, Describe if Yes )
Seepage? Yes X No
( Check One, Describe if Yes }
Erosion? Yes X No
( Check One, Describe if Yes)
Condition of Excellent = grass
Vegetative Cover
{ Grass, Trees )
Did Dike Overtop? Yes X No
Follow Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
Yes X No

Lagoon Dike Inspection Report
Name of Farm / Facility _ Chase, Donald (Carrols)67-19
Location of Farm / Facility Sr 1210 2215
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes }
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
9 / 28/ 99 Names of Inspectors Patriok Grogan
Lanet Paith
3.5' Freeboard, Feet -4'
2,0 Top Width, Feet 10,
2101_! Downstream Slope, xH:1v _3 to 1
Yes X No
Yes X No
Yes No
Excellent uaas
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No !
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments

0 Division of Soil and Water Conservation 0 Other Agency �� _
Division of Water Quality`
7, V" 7
Routine 0 Complaint 0 Follow-up of DAVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 3Q 24 hr. (hh:mm)
© Registered efCertified © Applied for Permit WPermitted 10 Not Operational, Date Last Operated:
Farm Name: GI ................... ............. I....... County:. , .............
Owner Name:.... . -�1 ...... G?.............. .......................... I...................... Phone No: .�. .�,tL......a� :. g� .....
Facility Contact: J;!M�`.4..... ......... Title:..... . )1� r` ............................... Phone No: --.. ...----...........I............----........
Mailing Address: /�Oto � NC / /.. ..G..... 'RX................. ................................................ ..........................
u
Onsite Representative: ..... B.ct.�. ..... '! ti............................................ Integrator:.....C9.Q,e4G ...f..........................................
Certified Operator;... ................,................................................... Operator Certification Number,......1it�
................................
Location o
,S................................................... 7"o a eJ LC- pN cYr'.PEr�. 4�!C... ! ... ?�./..Qi..... .. F'..........
.........
rl - - .....
Latitude
Design ' Current •Design Current : 'Design Current
r Swine-.pCapacity Populatioia Poultry Capacity Population Cattle Capacity: Population
❑ Wean to Feeder
® Feeder to Finish
e)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer Non -Dairy
❑ Other a
Total Design Capacity
Total SSLW r'
Numher of Lagoons lHoldtng'Pands ` ubsurface Drains Present ❑Lagoon Area Spray Field Area
❑ No Li uid Waste Management System
<. r
Q g Y :r
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga!/min?
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 lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125197
❑ Yes [3,No
❑ Yes %No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
cxgo
❑ Yes
O No
❑ Yes
( No
❑ Yes
LA No
❑ Yes
No
Continued on back

4d`
Facility number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes j�j No
Structures (Lagoons ,llloiding Ponds, Flush Pits, etc.)`
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFier: rr
Freeboard(fty .......... ....................................................................................................................................................................I....................
10. Is seepage observed from any of the structures'? ❑ Yes ,r-w No
I L Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes S'No
12. Do any of the structures need maintenance/improvement? ❑ Yes Wo
(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 ( rNo
Waste Application
14. Is there physical evidence of over application'? ❑ Yes XNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type e .�.... 5 .� - ...`..!l .'! -Q-.................•-.---..---.........---......_........_........................................................................................_..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes R No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 'o
18. Does the receiving crop need improvement? ❑ Yes IXtib
19, Is there a lack of available waste application equipment? ❑ Yes N�io
20. Does facility require a follow-up visit by same agency? ❑ Yes EYXNO
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes qN10
22. Does record keeping need improvement? WYes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ( No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ! No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes " /*0
0 No.violations or deficiencies. were noted during this:visit.-.Youmill receive no further
- : -correspondence at3out this.visit:• : � : :.. :. . � . � � � � � : :: :: � � : ::: � : • : :.:. • : - :
Comusents;(refer°to;questinn`#): Explain any Y`ES'answers and/or any recommendati6w-or any other Comment:
Use drawings of facility to Netter explain situatioris. (use additional pages as necestiarv.);
7/25/97
Reviewer/Inspector Name','P•� r �U�f%/�' ' 3
Reviewer/Inspector Signature: Date: // / S

® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number �
Time of Inspection L/ m wJ 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 El Permitted or Inspection includes travel and rocessin
► ❑ Not Operational Date Last Operated:
Farm Name: ZAA2E,.... _...... . .Ae ....... W_....__....................... County:.__ C.�r' ?� v `J ...._....... _.... _..... .....
Land Owner Name: _.J�..� 5 Phone No: ',ff
',�
FacilityConctact:L ............Title:Phone No:
b(0 +
Mailing Address:.... ..... _ .!?..�J rlf_. G• �. �'j��....
Onsite Representative:
.........
p LL7 Integrator: ... 5.... ----- ..... ....
Certified Operator:..17 ee-i................... �,' Operator Certification Number:
Location of Farm:
Latitude a " Longitude �' �4 4,
Type of Operation and Design Capacity
`�„ a.ti✓ ';'t IiestCuiTent
Design Current �� MDestgn Current gn
Swtte s 1'oui Cattle
:Ca act'PVo itlation._, �, , Ca` icily Po NulahCa actPo ula�on
❑ Wean to Feeder
❑ La ❑ Da'
Weeder to Finish ❑Non -Layer , ❑ Non -Da
Farrow to Wean
Farrow to Feeder Tot`al Design Capaeity�
Farrow to Finish �
❑ Other
�'ISumiier of�Lagoon ! Iioldtag Po its "...._ ....
0 Subsurface Drams Present _ .._. _
a � ❑ Lagoon Area*. S ❑ pray Field Area H
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ["No
2. Is any discharge observed from any part of the operation? ❑ Yes ✓[ 4o
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 9 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 EWo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑qllb�
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes �o
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ERKo
4/30/97 maintenance/improvement? Continued on back

Facility Number: %...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes RXo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 9-Ko
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑-No
Structures (Lagoons and/Molding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Boo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
...._ ..... ............... ....... ................ _ ...._.......
_
10. Is seepage observed from any of the structures? ❑ Yes M- o�
11. Is erosion, or any other threats to the integrity of any of the structures observed? [:]Yes ❑KO
12.
Do any of the structures need maintenance/improvement?
ff 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
[9-9o'
Waste
Application
14.
Is there physical evidence of over application?
❑ Yes
9 -NO
(If in excess of WMP, runoff entering of the State, notify DWQ)
15.
lorr waters
Crop type ........3. -f ........................... ....................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
12-1Zo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0.90
18.
Does the receiving crop need improvement?
❑ Yes
EKo
19.
Is there a lack of available waste application equipment?
❑ Yes
0-56
20.
Does facility require a follow-up visit by same agency?
❑ Yes
&KO
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EK
1E4r
Certified -Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
UKo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(Wo—
24.
Does record keeping need improvement?
❑ Yes
B-go'
Comments (refer to question `#} Explainany YES inswersland/or any recommendations or any other comments
Use,drawirigs. of facility tsituations (use additional pages as necessary) 4
Cvt�, lam- Cddpa-s �; - A4K .L - 9 D
r S a t=•�tc 1� , 5 ��,,y�l„��✓Y AT �5%-s -:r!m T,.
a
Reviewer/Inspector Name ;>>�� :`s ',.�
Reviewer/Inspector Signature- Date: oy,1,7
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 RECORD
DATE: , 199`
Time:
Farm Name/Owner:
Mailing Address:
County: h n
Integrator:
On Site Representative:
Physical Address/Location:
Type of Operation: Swine
Design Capacity:
!le 0 Phone:
i Nl,,% C" , i -- Phone -
Number of Animals on Site:
DEM CerdAcpxion Nu 1 ber• ACE DEM Certification Number: ACNEW_
Laritude:° Longitude:7--2-° Elevation: _—Fe; t
Does the Animal Waste Lagoon hav
(approximately 1 Foot + 7 inches) (I
Was any seepage observed from the
Is adequate land available for spray;
Crop(s) being utilized:
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
or No Actual Freeboard: Ft. T Inches
goon()? Yes o i a Was any erosion observed? Yes or l,To
re or No Is e cover crop adequate? ((Yet or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? > e or No
is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Pine?
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ,. Yes ore
Is animal waste discharged into waters o . he state by man-made ditch, flushing system, or other
similar man -trade devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied.
Inspector Naive
Lc: Faciliry Assessment Unit
Si
Lase Attachments if Needed.

Site Requires Immediate Attention:
! Facility No. b -i - 19
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 3 , 1995
Time: 2 S
Farm Name/Owner: C NA5C. VAR-t4 s Do u A L-p CI-IASF-
Mailing Address: _ 180 (o S IV C 111 G N 1 NI & uA Pi NA , NC Z f3 S 2 1
County: Dot( S Lo tom!
Integrator. Qk Y'Y'o t i Phone:
On Site Representative: n.uv_A_ Phone: Z 98 - 5Z 34
t'r&­ 7q f• nc14-VIIi �v t3Acx sw4,-1, con-, . M00, , [�t,1 1 s7 p�cst ari po F t-
Physical Address/Location: W �. _( s,e ►i cq) g o l • a M;ins +u -.,
?- / 1-/L3 (_. F tAA rti 1 A4) a D fb 12
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: S Z O Number of Animals on Site: 36,66
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude. 3 4 ' q 4 ' RO ST , Longitude:-7 7 ' 340 ' 53 Yl" Elevation: I Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6i or No Actual Freeboard: 3 Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes osoWas any erosion observed? Yes o SN
Is adequate land available for spray?6Yeor No Is the cover crop adequate? Ye or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cove ? Yes or No
Additional Comments: O w
Inspector Name S ignature
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
OPERPT I ONS BRANCH - WO Fa : 919-715-604d Jul 24 ' 95 . 1 J : 09 P. 17/ 18
Site Requires Immediate Attention �/a
Facility Number: G 7-/f' _
SITE VISITATION RECORD —
DATE: uc de .1995
Owner: Farm Narne: c&.2-r� •� ••.� -
County: O^v.rt e.v.
Agent Visiting Site. of Phone: 7;
Operator: _APe.—y�e4l CIV-7zei" _ Phone: r-
On Site Representative:►�+�_ e.v�.: _ Phone:
Physical Address: ^_.4� ,,�=... dr= s .s 1,41o, !..i o" / -,e,& . �„rr, / 'K i:'. X.rLiH
Mailing Address:
Type of Operation: Swine
Design Capacity; A re
Latitude: -0 '
Type of Inspection: Ground.
f
Poultry Cattle
Number of Animals on Site: _ ,?s-,r o
Longitude:' "
Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +9 inches) (e or No Actual Freeboard: _ Feet , _ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
con -rents section,
Was any seepage observed from the lagoon(s)? Yes or�as there erosion of the dam?: Yes orey
Is adequate land available for land application? es r No Is the cover drop adequate? e�r No
Additional Comments:
Far to [phone]
�rZL f�r
Sign turn of Age

T�cse cwe )i(4u es of -T-hlllp is �►�►�-�G�'�3��_.
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w Cq s 5; � i �� Ve close 6 ��� d ►"tG�n � There -
weY'e 0 f 5p ok,,iloe/S 4,- VF,- Surfr4C e Qua f^,71e -rrar� Tie

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