160001_INSPECTIONS_20171231

I
I
NORTH CAROLINA
Department of Environmental Quality

• ivis'ion of Water Resources
Faciillity Number - � Division of Soil and Water Conservation
0+ Other Age�ey
Type of Visit: o ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit. Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 t Arrival Time: P Departure Time:® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title: Phone:
Onsite Representative: Vic '` f o t c_.' Integrator:
Certified Operator: Certification Number: /-t-fjp
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poult , Capacity Pop. CattleME .YMP.
Wean to Finish I 11-ayer I Dairy Cow
Wean to Feeder I jNon-12jer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D . P.oult, C*.a acii P.o , Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts on-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turfce s
Other Turkey Poults
Other I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Zf 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 ❑ NoDNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,D'Now❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes B_N10 0 NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

a
[Facility Number: - Date of Inspection: '27V71 �
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Lfo
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes � o 0 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 eat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes '� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ 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 ❑ NA WO'NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes ❑ No ❑ NAE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA THE
acres determination? d��
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ No ❑ NA ;1E
20. Does the facility fail to have all components of the CAWMP readily available?if yes,check ❑ Yes [] No ❑ NA ]NNE
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 No ❑ NA
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NAgN/E
NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑'NE
25. Is the facility out of compliance with permit conditions related to sludge? .If yes,check ❑ Yes ❑ No ❑ NA E-iQV___
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 NAB
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No D A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE 4
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 EfNo ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility? If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA W-+ "`"
❑Application Field ❑ Lagoon/Storage Pond ❑ Other: — '
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes j3:�Co ❑ NA ❑ NE
ComFnen'ts(refer�to question"##) )explain any YES a©swersaand/or any`°add2t�oiaal Fec©mrnendations or°any`©then cowmen#s.`
Use d6win s-. facile" to r
g ` "ty ' better:°egplaj©siliia#eous,e(ase ad" ,d�tsaoalpages as necesSaO'
f
,"- CL OTC- ,
Reviewer/Inspector Name: DWI ���"� Phone: ���?�i� 7 jny
Reviewer/Inspector Signature: 1 01114 Date:
Page 3 of 3 2/4/20I5

ivision of Water Resources 7W
low
uEMU= ], - 0 Division of Soil and Water Gousen+anon
©Other Agcy
Type of Visit: Com nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: O Q Departure Time: 2 O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
�1
Onsite Representative: Integrator:
Certified Operator: Certification Number: f 7 0•3 T—
T
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design C*urrent Design C*urrent
Swine C►specify Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I 11-ayer I Dairy Cow
Wean to Feeder 11 jNon-L2yer Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean EUW12n Current Dry Cow
Farrow to Feeder D P.onI Ca aci P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other r Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [::] Yes _ Ocl NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

(Facility Number: - Date of Inspection:
Waste Collection &Treatment ����
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a go ❑ 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 [a �_o ❑ NA ❑ NE
(i.e., large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ONo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental t eat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VINo
❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
11.Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13.Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [] No ❑ NA
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA 9�
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA rN
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA Lj
E
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ No ❑ NA NEB
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ❑ No- ❑ NA L�J NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]maps ❑ Lease Agreements ❑Othe - /
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 SINE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fo NA
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412015 Continued

Facili umber: 110 - Date of Inspection:
24.`Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 6E
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes [] No ❑ NA rNE
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 ❑ N dNE
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 �N
permit?(i.e.,discharge, freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ N ❑ NA �NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments refer to f"( ' question€() Explain any YES answers andtor,any additiotial'rec©mmeudatipos ar any otlier'eainments. . y
" �. §< `:r _ - 3@> �Pvd,-,€� ,
Use dra*ift9sjof fkcHity tq better explam;sifaations (usi additionaF ages,as�necessa ,
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�9ppn �S✓� '^ f w� �'�irL �`? � rs 1'f� '�,�'�01 I�'[.t � fQe C4
,SleLe
Reviewer/Inspector Name: Oare 9'-�$ 1 v` 1 � Phone: q)0 79b 73af
Reviewer/Inspector Signature: f Date:
Page 3 of 3 214,12015

` Divi"sion ofWater Resources
��'acllity;�Number � ®Division of�Soiitand Water Conservation
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 1`7 0S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Sw,ie Capacity Pop. Wet Poultry Capacity Pop. Cattle C*apacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Non-Layer aia Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Q Y Design Current Dry Cow
Farrow to Feeder D., Poultry Ca aci P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Q.ther _ Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ 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 ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes T�J(No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Number: - Date of inspection-
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 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 IL_I No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I ZJ 1Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1 yNo ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? dYes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes rNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement?If yes,check the appropriate box below. [ Yes ❑ No ❑ NA ❑ NE
D.Waste Application ❑Weekly Freeboard ❑Waste Analysis Soil Analysis ❑Waste Transfers Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections Enthly 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 YNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility T jDate of Inspection:
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes C?(No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Vf 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 YNc
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? [:] Yes ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [-] Yes dNo ❑ 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 2 No [] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes do ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes U No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Fn/No ❑ NA ❑ NE
Comments{refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Used..rawings of facility to better explain situations(use additional pages as necessary).
gt)
�J6E19 d 'sc Recpweo
SLVD6: C StAOE �J C C 12 Oo W_U­ ASK_
K_
Reviewer/Inspector Name: FWZP C V - Phone
Reviewer/Inspector Signature: Date: 50
Page 3 of 3 21412015

ODiviRon of Water Resources '
Facility Number � - Division of Soil and Water Conservation
�Other Ag�y
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p 5 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: R7('y}��.� d� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer I Dairy Cow
Wean to Feeder I iNon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
arrow to Wean Design C*urrent DEZCow
Farrow to Feeder D . P,oul Ca aci P,o , on-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turke PouIts
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 n NA ONE
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 Oo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yeso ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

acilE Number: - Date of Inspection: S
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:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not property 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 environm7j�o
threat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes CrNp ❑ 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 t0 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12,Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Yo ❑ NA 0 NE
16.Did the facility fait to secure and/or operate per the irrigation design or wettable ❑ Yes gNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes C�Xo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Renuired Records& Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes YNoo ❑ 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 k
❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F. cili ,Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NAgNE
NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ No ❑ NA
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA VNE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No ❑ NA
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?
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZNo ❑ NA [] NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 261'��o ❑ NA ❑ NE
permit?(i.e.,discharge, freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes []/moo ❑ NA [] NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments(refer to question#):-Explain any YES answers and/or any additional recommendations or any other;comments.
Use drawings of.facility to better explain situations(use additional pages as necessary).
Reviewer/Inspector Name: V 'F J QV t✓ Phon
Reviewer/Inspector Signature: Date: 30
l ts-
Page 3 of 3 21412015

CH
ty Number L - ©Division of Soil and Water Conservation
OO Other Age©cy
Type of Visit: Co fiance Inspection Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral Q Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: E Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: "'I'a y - , Integrator:
Certified Operator: Certification Number:
.Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design C*urgent
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I La er I Dairy Cow
Wean to Feeder Won-Layer I Dairy Calf
F eder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder I) , P■oul Ca acity P■o , Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other I 10ther
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 ❑ [3NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ YesVN
❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Eacili Number: - Date of Inspection:
Waste Collection&Treatment
4.4s storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
�Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: �,�lls��
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No CO 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 o/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 environm7-Vo
threat,notify DWQ
7.Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9.Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes W_�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
l3. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
IS.Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes Yo ❑ NA ❑ NE
Required_Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ YesVNo
o ❑ NA ❑ NE
;/
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fatili -Number: - Date of inspection:
24:Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
2i Is the facility out of compliance with permit conditions related to sludge? If yes,check [—] Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [,NNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 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 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ixo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ YesFNo
o ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility.to better explain situations(use additional pages as necessary).
TOReviewer/Inspector Name: U71 �NG�-� Phone 3
Reviewer/Inspector Signature: Date: a
Page 3 of 3 21412 11

!- � Division of-Water Quality
Facility Number © - � 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Co m [lance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7. Arrival Time: Departure Time: County:Qjk7l�R4Et Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: +'[uA i7 t To Integrator:
Certified Operator: Certification Number: V r 6 3 S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer Dairy Cow
Wean to Feeder on- ayer ai Calf
Feeder to Finish Dairy Heifer
Farrow to Wean d Design Current Dry Cow
Farrow to Feeder D . P�oul. . Ca aci P,o , 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 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 ❑ o, ❑ NA ❑ NE
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 �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili umber: 1 - Date of Inspection:
Waste Collection& Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1; Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t8 44
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): e3 2
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No [_] ❑ NE
(i.e., large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmenta hreat,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 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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes F3/N
No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;" ° ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ YesTNo
oVNA
❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes [] 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 116 No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall [:]Stocking ❑Crop Yield ❑l20 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeifi umber: - Date of Inspection:
24.Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail 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 N ❑ 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 VNo ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 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 Zo ❑ NA ❑ NE
❑Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ ❑ NA ❑ NE
33.Did the ReviewerAnspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
Reviewer/Inspector Name: 68e,) �Uv Phone _q/6 �3�0
Reviewer inspector Signature: Date: P.ul 3
Page 3 of 3 21;12011

� Divi"sion of Water Quality
=Ni
mber f�� - ®Division of Soil and Water Conservation
Type of Visit: 7Routine
pliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other Q Denied Access
Date of Visit: *22 Arrival Timer Departure Time: County: 40 � ���Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: T ,�A (f Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder Non-La er Dairy Calf
eeder to Finish Dairy Heifer
Farrow to Wean 0 nt Dry Cow
Farrow to Feeder D, P,oultry Ca aci P,o Non-Dairy
Farrow to Finish ILa ers Beef Stocker
Gilts on-Layer Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Pouits
Other Other
Dischar es and Stream Impact
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 �grNo/[:]
❑ NA ❑ NE
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 o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

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

Fa ' ' 1Wrmber: jDate of Inspection: 51.31 1 JIZ,
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check [] Yes �No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes FfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes P4 ❑ 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 E2rNo ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes [] NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ YesVN9� ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes I 0 ❑ 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: D Phon(- b 43 OU
Reviewer/Inspector Signature: 142ZDate: "E--
Page 3 of 3 214/2011

r
Divis""ion of Water Quality
Facility Nuirtber © - © I ivision of Soil and Water Conservation
®Other Agency
Type of Visit: Copfpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QRoutine ()Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: E Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
1�
OnsiteRepresentative: R CHAaD CA�, Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
FSwine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dai Caw
Wean to Feeder Non-La er airy Calf
Feeder to Finish airy Heifer
Farrow to Wean Design C►urrent Dry Cow
Farrow to Feeder D, Ploult, C•a aci Plo , Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
ffLj2ther 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 n�o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes fN
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility'Number: 76 - I jDateof Inspection: 1
Waste Collection&Treatment
4. is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D 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): q V
5. Are there any immediate threats to the integrity of any of the structures observed? [:] Yes No ❑ NA ❑ NE
(i.e.,large trees,severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health oroYesronmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E/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 C/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need [:] Yes [2/No ❑ NA [ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes C�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Zo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA [:3 NE
acres determination?
17. Does the facility lack adequate acreage for land application? [] Yes E2<o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [:I/No ❑ NA ❑ NE
Required Records& DocumentsWTI�19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ YesVNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I" Rainfall InspectioW-N)
❑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 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acui Number: -7 Date of Inspection: 1
24.Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes VNo
� o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZN ❑ 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 E�/N o ❑ 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 f'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 Ea No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes I�J '� ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �Vo
N ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).:
Reviewer/Inspector Name: DN �ILJ Phone:�*%q4
Reviewer/inspector Signature: Date: i
Page 3 of 3 21412011

Division of Water Quality
C761ity Number - Q Division of Soil and Water Conservation
Q Other Agency gig
Type of Visit gRoutine
mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 12 Arrival Time: Departure Time: County: CA)z Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,Q Title: Phone No:
Onsite Representative: ►r�ru� V e �t L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o =1 u Longitude: =° =i =
61
Design Current Design Current Design rentillill
Swine Capacity PopJulati n Wet Poultry Capacity Population Cattle Capacity Population
❑ an to Finish iry Cow
❑ an to Feeder ❑Non-La er ❑Dai Calf
❑Feeder to Finish aia Heifer
®Farrow to Wean a DrY Poultry ❑D Cow
❑Farrow to Feeder El Non-Dairy
El Farrow to Finish ❑Layers
El Beef Stocker
❑Gilts ❑Non-La Non-Layers
❑Pullets ❑Beef Feeder
❑Boars ❑Turke s Beef Brood Co
❑
Othe 10 Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes
❑N [I NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? El Yes No El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes _�/No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: Date of Inspection Fp
.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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lh
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any,of the structures observed? ❑Yes ZNo
❑NA El NE
(ie/large trees, severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental th at,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes 7No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LEI 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 1Vo ❑NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. El Yes o ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑ Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑YesXEI
❑NA [I NE
15. Does the receiving cropand/or land application site need improvement? El Yes NA [INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes ❑NA ElNE
18. Is there a lack of properly operating waste application equipment? ElYes No ❑NA ❑NE
Comments(refer,to question#} Egplam auy YES answers and/or any recommendations or.any otheryco mme ts ' _
,a ,
-Use drawings-of facility to Better explain situations (use additional pages as necessary):
G AlMt J�J�,-
-Zo
Reviewer/Inspector Name a " Phone: « 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

y
Facility Number: lb — Date of Inspection 1
Reauired Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes No ❑NA ❑ E
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes ❑No ❑NA NE
the appropriate box. ❑WUP ❑Checklists ❑ Desig
n ❑Maps
p El Other
21. Does record keeping need improvement? If yes,check the appropriate box below. ❑Yes ❑No ❑NA E7 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 CJ'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 ❑No ❑NA eNE
25, Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑�No ❑NA VNE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes E No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA EIN-'E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ZNo
N El NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes ❑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 B N' 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 Eo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes To ❑NA ❑NE
k ,a 40:
AddittonaliComruents�andl.0r Dr�awiyngs:
12128104

• Division of Water Quality
Iff
Facility Number ; Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit Routine O Complaint O FollGw up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /b1D� Departure Time: County: CWjffi ET" Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AKS/A"_ , A_,6 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 [=` 0" Longitude: =° "
Design Current Design C+urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La er ❑Dairy Cow
❑Wean to Feeder ❑Non-La er ❑Dairy Calf
❑Feeder to Finish ❑Dairy Heifer
Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts ❑Non-Layers
❑Pullets IQ Beef Feeder
❑Boars ❑ Beef Brood Co
❑Turkeys
Other ❑Turkey Po Its
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes d o El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes WNo ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes 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: S.A&WAJ
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes ENo ❑NA ❑NE
(ie/large trees, severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes VfNo ❑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 reat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑NA El 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 VNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes 7No
6o El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑ PAN> 10%or 10 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 dlNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ld No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes D No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes 2/1 o ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑NA ❑NE
`Comments(refer to question#) Explain any YES answers and/or any recommendations or�aity other3'com6ents
,.�•- ,.p.:
Use drawings of facto[ to better explain,situations (use additional pages as necessary)
ApPL'< �artr zf LJ lQC"'r #� )C_FATM �D­
Kl;C.P lZCC WXS �6rL-- PC--C—.6,PA" AND A>JH ?L+APVJG- C-Y(-_A1TS,
3M4T1A6A_ PASSU) -- NO C1AtRkniT' J-ECarLDS, 6eGZPu %%Wrg OW 0WOC_(Z,,
FrL(yC54 Va R p� G7C.,
Reviewer/Inspector Name p Phone. �9
Reviewer/Inspector Signature: Date: G 11, �
Page 2 of 3 12128104 Continued

Facility Humber: — ' Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes []No ❑NA C�NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes ❑No ❑NA WXE
the appropirate box. ❑WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA E�/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 ❑No ❑NA ENE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No ❑NA E3"NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA MINE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ❑NA Id NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes E�No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA ENE
Other Issues ,�,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes �J No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes VNo ❑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 D 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 [2"No ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application) —/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? El Yes E3 No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes [2No ❑NA ❑NE
Additional Comments and/or Drawings:
H,
Page 3 of 3 12128104

bQ
Division of Water Quality
Facility Number (o Q Division of Sa175 d Water Conservation
Other Agency
Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint () Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: z9 6 0 Arrival Time: Departure Time: County: CA-R ad-f-t Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: e. J(T7 LL Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=° 0 d =N Longitude: °
Design Current Design Current Design Current
Swine Capacity Population WeE Poultry Capacity Population Cattle Capacity Population
❑We to Finish ❑Layer ❑Dairy Cow
❑We to Feeder ILINon-Layer El Dairy Calf
❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder El Non-Dairy
El Farrow to Finish El Layers
El Beef Stocker
Gilts ❑Nan-La ers
ElPullets ElBeef Feeder
po Boars ❑Beef Brood Co
❑Turkeys
Other urkey Poults
❑Other 10 Other Number of Structures:
Discharg s& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑N ❑NA ElNE
2. is there evidence of a past discharge from any part of the operation? ElYes . N El NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes [ No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number:l — Date of Inspection S
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes JNo ❑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: t44C7-00#J
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): -2A
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 dNo ❑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 environmentaZNo
reat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes [2/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 0 No ❑NA ❑NE
maintenance/improvement? ,.,
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ElLJ
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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes ,�,N El NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes E o ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes PKo ❑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
v�Comments1(refer to queshoi #} ,Explain$any YES answers andlor�anyyrecommendatIons'or any other,comments.
�P3s'pn3'^,.,'�""�aa.,w:"� nr �' .d1:' �'•�-�_..w4+ "'�.'h' 5"�x,u x �S':'si' � a-.w.3� e"._.. __ �.;
Us drawings of facfibty to better,explain srtuahons.'(use,,addihonal pages as necessary,);
u^',a"� .'•"�, �_ate
aWNFrc- 4SW P AS t /V . ayvNE S,jtP JA/ Qd JFaot/ AVj9 r<eCpjCD� A,
d? UIST 9 F r-M� 4a get g o
.j A aC FAxep �1Tyztj to /3u3rAJ6s5
DABS . CNA,6IG-E 6F &►JWEa-S4 to �� Qa�l�, brG wAS Mf61UTI ,
!✓6E o `� �� v r6+�I+ n G
Reviewer/Inspector Name �/` Phone: 9�0 7 3ZX
Reviewer/Inspector Signature: Date: .S G
Page 2 of 3 12128104 t7onfinued

0� 0651 xg(og I
Facility Number: Date of Inspection IS124h9l
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ❑No ❑NA
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
g [I Maps [I Other �.f
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? ❑Yes ❑No ❑NA IJ N
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No ❑NA LANE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA EkNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ElNo ElNA ,[2/NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ElNo ElNA _NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ElNo ElNA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes Z1No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes �No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ❑ 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 [21/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 ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? El Yes WT-.4o ❑NA ❑NE
Additional Comments and/or Drawings:.
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 00 ther Agency
Type of Visit C�om�fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ['Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !r 6'1 Arrival Time: Departure Time: County: E Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: ?ZW,4Kp Integrator•
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o ` " Longitude: 0 D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑Dairy Cow
❑ Wean to Feeder ❑Non-La et ❑ Dairy Calf
❑ Feeder to Finish ❑Dairy Heifer
® Farrow to Wean t*$ Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑La ers
❑ Beef Stocker
El Gilts ElNon-Layers
El Pullets ❑ Beef Feeder
❑ Boars ❑Beef Brood Co
❑Turkeys - -
Other ❑ urkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes Fe No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA LINE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes 7No
❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes
[I NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes ❑NA ❑NE
other than from a discharge?
12128104 Continued

acikty Number: rI Date of Inspection , o
Waste Collection &Treatment �,/
4.ZIs storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? El Yes LJ 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: tA40V /
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes 2 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 E 11 0 ❑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'No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 0 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 FfNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes,check the appropriate box below. ❑Yes El"No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes dNN, o El NA El NE
B
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 LJ 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 la 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):
,2 5*W06G rVh5 MC&M [ ,q 6,Ac (c f 1.CVL4r N r6iE P 9E "XofJ6. /M It
s•¢ w Look Nr 4 GA E
20 J 3 d DA S/1 Td vpv/1TF GJUP, C.t�k Ar dPPArJN---- GA Go-oN De S16AI
r,✓srll�w 30 PVS,
Reviewer/Inspector Name p � Phone:( /1)
Reviewer/Inspector Signature: Date: p
12128104 Continued

yFacility Number: — r Date of Inspection 0
_Required Records& Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes E�No ❑NA ❑NE
20. Does the facility fail to have al omponents of the CAWMP readily available?If es,check Yes [—]No ❑NA ❑NE
the appropirate box. p ❑Checklists ❑Design ❑Maps LI Other
21. Does record keeping need improvement?If yes,check the appropriate box below. Yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑ Annual Certification
❑ Rainfall stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ONo ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ;N�
El NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? 9Yes ]NNo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes (_/J No ❑,NA El NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No [3 NA ❑NE
Other Issues 1
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes E NNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes 2 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 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 �N ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? El Yes �J No ❑NA ❑NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation /
- - - O Other Agency
Type of Visit 7Routine
pliance Inspection Operation Review Structure Evaluation Q Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Arrival Time: 9 4,r' Departure Time: County: I IAXM .FT Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1 ^rt 3au c e 'R8 to ,)a-t c*- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: �° �' � Longitude: �°
Design Current Design , Current; Design -Current
Swine Capacity Population Wet Poultry Capacity Population Cattle: Capacity-..Population.-
Wean to Finish ❑ La er ❑Dairy Cow
❑Wean to Feeder ❑Non-La-Layer �. ❑ Dairy Calf
_j
❑Feeder to Finish ❑Dairy Heifer rp
©Farrow to Wean 1 4 Dry Poultry E]Dry Cow
❑Farrow to Feeder ❑Non-Dai
❑Farrow to Finish ❑ Laers � ❑Beef Stocker
❑ ❑Gilts Non-La ers
ElPullets ElBeef Feeder
[I Boars
❑Turke s El Brood Co
Other
❑Turke Poults
❑Other I ❑Other Number of Structures.`
- —TT
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes L/J No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes �LkhTo ElNA ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes EK ❑NA ❑NE
other than from a discharge?
Page 1 of 3 12128104 Continued

t
Facility Number: (p — Date of Inspection O b
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes dNo ❑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 GrcxsIJ
Spillway?:
Designed Freeboard(in): 9, S
Observed Freeboard(in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes d 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 UJ
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 VNo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes dNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes C No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes,check the appropriate box below. ❑Yes 2�No ❑NA ❑NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑PAN> 10%or l0 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s) _ 9 w S6 C7
13. Soil type(s) )�o e ^
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes EfNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ONo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes ,_!d No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes VNo
❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? [I Yes ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recommendations or anyother:comments:
Use drawings of facility to better explain situations.(use additional pages as necessary):
ti.) GEr COP,? Fit 1-, 94ICJ C.e,SZTSGATE or COVE"C'6 Z, 0
GET 11,�ud AWD AGP_kAG& (0oDA 5. sfwl.] To
'F
AC9,0gCE -Fdfk . 5 ot.so SEts [�1~t.ud ran cotiREc r �. �'
Sou +4u�►Lt'tLs SCNT ZN A#D Nor 126CZ(,V g-CYo1_i rEA/p w1T8 arlaG�,
Reviewer/Inspector Name � � Phone I 796 -7 6 S
Reviewer/Inspector Signature: Date: V
Page 2 of 3 12129104 Continued

r
Facility Number: Date of Inspection T o
Required Records&Documents
19.. Did the facility fail to have Certificate of Coverage&Permit readily available? Yes ❑No ❑NA ❑NE
20. Does the facility fail to have a components of the CAWMP readily available?If yes,check L7 Yes El No [3 NA [I NE
the appropriate box. YWjJp ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box elow. WYes El No El NA ❑NE
�aste Application El Weekly Freeboard ❑Waste Analysis Soil Analysis ❑Waste Transfers ❑Annual Certification
L�J 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 DTo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ETINA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No El NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes EK ❑❑NA ❑NE
❑ ❑ `�
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? Yes No I?NA ❑NE
Other Issues ,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes �B o ❑NA ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes ET 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 2 o ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes 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 Q< ElNA ElNE
33. Does facility require a follow-up visit by same agency? ElYes L No ❑NA ❑NE
Additional Comments and/or Drawings:
DEFp 54n,.. SArAp(_f DoN& NEea CAt._LUL- X0 wort4C SHEET FoX
Page 3 of 3 12128104

FEE'
visit
f Water Quality
acili�y Number - visif Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technica=Assistance
Reason for Visit 0Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑
Date of Visit: '1 JS Arrival Time:® Departure Time: County: C&IMFNCT Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: azCgfkgz �}ycz-- _- - - Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of farm: Latitude: o Longitude:
Design Current Design Current t Design Current
,. ..
1.
Swine Capacity Populxteo� yNet Poultry Capacity. Population _ :-Catty Capjacity Population
❑ an to Finish ❑Layer ❑ Dairy Cow
❑ an to Feeder 1 1110 Non-La et ❑ Dairy Calf
❑Feeder to Finish I Dairy Heifer
Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dai
El Farrow to Finish ❑Layers
El Beef Stocker
❑Gilts ❑Non-La Non-Layers
❑Pullets El Beef Feeder
❑ Boars ❑Beef Brood CoLd
❑Turkeys
Other ElTurkey Poults I
❑Other ❑Other I Number of Structures: ..r
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑Yes [I No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes I�vl No El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes E?f o ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: JU — Date of Inspection
Waste Collection& Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes JNo ❑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(AZ- 1i
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 29
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes [3 No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes Ud"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 ETNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q<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 0 Yes ffeNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes Cj No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of(Wind Drifl ❑Application Outside of Area
12. Crop type(s) g e MI t1V 360
0
13. Soil type(s) a
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes EN'T o ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes [2 No. ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:]Yes IJ No ❑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
@omments refe%to que a#) I m;apyYESanswers' andlanyrca m end s or any other comments.
Use drawing's offacil�ty;to betterexplatn sEtushans (use add�ttorisl�pagesas necessary
iq,) 0661) 06W LC it-A, LALL wAW l)We A'f pnw✓_60 uvM.1b6(L .
2:0,) VPDOC, WUB wrrN Cr e w-vd-00W-1 AND ACC-CAG-C V ZA&)C5,
al ) W G-2Nt t2EQ�rR�,S oJE t.J �n�1��u T3�� .,PPA7(-
11t 0 sA-'Vj =Ns'feC C Ko Q coots,
FAn4VtG6L_ WAS POT MOCA EFK6Kr. 1V CIAAC& GJ-oP ww 4 jAx(?Q4JC9 �y
Reviewer/Inspector Name o � lv }� ,'° Phone:CQ !�(o —
Reviewer/Inspector Signature: Date: 66 S
12128104 Continued

Facility Number: — Date of Inspection toy
Re uired Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? l!J Yes ❑No ❑NA ❑NE
20. Does the facility fail to haWw"UI'
components of the CAWMP readily available?If yes,check aes ❑No ❑NA ❑NE
the appropirate box. ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. w1yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑Arinu l Certification
❑Rainfall Stocking L✓J Cekrop Yield �120 Minute Inspections E onthly and 1"Rain Inspections � VeatherCode
22. Did the facility fail to install and maintain a rain gauge? ❑Yes Er/NNo El NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes D N o ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El El No NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes 2<o ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes No ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes L:d'No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes 2No ❑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 2rNo ❑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 Oo ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application) ��
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? El Yes D o ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes �io ❑NA ❑NE
Additional Comments and/or Drawings:
12128104

Jit-Y
IBM
Q,tD Madn of Qoil'
an dWater ic Siservation*
y7 T
NMI ,OM
RIM
w-10 :,VO�M­ 001
Type of Visit g(Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit /Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number
Date of Visit: Time:
I I
10 Not,Operational 0 Below Threshold-I
)gPermitted [3 Certified 13 Conditionally Certified 13 Registered Date Last Operayd or Above Threshold: .......................
.... ..................... C.ountv.
Farm Name: ......
Owner Name:• elsjgET.. .............
]PhoneNo:
Mailing Address: ...................................................
12Y 6
Facility Contact: ­-­..­-................. Title: ........ ---------- Pone No:
; qC C
­-- Integrator:Onsite Representative: .................).. J...............................
Certified Operator Certification
Location of Farm:
A6
Swine 0 Poultry 0 Cattle ❑Horse Latitude Longitude
- Desi'go urren
-ci i),
a
E]Wean to Feeder 0 Layer
E]Feeder to Finish `0 Non-Layer ❑Non-Dairy
J­
Farrow toWe
an
-1[3 Other
­­5
Farrow to Feeder
'E]Farrow to Finish Totat Design Capacity
El Gilts
Z
Boars
L
Number
Discharees&Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes No
Discharge originated at. El Lagoon [I Spray Field [I Other
a. If discharge is observed,was the conveyance man-made? 0 Yes E3 No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) 0 Yes 0 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 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 P1110
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? 0 Spillway ❑Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6�1
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 XNo
seepage,etc.)
6. Are there structures on-site which are not property addressed and/or managed through a waste management or ❑Yes XNo
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 maintenancefunprovement? ❑Yes /0 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes P?rNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ❑Yes ❑No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over application? If yes,check the appropriate box below. Oyes ❑No
❑Excessive Ponding ;jfPAN ❑ ydra 'c Overload ❑Frozen Gro nd ❑Conver and/or Zinc
12. Crop type f tv SF�.p
13. Do the receiving crops differ with those design ted in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes 0 No
14. a)Does the facility lack adequate acreage for land application? ❑Yes VNo
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? 0Yes 0 No
16. Is there a lack of adequate waste application equipment? ❑Yes I&Na
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑yes 12mo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes VNo
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes ONo
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 ZZNo
Air Quality representative immediately.
z on#} 4A*R ara any A§answers anu/or a ny recomumemdations orany odixer co aments.Comiitents(refer to'quesh
Use drawl of facility to better explain si tnatio>is.(ase additional pages as becessary} ❑Y. Field Copy �❑Final Notes
d? S t�r N 5 li d` loe
/r,M 46,4W41 4V-4,
-. �.:= _ __ .-.-,--ter•-•-r' 3r t. -T-'—.- ,�-�-..r-,.�'r--^"�'�rS,,�;-,-r�. ,i.- - , �,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /
12112103 Continued

• Facility Numbers — Date of Inspection
Required Records&Documents
21. Fail to have Certificate of Coverage&General Permit or other Permit readily available? Yes ❑No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/WUP,checklists,design,maps,etc.) ❑Yes PfNo
23. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes JZNo
❑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 VNo
25. Did the facility fail to have a actively certified operator in charge? ❑Yes ;KTo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes P(No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes PffNo
28. Does facility require a follow-up visit by same agency? ❑Yes 17No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes VrNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit?(If no,skip questions 3I-35) ❑Yes ;jfNo
3I. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No
32. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑No
33. Did the facility fail to conduct an annual sludge survey? ❑Yes ❑No
34_ Did the facility fail to calibrate waste application equipment? ❑Yes ❑No
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes ❑No
❑Stocking Form ❑Crop Yield Form ❑Rainfall ❑Inspection After I"Rain
❑ 120 Minute Inspections ❑Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddltyoaal Comments and/or DrawingS W C '
� -� L1Jlr� � T�Cr-E , PFC. NSF.-� (p QDCe�iviE�T CiLnP �tJ2nJOouJ �qN
Onsrl_
Vp
NSF 1-79
ef
�.N'p �✓r—I�/9 PYG�C�T�20`v O� ��N ��.�-, G15,�' D,G G�,�4or+/� �NR s
��� D�,�iPi¢�t r�J�!>'� 5 LUG /�L1-Zi✓��-�NCO �,enwJfQ 2�
..
12112103

Division of V4'ater Quality
�Division of Sail and Water Conservation
�Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 6Complaint 0 Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number 1 Date of Visit: d 3 Time:
18 Not O erati nal 0 Below Threshold
Permitted O Certified 0 Conditionarlly Certified 0 Registered Date Last Operated
ddlor Above Threshold:
Farm Name: TA vl G Q �� t`�`�� _ County: (JG�✓�G/C�
Owner Name: gob c`4 T� C Q Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: LL Ce 1 0 v _P Integrator: lj14"Jh t?f l'1
Certified Operator: Operator Certification Number:
Location of Farm:
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude 0°�K Longitude
Design CurrenE Design Current Design Current
Swine Ca aci Population It , Ca acity Po Elation Cattle Ca acity P,o ulation
❑Wean to Feeder ❑Layer JE1 Dairy
❑Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean : = .rs
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
El Boars Total SSLW
Number of Lagoons �_J ❑Subsurface Drains Present ❑La soon Area S ra Field Area
Holding Ponds/Soliid l MID No Li uid Waste Nlana ement S stem
Discharges & Stream Imkacts
1. Is any discharge observed from any part of the operation? ❑Yes 0
Discharge originated at: El Lagoon ❑Spray Field El other
a. If discharge is observed,was the conveyance man-made? ❑Yes Cl 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 _Z 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
Identifier: 1
Freeboard(inches): Z
05103101 Continued

t
Facility Number: f!p — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion. ❑Yes ❑No
seepage,etc.)
6. .Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ❑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 maintenanceliimprovement? ❑Yes ❑No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ❑No
Waste Application
10. Are there any buffers that need maintenanceiimprovement? ❑Yes ❑No
11. is there evidence of over application? ❑Excessive Ponding ❑ PAN ❑Hydraulic Overload El Yes ❑No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ElYes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. is there a lack of adequate waste application equipment? ❑Yes ❑No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes ❑No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design_maps,etc.) ❑Yes ❑No
19, Does record keeping need improvement?(ie/irrigation.freeboard,waste analysis&soil sample reports) ❑Yes ❑No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑No
22. Frail to notifi-regional.DWQ of emergency situations as required by General Permit?
Del discharge.freeboard problems,over application) ❑Yes ❑No
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 ❑No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Gommetits'(refer to gnedioaj:'Eip7am apy YES answers and/orany recatnmenc#at�ott5`or sm_%a�er eommedts. a _ z� `=
Use drawini,s of facility,to better explaen situahons.(use additionslpages a necessary) r Field Copy ❑Final Notes
x� �.�-...,wiczr,�'$��_i,=�..�`.�'.::=»._.�'_i-�_-, _`"-+�;c+e�._.`.,�C".�-.� ..R.'«.�T�"s'- `c..-,�.e'_-','w �r.:r4< �-•�_.. _ Ate•k:1�'
Th;s rnr,petw1'a*-t t.�l� Gmr1G�v64eG ;+�, re�p©nse 4 a Ce�+,fat�►''r
;rah 1"00PN leuerls and eVC.r /evtrit�+q Ia�oO» T _<ee rio ev,'detice
-1 k�� I arJcurt level "s beep r'n 0r0101+110" e e 0%1fe �-
i nvGs� f� �� j4e �';e/d g v f-tWelf n;_t 4t e area,^b .s4re'n^%. oinpt T Ste
n vSde� eC� eF a G��'sGha� e• ` jefe aeg soMe 4COIR/ 17093
o,�0 m 'q Ae' and- lie heed �o /tee Uovey-e'ooy . Alsv.�
-�
Reviewer/Inspector Namer'
Reviewer/Inspector Signature: Date: s C?3
05IV3101 Continued

Facility Dumber: — I Date of Inspection 5 G
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? -OYes ❑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
X NVare 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.) ❑)'es ❑No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes ❑No
32. Do the flush tanks lack a submersed fill pipe or a permanentitemporary cover? ❑Yes ❑No
Additional Comments and/or Drawings:
e Boas are -al r, derA of
F�1 u/TAce ;-4ttr hee®C-In de /cas-C 3�ee� 6elml� �vr��LP .
The. Y-eceiv;�� ero10 ��pe�r-s jo E,e �o►VJ9 well ten( -the Ca aok)
�}•►a[ sw� 'te Gla�cse ot✓'e�r iS r-ve1J -rh t.k vm far Ottvl^
} � y
I'bl(l i rf'�4i YJ T �� trr� r h CiC'4� Gav?d►�-� r OL. �e✓" GI/o,f YHLi"'�JgeP-W $7
t
05103101

' 4
Obmston a Water Quality
Dtvision of moil and Water Conservatton { .
Other Agency
- art
7,7
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ,OJRoulline O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number j Date of Visit: D S OZ Time: Printed on: 7/21/2000
O Nat O crationat 0 Below Threshold
Permitted ©Certified [1 Conditionally Certified ©Registered Date Last Operated or Above Threshold: ............
Farm Name CQ ,Cf. ��.. .r.t'` L...................................................... County: ......C. r'��.'r2 .......................... .......................
......................
Owner Name: 90 f, - J-6�CQ Phone No: .......................................................................................
............... ................................. .............
Facility Contact: .....Title: ..... ...................................... Phone No: ...................................................
MailingAddress: ............ ............................................................... ..................................................................................... ..........................
Onsite Representative: ......,A',Cj!i.a./ `je''fC'e fi M [,
...... .............................................................................. Integrator: ....G...... :W.ue--r1
Certified Operator Operator Certification Number:................
Location of Farm-
End S Q 1136
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� ��° Longitude �• �� ���
-1- = Design Ctirrent Design Current Design. airrent
Capacity Po elation Poultry Ca aci Po elation Cattle. Ca act _'P i la6on
-_ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non-Layer 10 Non-Dairy
Farrow to Wean
❑Other
Farrow to Feeder ;
Farrow to Finish Total Design Ca cit
Gilts Y
Boars Total SSLW
p p E j Subsurface Drains Present Lag#svn Area 10 Spray Field Area y
w5l4tingyP�nds f Sohd' 'raps ❑No Liquid Waste Management System
Discharges&Stream Im acts
1. Is any discharge observed from any part of the operation? ❑Yes XNo
Discharge originated at: [ILagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made'? ❑Yes 0 No
b. If discharge is observed.did it reach Water of the State'?(If yes, notify DWQ) ❑yes 0 No
c. If discharge is observed. what is the estimated flow in gal/min? n ICt
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑Yes JdNo
2. Is there evidence of past discharge from any part of the operation? ❑Yes 4!f No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes gNo
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ffNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................. ...................... .................................... ._......._....._................. .................------..........
. ................... . ............ ...........
Freeboard(inches):
5100 Continued on back

FacilkNumber: — f Date of Inspection 25
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑yes'RfNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ,!fNo
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes ,�No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes Z- No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes oNo
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ,H Hydraulic Overload , Yes ❑No
12. Crop type �B v eeinv �aj , Sma -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMPV ❑Yes E!rNo .
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettabie acre determination? ❑Yes -PIRo
c)This facility is pended for a wettable acre detennination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ONo
Re uired Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ,ETNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ,fYes ❑No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes EfNo
21. Did the facility fail to have a actively certified operator in charge? ❑Yes A�JrNo
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 JPTNo
24. Does facility require a follow-up visit by same agency? ❑Yes PfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ONo
iPils.B &fleiendi$-ware)a0(e#0 g thisylsiti Yoh ee�ive i1q fu;t ior
comes orideirce awlit this visit.
'Cc►mments(refer ttr gaesttonr#) ,Explaun`any,YESanswe"rs and/or any recommendations or any otliercomnaenta.
��dravvr��,of_;,�acility,�tcrbetterexp�arts�tuahbns.{use ad�bonal pages�as neccssatyjz .A��-T���.�,�: �,e.r��x
You hied �o not r}vn any zO.Vie �o� more -Actkk' 44,-ee and ���lc�c�f'! •
'�Gre tnui Stour Oerltca'a".07_ts %,ee '(tsvffi.-q )"r, ►vtC:'G 4Z► ;j 0✓?e i✓IC1
der QG/e beF'rk� aef/icd -
18. IVeeA 4o a9 ooh 4er,1,5 j 1',)Ao
1�. Be sv�e -fro c.tse r-j - analrf.'s
�pal�c��;6n e✓�n�r -�o cajevla4e _/he
Ile- sv av -I n ke r"'ey iQ'?4 j &'n 6 c � Gave/' 0111 n.�,o lI cg-1►'ril evens'
Reviewer/Ins for Name ,. r * ;- _
Reviewer/Inspector Signature: Date: Z.S QZ s/pp

Facility Number: Date of inspection ! 25 a� Printed on: 7/21/2000
-Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ❑Yes ZNo
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 JE�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 ONo
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 ETNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes ,ffNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑No
F
-ommentsan or swings::.C'O't4;Jue Yettr e+rrO1 -$ 4C> esl'z "S� caves Dn Ae back c.ernee-
Yo4r plead bvet'a[ Pf'4 mA1 b-e - � dose 4, -the -4/rn, . "ee/,
4o keel Q1 ��O �� . by-��e� �ce�► by���I al-1'ee-i �O siren►+-t .
5/00

®Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Beason for Visit Woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 10 6b Time: ® Printed on: 7/21/2000
�(,
Q Not Operational Q Below "Threshold
0 Permitted [3 Certified0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .............
FarmName: .................I1.4li.ce..... s........................... .. .. .. .. .. Countv: .....ckx.fth"'�-- .............................. .......................
Owner Name: ....................... -S.ii-�y� 3.-. '� .
.......................... ....... �te.r....................... Phone No: Z
..........................................
FacilityContact: ..............................................................................Title: ................. Phone No: ...................................................
MailingAddress: ..................................................................................................................... .....................................................................................
Onsite Representative: .........&. ..ISo1'eu............................................. Integrator:....
Certified Operator:............... !r ....t;,._...... ....3.Q*.e.......................................... Operator Certification Number:....J. ja.3�...............--•--.
Location of Farm:
i
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude 0• �' °�
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
El Feeder to Finish ❑Non-Layer ❑Non-Dairy
Farrow to Wean pp
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lawton Area 10 Spray Field Area
Holding Ponds/Solid Traps ❑No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No,
Discharge originated at: ❑Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made-? ❑Yes No
b. If disclarge 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? Af��
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 Q No
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage) less than adequate? ❑ Spillway ❑Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............q.s............... ...-.......................I........ .......
Freeboard(inches):
5100 Continued on back

acilit�Number: — l hate of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes [9 No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes IM 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? tA Yes ❑No
8- Does any part of the waste management system other than waste structures require maintenance/improvement? ]Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ®No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes RNo
IL Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Yes PNo
12. Crop type
13. Do the receiving crops differ with those designated in the&rtified Animal Waste Management Plan(CAWMP)? ❑Yes ®No
14. a)Does the facility lack adequate acreage for land application? ❑Yes [X No
b) Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ®No
16. Is there a lack-of adequate waste application equipment? ❑Yes ®No
Required Records & DocumenLs
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes R No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) 91 Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis& soil sample reports) VI Yes ❑No
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21- Did the facility fail to have a actively certified operator in charge? ❑ Yes W No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑Yes WNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes CR No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
. .N. 6-yiolati6xis or di fc�en66•were hated du-;ing 4bis.vjSit. Y;au will reeeiye do further:
: : ,corres onctence:about this:visit: : : : : : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
7. Nuc. �,(cc s (�la ns N4LkQ UL- `lama d(4 t,x'A1 0f A��r.- lie h,ps Ar,
u+`t1 _NV, t_e"�
1 ` �p rS�tu e cN� �S• !plc nor Px05�at` a r *L L 41 f kmtt
�. yu lie-
Le 69 �� a � r �e�o ,L c r od
rtkK
4� 4"_ �aY-►­ 0 __ W V.a,.l(,s -',""W be "a�c`tc�
Ig. Irsee jbkrlroo�e'�'& Cotc� GkcA i%�5 S�noulU ;r` he�0 Can e �e�co� NRCfi/�6
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 0 3 oc7 5100

Facill[y Number: l — t Date of luspection f 6D Printed on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aYor below ❑Yes IJ 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 `p 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 Iagoon? ❑Yes No
30. Were any major maintenance problems with the ventilation fan(s)noted? O.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ®No
Additional Comments and/orDrawings:
uo as sl oA �e loAw.Q a� I�R L tar e.cC� ct�Qkce ew�. •
l�ve�s sh0��� cctpf)el w.Ut OA� W��- t0; NSr,,. nco-k
5100

l
;Division of Sod and Water Conservation ©peration Review
Division of Soil aiid•Water Conservation Compliance Inispectioii
IZDivision of Water Quality
enc Compl>isnee Inspection r
`"- Other A O eratlou Review - _
1'a y_ l?_r w= -16DRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-u_p of DSWC review Q Other
Facility Number Date of inspection Ib q
Time of Inspection L 9L.o 24 hr.(hh:mm)
©Permitted {Certified Q Conditionally Certified Q Registered 0 Not O erational Date Last Operated:
FarmName: ...... 4YCi'r........ .j... 1'r*..•....................................................................... County: ......�?'�K�.._............._......._......... ._....................
OwnerName: ...........:............ l JJJiC ......... ........ f.. .................................................. Phone No: . l.Z' .- 4,0.....................................
Facility Contact: ......... ...................Title: ........................... Phone No
Mailing Address: ......14..........C.. .134...... �....... -........ ...11�cw. (� NC............................................ ?�Mq......
Onsite Representative: ........... k U f,.�r....................................... . integrator:... c 1 _ DY.h4..................
Certified Operator:................................................... ............................................................. Operator Certification�Number:..........................................
Location of Farm:
R4sr.Y?�........I ........0.{C...... ja ........ ........t..(..�........ . .r��.... ,0� k ..... .............................. ..... ��
................................................................................................................................................................
Latitude •�� �•� Longitude �• �� ���
' Design Current =' Desi. . ,
gn ;Curr`ent= -, Design Current
Swine . „ Catle:o •Cacity-.Po •Ca acity Po ulatton. ....Capacity Population P
Wean to Feeder ❑Layer I I El Dairy
❑Feeder to Finish ."'❑Non-Layer •' ❑Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity g
❑Gilts,
-- - -
❑Boars =Total SSLW
Number of Lagoons,: ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdiiig Ponds'/.Solid Traps .; ❑No Liquid Waste Management System
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ®No
b. If discharge is 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. Doe-,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 �TNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes RNo
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes [�3 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...........;IT................ ................................... .................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees, severe erosion, ❑Yes �j Na
seepage,etc.)
3/23/99 Continued on back

Facility�Numberl — Date of Inspection �Q q
6_ Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Qg 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? 12 Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes P No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes N)No
Waste_Application
10_ Are there any buffers that need maintenance/improvement? ❑Yes WNo
1 L Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Yes M No
12. Crop type % ��.� _ small RVZ,4-.
13, Do the receiving crops differ with those designated in the CertifieAnimal Waste Management Plan(CAWMP) 11' •Yes� ❑ es [g No
14. a) Does the facility lack adequate acreage for land application? ❑Yes U 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? (PYes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes Pj No
Required Records& Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes 09 No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes [$No
22, Fail to 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 [RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
E .Nb.yiblafibns;or-deficiencies were hbted•during this;visit:•Voit will-reeeiye irio futftf
6 res• oricfe. . .abauf this visit: : : : : : : : :
Comments(refer to.question#) ,Explain any YES answers and/or any reco i mends ions o-any other comments a
UseArawin of 1icrlt to-better e _
lain situations use additional pages as necema x w
7. �ie a�QS S�wu�CJ j3e vfl�efq C[�• EtoSiGn 0.,3 s Vqj v aV (6- cwr. 6At t'W1 -sIatd 6f- `
F, I 1 rotas (' u-1 L (f
eS. l4r VXy,,JP- 5 1� 62 �YV'*1SQ ,,& SOOV\ GS Tlf�� C&,W oKS Q 1t01�.
lls- `�'� "SCON aeS,c�t` 56U@ 6 ire rusty, KCOA .
ti. 6e le,61WK wok V-a ?�t� tturv� r Pack o �1��SL&�'I
e � cor,Lct �t N siwt be- faloojel� ��
be Oc{ wtf\c Out �r bcKodm.
T
Reviewer/Inspector Name t -�� �,�=�
Reviewer/Inspector Signature: Date: jb
3/23/99

Faciliij Number: — Date of Inspection Io I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes RNo
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 [R No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes 7 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes RNo
Additional:Comments and/or Drawings"
a
3123/99

� u
• -.,� � _ � s"�--..:fix ,;�_,.b:•„,.�.:s:..A;;;.;,.:..M,;,...F,� _.:� ...,�.,.:.:. .,..,�. :a8a�%�
F� 0 Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
y
., ;_. �€..,� .�.-�,� ,; ;".-�.":" •.=`-�.,rc•. .+rrrsvaa...���._,.a.;m'�:z°�^?�.°-.�: .,.rr��yeg,•z'.,..� � - b3. m:«'°°°...�
Routine O Cont taint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Date of Inspectioi
Facility Number
Time of Inspection 24 hr.(hh:mm)
Registered [3 Certified 13 Applied for Permit ©Permitted 113 Not O erational Date Last Operated: ............ .
Farm Name: .. .... C1.�{.L -....... G tt'�h��.l� County:..... .. ........................... .........I.............
...............�.I.. ........................
Owner-Name:....... e............ ....., 7:- a ................................ Phone No: ....�,r,-... .' {. Ci0.........................................
Facility Contact: ...,,,.„1.LkA.a v. . �+!Z G Title: [� w Phone No:Y ..... ..........
Mailing Address: ....:... .2_2.........
iegr ..........t � o,..)e r........................
Onsite Representative...... .. ! Z fi? WVIL.li._...... .. Integrator:.....-Y01C.�,j4/&U1 ...................................
� �? Number.•
Certified Operator......... ............... . . -.... .��................................. Operator Certification .-----...................................
Location of Farm:
............ ................I—... ....... .. �
Latitude Longitude �• �° ��
3 Designer Currenty Designs Current ''', Design Current ,
Swme Ca`paeity�Papulahon Poultry Capacity;Population v Cattle & Capacity;Population
_ „- a u,
El Wean to Feeder ❑Layer ❑Dairy
❑Feeder to Finish 1E1 Non-Layer "❑Non-Dairy
r F ow to Wean C7i' a: 33
❑Farrow to Feeder ❑Other Y
,
Farrow to Finish
Total Design C apa city,,.
❑Gilts
❑Boars
Total SSLW
x
.Number of Lagoons/Holding Ponds ❑Subsurface Drains Present110Lagoon Area ID Spray Feld Area
+' FO No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes No
2. Is any discharge observed from any part of the operation? MYes ❑No
Discharge originated at: El Lagoon [I Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes JKNo
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes JZ 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 IX No
3. Is there evidence of past discharge from any part of the operation? ❑Yes ®No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes No
i
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes ANo
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes $No
7/25/97 Continued on back

Facility Number: --
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes _I No
Structures(Lagoons,Holding Ponds,,Flush fits,etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes 4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(1t) ....... .F.. ........... ................................. ............................. ................................... .................................... ................I...................
10. Is seepage observed from any of the structures? ❑Yes IQ No
11. Is erosion,or any other threats to the integrity of any of the structures observed? Yes ❑No
12. Do any of the structures need maintenance/improvement? Yes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes No
Waste Application
14. Is there physical evidence of over application? Yes ❑No
(If in excess of WNW,or runoff entering waters of the State,notify DWQ)
15. Crop type ........�.7:I ,. ............... .��i.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes No
18. Does the receiving crop need improvement? EI—Yes ❑No
19. Is there a tack of available waste application equipment? ❑Yes M10
20. Does facility require a follow-up visit by same agency? Ayes (3 No
21, Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑YesVrNo
22. Does record keeping need improvement? ❑Yes Q 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 EjLNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes MNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes &No
No violatio'ns-or deficiencies.were-ho'ted-during this:visit:-You.will receive-no-furtlier:
correspondence about this.visit:
,: ..e�s >� -' a -- � -- was ".a- z� � �„•: a�.,.�.-�:ans aaA°s*.- ��� v� -.
Co`inments(refer,to�queshon#f} Explaue any,YES answers andlnr any re�om�enda�t�©ns or any other ct�mments.
Use drawttigs of factbty to better`.explatii sttuativns�`(usejaddttioi�al,„pages as necessary) � �, �,��� �-� ,�� : �{k
mr�,u ,9e .�:�• ' seT a�: �-.�. a �'�_ •x,F�� �. �':'��'- .o , .�>a.�,,,�?,,,a� � i�r. e �,_ .,,,�
jA c-c-oP_0-,-'U-7/ fvAC L
7/25/97
Reviewer/Inspector ame "�:, `. •� r� d
Reviewer/Inspector Signature: Date: g

x,t S�VC Animal Feedlot Operation Review REC E1V�' D
❑ D«'Q Animal Feedlot Operation Site Inspection AUG :.;, 1997
Rnutine O Com laint Q Fnllo\r'-rr ► of T)1�'t) ins �cctiarti O T'nlln\�-uTT nF 1fti�V(: rc\'ie\� — —
Date of Inspection
Facility Number (o
_ Time of Inspection 1. ' 24 hr.(hh:mm)
Total Time (in fraction or hours
Farm Status: ❑R e stered ❑ Applied for Permit (r.x:1.13 for I hr 1. ruin)) Spent on Review 3 O
54'Cert-if ❑ Permitted or Inspection (itrcludes travel andprocessing)
❑Not Operational Date Last Operated: .............. ..... _
Farm Name: �`�� ...F�i.. .............................................................. COMM.......... Q'� ��� __.. .. . ._
Owner Name: .. Phone No:
�_- ...........................................................
FaeilirvConctact: ..................... Title: ------ Phone No
Mailing Address: �Jls...S. A� rQ...1\oQ ...... U?�O{}....... .L..L..... 9_.. a .. . . .» . ...
Onsite Representative: ..15..An,A...... ...................... Integrator: ..
Certified Operator: 7,..._._.�... ...�p ���- rl�,. ..._......................................................... Operator Certification Number:�.�...
Location of Farm:
1fn��c� F N�w4or'C.4 n ...etI..S?.��..'.....S.,.L......ilas)......c�.��A�.._..P�.���..��. �.t...........
Latitude ' ° • �` 30 Lon-itn+le �' �• { l v
Type of Operation t' 3G � � r
M ,�� r - Design : :.Current Dcstpn .Current �f DM,i '� �
, Destgt Current 'n
Swine .Ca achy Po ulatton �'otiltry :t Ca 'achy= Po pit ,
wine., rCattle � Ca acitvPti�ulahon
v
❑Wean to Feeder �❑ Laver ❑Dairy
❑F der to Finish ; ❑ Non-Laver airy
. arrow to Wean
Farrow to Feeder Total Desttn fiCapaclty
Farrow to Finish
�1InSSLW Sy ko1 {
-
"❑Other.
.,,•i.,M,r�.--sr., .. �'� - ..�€.-� �.i��b?aine�ads y �-,'Xs�:;ri rr. ,-�
1F- Y��C' v
Nuinher of Lagoons/Hoidtng,Pondsry _ ❑Subsurface drains Present ❑ La�aon Area ❑Spray Field Area
General
I. Are there any buffers that need maintenance/improvement" ❑Yes 7110
2. Is any discharge observed from any part of the operation? ❑Yes
Discharge originared at: ❑ Lagoon ❑ Spray field ❑Other
El Yes El No
a. If discharge is observed, the convc\��tnct:nt::n-mark':
b. If discharge is obsc:n'Ld,did it reach Surface \Water? (If 7cs, nori±y DWQ) ❑Yes ❑No
c. If discharge is ohscr cd. \vhar is the estimated How in `�Irnrist'?
d. 'Does discharge bypass a lagoon systenn flfyes. notify D\VQ) ❑ Yes ❑N
3. Is there evidence of past disch:r e front any part of the operatiom? ❑Yes No
4. Were there any adverse impacts to the \voters of the Stare odier than fr+ten a discharl?c? ❑ Yes
5. Does any part of the waste marnt-,en-,nu s_,.•stem (other thsn iu-+oonslhoYin,t pon(k) requirc ❑Yes r ro
:Hain+cno:T�cri::�ixo\'C:T7C'nt.'
4/30i97 Continued on buck

Facility Number: ....U(O....—....�.....-...
1 fi Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ]VW'O,
7. Did the facility fail to have a certified operator in responsible charge? El Yes
8. Are there lagoons or storage ponds on site which need in be properly closed? ❑Yes.- o ..
Structures (Ln;pons andior 1'1old1w, Pntrdsl
9. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Yes o
Freeb(yard(ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.._......—....-....... - ... .--- .......--........-......
10. Is seepage observed from any of the structures? ❑X
VNo'
11. Is erosion,or any other threats to the integrity of any of the structures observed? es ❑No
12. Do any of the structures need maintenance/improvement? ❑Yes to
(If any of questions 9-I2 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 i/No
Waste Application
14. Is there physical evidence of over application? ❑Yes L o
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type C[xtr��...��r ��t�._.�r CABS..._...................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)?•. ❑yes
17. Does the facility have a lack of adequate acreage for land application? ❑Yes 70
18. Does the receiving crop need improvement? El Yes INNNCQV
19. Is there a lack of available waste application equipment? ❑Yes
20. Does facility require a follow-up visit by same agency? = ❑Yes 71N."O
2I. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes :zo
For Certified Facilities Only ,_
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ZN(�,
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes
24. Does record keeping need improvement? ❑Yes t��o
Comments(refer to question K): Explain any YES answers and/or any rccommcndations'.or any.other:comanents 'w :n- �:_
Use drawings of facility-to better explain situations. (use additional.pages as necessary):
Son.� m;nor eYeSien w�S f nk ROJ5, Aro Vw,z 4
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Slime. e405\00 �� t3ac�l5 tde oT �i1ti.�, fr1R.7o�tce 5a;d �� wo;,,�c� ring c�it��l1 QAa �ct$><
t 0.5 Saar a5 it �r:Qcl ot,.� s11oUa�� -o dp Sot F,cv�.x& i1Reo,
No makes Psbrole�S weYe secv.to:s�ralt Discus^
�,,,:�ti mR,.Tp,�� V-�-P i(� RocF' Water QCo,i 8 i1 f~to�ea, Fk0.eo5
A(e O•S b t&e r Gn>1k,�O l t ❑ ❑V
Reviewer/inspector Name ►• 'v" -
r '
Revie►ver/Inspector Signature: ( Date:
cc: Division of Warcr Quality, Water Qualirr Section. Facilit.v elssessment Ur„r 4/30197

acilitp Numher:..A .. Datc of Inspection: —�—
Additional Comments and/or Dra%vim-,s:
4
4/30/97

c,a^e-��y ���-s.S.��:, F°S�'..c9- ,v �` atsg�•�,• s�.��• 75�"x w3x�-e a�?S �'. � �s� ax a � s'a" ±•w�.� ..�:„f�'- �
T ��` � E DSW Aa�maI Fee of Operaflon Renew
, - *�e-•s i'.'"` & i k r . ..fin"' . �'
e
DWQ Aairnai IFeedlot Operahaa Site inspection
,0 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection �
Facility Number
Time of Inspection 5tK51 Use 24 hr.time
Farm Status: .-.,_.Zz-CidE...-- ,T -_-._.-,•.,.__
Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
Farm Name' �M(!r".
Owner Naive:. Phone No: iZ — .... _
Mailing Address: 3. _ n yL j j4E2 +�_ —1&4�tt
Onsite Representative:_- -_ Integrator:
Certified Operator:_ � 5� .....__ _ .� Operator Certification Number:_----_-_---.__-- „-.
Location of Farm:
Latitude Longitude
Not Operational Date Last Operated: A y-7 .....
Type of Operation and Design Capacity
Svvtne Nuumber `wPoultry � Number Cattle Number h
�.
E ❑Wean to Feeder ❑Laver TEI
Dairy❑Feeder to Finish ❑Non Layer Beef
Farrow to Wean
Farrow to Feeder
Farrow to Finish Other Type of Uvestock =sue
i
�s �Nnmber of Lagotsns faHoldingPonds f ❑Subsurface Drains Present
a `
❑Lagoon Area ❑Spray Field Area
` znt
General
1. Are there any buffers that need maintenance/improvement? El Yes ErNo
's 2. Is any discharge observed from any part of the operation? ❑Yes E No
a. If discharge is observed,was the conveyance man-made? ❑Yes O'NO
b_ If discharge is observed,did it reach Surface Water?(If yes,notiry DWQ) ❑Yes [?<o
c. If discharge is observed,what is the estimated flow in gaUmin?
' d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes E3-Ko
,. Is there evidence of past discharge from any part of the operation? ❑Yes ErNo
Yv4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑Yes 131NO
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes 0<0
maintenance/improvement?
Continued on back

6. Is facility not in compliance with any applicable setback criteria? - ❑Yes D�o y
7. Did the facility fail to have a certified operator in responsible charge(if inspection after l/l/97)? ❑Yes ,(—,C]NN
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes t�vo
Structures (Laeoons and/or Holding Ponds)
9. Is structural freeboard less than adequate? ❑Yes la�Ko
Freeboard(fr): L.a��l� Lagoon 2 Lagoon 3� Lagoon 4
s
10. Is seepage observed from any of the structures? ❑Yes 0'0
11. Is erosion, or any other threats to the integrity of any of the structures observed? EKes ❑No
12. Do any of the structures need maintenance/uprovement? ❑Yes 0-f o
(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 stnuctures lack adquate markers to identify start and stop pumping levels? ❑Yes ["No
N aste Atzplicatioa
14. Is there physical evidence of over application? ❑Yes [9-K6
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
is.- Crop type �� • _. �. . .__.�-
16. Do the active crops diner with those designated in the Animal Waste Management Plan? ❑Yes G—Ko
17. Does the facility have a lack of adequate acreage for Iand application? ❑Yes O Vo
18. Does the cover crop need improvement? ❑Yes 19-50
19. Is there a lack of available irrigation equipment? ❑Yes Lti'No
For Certified lF'acilitim Only-
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ❑No
21. Does the facility fail to comply with the Animal.Waste Management Plan in any way? Cl Yes ❑No
22. Does record keeping need improvement? ❑Yes G Ito
23. Does facility require a follow-up visit by same agency? ❑Yes D<o
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge? ❑Yes ,Bf4o
'�32"+c .. - -R:➢M5 �-y _...e$, - - i9 ...Y �:�se� 2....T -+riY.-3' -
Commeats(refer to questtan.lr}�E�latn ariy�YES answersand/or any recomtnendattons orzany other comments
ate, xY8°«8c"� �• 3 °` :�"��°x.�,, ggwP...— -�:„,��,, 3+- .�' �s,: fmt' ,,Y3 ,.,;��* --..-' �. �x � -:'M �4 :.
Use drawings offacihty to better explain sttuattons� use addtltonalpages as necessary) r � �� � �� �=
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AN� is ��/,.vG p,v�LoOi�io»•�� /-��s �,rW.�_ i./lt��- esiv
rk-Offr7 0,,V 3�c off' GR r+1 ►����
a - .
Reviewer/Inspector Name i Reviwer/Inspector Signature: �� Date: S 2tJ'
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 1 1/14/96

Site Requires Immediate Attention:
Facility No. Ito-!
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:
Time: I 70
Farm Name/Owner: e6r AK lzg�, e." v P �Ycel i
Mailing Address: 38.E C u.S A llWh �..a s3 . �✓rw0�t� n/C Z�l�a
�.�K�cn.6r°r County: __ _-
Integrator: Phone:
On Site Representative: Phone: 91 1_ZZ3.— 5*4 o
Physical Address/Location: 2.2 :�c�/ �
Type of Operation: Swine X Poultry Cattle
Desig'n.Capacity: *0 Number of Animals on Site:
DEM Certification Number: ACE DEVI Certification Number: ACNEW
Latitude: " Longitude: 76 " _'5 __' �� Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboazd of 1 Foot +25 year 24 hour storm event
(approximately 1 Foot+ 7 inches) d9or No Actual Freeboard: __�Y Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oio Was any erosion observed?(S�R or No
Is adequate land available for s rays p or No Is the cover crop adequate?<D or No
Crop(s) being utilized: -- _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?fdDor No
100 Feet from Wells? Y-es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? a or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o To
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oKV If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: efvlft S Xz�_
-.�-7� �i�t� lJ✓hf� //r,/�Q/L� (/�rP�T/U�� �L� tJ/��t�� L_�:Qi�
inlS /�J15•r� `��/L
Inspector Name gn tore
cc: Facility Assessment Unit ' Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. L-!IC
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE_, 19*
Time: 1 1 ;00 r
Farm Name/Owner: Cam" Ax lxA� e,n '
Mailing Address: „383 CVxgf ll � ,� . �/Cc,.Ipdxf A/c rsf:qLa
County: __C W_/CX T_
Integrator: - 6yL w tJ T Phone:
On Site Representative: Xce Phone: ZZ3- o
Physical Address/Location: ed w *.elW Z7f ICl/
Type of Operation: Swine �� Poultry Cattle
Design Capacity: 100 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot+25 year 24 hour storm event
(approximately 1 Foot+7 inches) (�gor No Actual Freeboard: -Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oiC9 Was any erosion observed?(YR or No
Is adequate land available for s ray? oor No Is the cover crop adequate?<D or No
Crop(s) being utilized: 114cfvc
-, Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?ODor No
'A.
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? IM or No ,
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o co
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oX9 If Yes, Please•Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or Nb
Additional Comments: _2/.1/ _ €T ZX,9.,1,A77 6_
�I►is f�"C115�.,�!�2
Inspector Name Cgn tore
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - .WQ Fax:[phone] Jul 21 '95 13:11 P. 08114
- ------ I VyiVy
she roq-jcos immud€it4 s tanug m
040fill f nufnh 7r
SITE VISITATION RECORM
Owner; g '�y Fame Name:
County: C.C4
AgantV15lting site: . -..,.,....,._.. Phone:
Operator, cs Phone: S Lk
OnSite,,Representative: __. Phone:
Physloai Address: ins.
Malling Address:
Type of Opar'atlon; , Swlne .,.— Posillry
Design Capacity,o-so�eU ATE: t t"ftj,, . dumber of AnImale on vita;
Type of Inspectlon: ,,. Ground _ Aortal
G1rcl(, Yes or No
Does the Animal Waste t-egoon have sufliclent froeboar 1 Foot}26 year 24,hour Gtorm event
{approximately t Foot+ 7 inches) or No
Actual FreeE oord: , Feel 0 inchaa
For facllfties with more than one lagoon,p:a:is address the otherrlagoono freeboard under the
comments secvon,
Was any seepop obsarved from the lagoon(5)? Yes or '
Was t1*9 aroslon of the dam? Y or
Is adequate land evailabla for lard appkatlon? a . or
Is tha covor crop adoquale? or No
Addltlorfal Commants�
1
Fax to (Die) M9 -35a

. . . . . . i VI/V`f
' Sffs requires Immediate sUadan
« Fadnry number
SITE VISITATION RECORD
Date: a�,\�{ fly
Owner: sa. 'R Farm Name:
-
Agent 1llslting Site: _._ Phone:
Operator. Phone;
pnSitelepressntative: _ Phone:
Physical Address: ,��,� i+a�r �a� �.� t,Le, a& 4 \k
Mailing Address: Qu, -z a qn\
Type of Gperailon: . $wine _._ Poultry Cattle
Design Capacity:aAo Number of Animals on Site:
Latitude: �.. .�° ' .� r l onijitude:
Type of lri pectlon: '; Ground _--•- Aerial
y
Cirelci Yes or No
Does the Animal Wake Lagoon have sufficlont freabaar 1 Foot+25 year24 hoar storm event
(approximately 1 Foot t 7 inches) or No
.'Actual Freel oard: s Feet 0 Inches
'For facipties frith more than one lagoon,P a4e address the otharlagoons'frseboatd'under the
comments sectlon.
Was any seepage o�sorved from ttta tagoon(s)? Yes or QbJ
Was tharo aroslon of the darn? Y s or (2P '
Is adequate land avillable for land appgcatlon? or No
,Is the cover crop adequate? or No
Addltlo4 Cornmentel
inature of Agent
Fsx to (M)r15-3558

Site Requires Immediate Attention:
Facility No.
DIVISION(JF ENVIRONMENTAL MANAGEMENT
`G I ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
r DATE:ff �u�SST 1995
Time:
Farm Naive/Owner: CG-` Al-, &O,l/ Je ed
Mailing Address: 3 3 4r ?'rr�u
County: _11 1fly rt�2
Integrator. 6o K i b¢ _ Phone:
On Site Representative: 36� Joise_ _ Phone: _j )S , ZZ� 'S d
Physical-Address/Location: _ayh,Aj(4
Type of Operation. Swine Cam_ Poultry Cattle
Design.Capacity: - q 00 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot +25 year 24 hour storm event
(approximately I Foot+7 inches) or No Actual Freeboard: Z` Ft. Inches
• Was any seepage observed from the la oon(s)? Yes o No Was any erosion observed? Yes 00�D
Is adequate land available for spray? e or No Is the cover crop adequate? or No
Crop(s) being utilized: Cad 5 r74-7 -k*V0 A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oro
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or�
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 bn specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name ature
cc: Facility Assessment Unit Use Attachments if Needed.