310011_INSPECTIONS_20171231

NUHTH CAHOLINA
Department of Environmental Qual

.D"0 n i_�:;! 11
ivision of Water Resources
Fa Hity Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (�'l/Zoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time .Departure Time: ' ,Ad County: f • Region:
Farm Name: f`Vleft R �t T Owner Email:
Owner Name: J�[4 a✓L © d�+� j �4-C✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: bJ �� ilTitle:
Onsite Representative:
Certified Operator: l�
Back-up Operator:
Location of Farm:
Swine
Phone:.ff Q�
Integrator: S ket�t'
Certification Number: L f5 '?3 F
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
I INon-Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
pry n
Layers
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ea.NQ--- f] NA ❑ NE
❑ Yes
❑ No
E-1 A
❑ NE
❑ Yes
❑ No
E:;.htA
❑ NE
❑Yes
❑No
[ A
❑NE
❑ Yes
Ea.No
❑ NA
❑ NE
❑ Yes
Pj'rio
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: ] - Date of Inspection:
Waste !collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
A ❑ NE
❑ No ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): '
Observed Freeboard (in): D rL+
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej 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 Io ❑ 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
EK0
❑ NA
❑ NE
8. Do any of the structures tack adequate markers as required by the permit?
❑ Yes
Q4o'
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
2eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E 10 ❑ 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): � �.r W14� c�� G b C,UA
13. Soil Type(s): Hik 4(e✓" !ro
14. Do the receiving crops differ from those designated in the CAWMP? V
❑ Yes
la<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L20<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
hlo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�—,,�
L.� <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
[2r1N'0'o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,;�Po NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ElrNo ❑ 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? ❑ YesVOO
❑NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L.e ll'o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �o
❑ Yes tf No
❑ Yes [;I -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
cv't 4-, q— 4 0
`` s,7 1, 5 1 G
�- R-z-f
3 q3 30
f e, 2-,X �rS
�c> -OFS
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date:
21412015

Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation L/
0 Other Agency
Type of Visit: Co ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: D County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: n Title:
Onsite Representative: - '� 9� y {r'S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
vey routrry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
? ks 73k
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[-]No
❑ NA
❑ NE
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 E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: -117 jDate of Inspection: 1't
Waste Collection & Treatment
4. Is storage'capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ----�—
Observed Freeboard (in): 3 � J U S�
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 0 o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes [2-NU
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Q oo
❑ 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 Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [f N
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LJ 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
6No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2-<
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
��"­0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Oo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E ❑ 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 ❑'K-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej­No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes -i•J 5-o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. D Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes D No
the appropriate box(es) below.
ailure to complete annual sludge survey DFailure to develop a POA for sludge levels
D Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
D NA NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? D Yes JNo ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? D Yes D No ❑ A
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No D NA
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? D Yes dNo D NA
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 ;a D NA
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. D Yes No D NA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? D Yes D' Th O D NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? D Yes LJ N DNA
34. Does the facility require a follow-up visit by the same agency? D Yes No D NA
Comments (refer to question #�: Explain anyaYES answers. and/or any additional recommendations or any,other,comments.
Use drawings of facility to better explain situations use additional pages as neeessa y
pT�le­tr+�S C
Reviewer/Inspector Name: 0w I � 112 --.t
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
D NE
❑ NE
DNE
❑ NE
D NE
❑ NE
❑ NE
D NE
Phone: 1(9 79 G 7 3�
Date: 0 4f!F�
21412014 A

y (D'bivision of Water Resources
Facility Number � - j O Division of Soil and Water Conservation
O Other Agency
Type of Visit: UFomptiance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 09, 1 Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: � �► t f1`
. n_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: 1 �SS73dr—
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Opb f QO La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WR)
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 DW R)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ 1=J�No
Yes '�0 ❑ NA [3 NE
[—]Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Fac ility Number: IDate of Inspection: J / 77
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ©'< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ! No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El < ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]�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 dNo ❑ 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 El"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E2"k0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0"NNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r?Noo
❑ 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.
❑ W UP ❑ 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 l" 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 E:�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

, ac'li Number: -t Date of Inspection: ti T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©/� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0� o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
E]rNo
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
[ -M
❑ NA
❑ NE
[:]Yes [�No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[!�No
NA
NE
❑
❑
dNo
❑ NA
❑ NE
�] No
❑ NA
❑ NE
�o
❑NA
❑NE
omments re er,to.gnestion. ):-Expla n any . 'answers an or any -additional recommendations orxany,other comments::
Use drawings of facilitao,beter�explain situati
ons, use. additional pagesasnecessa rY)•
Reviewer/Inspector Name: tr r L ° ..-j f Phone:
Reviewer/Inspector Signature: Date: 1
Page 3 of 3 21412015

Type of Visit: 0 Copipliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance V
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /b �, Departure Time:E�County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: Title: Phone:
Onsite Representative: _ Ddo lzz.1f Integrator:
Certified Operator: Certification Number: 9y 7 J y
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
�DesignCurrent k Design Cetrrent
. .
Design Current
-
5 �Capcty�PopWetPoultryCapacity P,op.
Cattle
Capacity Pop.
Wean to Finish Laver
Dairy Cow
Wean to Feeder Non -La er I
IDairyCalf
Feeder to Finish
Farrow Wean D.es'Car
jDairy Heifer
Dry Cow
to - ren
Non -Da'
fi Farrow to Feeder i) ` P,oul# . Ca .aCi -Po .._
'
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turk e s
,t?ther LL
Turke Poults
Other
Outer
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C2rNZo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21417014 Continued

lFuhity Number: jDate 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: f ,t Z 0/i 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b � b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes E f No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes `� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CJ i10 ❑ 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 Cj/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 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F1`N0'o❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 040,
❑ 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
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]Xo_
❑ 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
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
ff�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
io
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes jNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yyes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
Tilureto complete annual sludge survey ❑ Failure to develop a POA for sludge levels
n-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 WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ZNo
❑ NA
❑ NE
[]Yes
dNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
'' No
❑ NA
❑ NE
6No
EYes
❑ NA ❑ NE
B; ❑NA ❑NE
No NA NE
❑ [3
❑ Yes
❑ Yes
FAa.l\ Vie.�kNFLY RrZAASEb A00 LAG0-01\j 21� �As 8.� S-.✓oCE.
ff -to O W 00z'S To R PO IZ,E Ss
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone TO � 6' 73 gD
Date:
21412014

v Division of Water Quality
FaCllity Number 0 Division of Soil and'Water Conservation
0 Other Agency
W .;.
Type of Visit,'1ornpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit _(;�<outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I , eparture Time: rf? ounty:
.�
Farm Name: U�i
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: AlQ Lf t S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Z ❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
A ❑ Farrow to Finish
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =' ='
= Longitude: = ° ='
=
. Design 'Current Design Current Design C
._
Capacity Population Wet Pouttry- Capacity Population Cattle Capacity Po
_LLJ Boars I I�
Other
❑ Other �-
❑ Layer
❑ Non -Layer
Dry,Poultry
❑ Layers
❑ Non -Layers
❑ pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dai Cow
❑ Dai Ca!
❑ Dairy Heifer
ffDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoyA
_Number~of Structures ,.'
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE.
❑ Yes No
❑ Yes N o
❑ NA
❑ NE
El Yes No
El NA
❑NE
Page 1 of 3 12128104 Continued

Faciflty Number: -__j Date of Ins ection: > /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %W 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: IV— _ _ C2
Spillway?:
Designed Freeboard (in): Observed Freeboard (in): 07 1V
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes �i No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) J"
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes XNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes rj} No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes j/� No ❑ NA ❑ NE
maintenance or improvement? Y,
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes PNo ❑ 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
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�"No
❑ NA
❑ NE
acres determination?
T�
17. Does the facility lack adequate acreage for land application?
❑ Yes
,5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jzf,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Z(No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

FacUi Number: - Date of Ins ection:
2?l. Did tie facility fail to calibrate waste application equipment as required by the pe t? [:]Yes '0 No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o
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'ONo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes o No
❑ NA
❑ NE
❑ Yes 0'No
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes FrNo
❑ NA
❑ NE
❑ Yes ❑/ No ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
IComments,(refer to question ft Explain any YES answers and/or any additional recommenuatnons,or.•any other comments
Use drawings of facility to better explain situations use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: .S
4/2011

Division of water Quality
Facility Number l' 0 Division of Soil and Water Conservation
I 0 OtherAgency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral /Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: F---] County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No.
Integrator• /6:
Operator Certification Number:
Back-up Certification Number:
Latitude: [::] n [=] ' =" Longitude: = o = =
Design Current Design Current .. Design Current;;
Swine Capacity 'Population Wet Poultry Capacity 'Population Cattle° Capacity -""Population,"
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ La er
❑ Non -Layer
,: Dry Poult .
�'y -
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field OP(Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
NumberofStructures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
XYs ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Z Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
,fYes
❑ No
❑ Yes
2TNo
❑ NA
❑ NE
❑ Yes
0"No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Cn lection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No El NA El 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
WNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
01No
❑ 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? ElL
Yes
I No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
In No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2No
❑ 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
❑ No
❑ NA `PrrTE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA P NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ONE
18. Is there a lack of properly operating waste application equipment?
• ❑ Yes
❑ No
❑ NA JPNE
tqusEanyESwmmendateons or anyLother8commenCommentsreer o#Yyts
:Ilse.drawings of facility to better explain situations. (use"a'dditional.pag'es as::iiecessary)
AL
Reviewer/inspector Name Phone � Gs—
Reviiewer/Inspector Signature: Date: l
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA P�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA WrNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [;INE
❑ 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 1;�NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ('NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA RNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA C21NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA PNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA PNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA P 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 P 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 PfNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C'No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? 9fYes ❑ No ❑ NA ❑ NE
Additional Commentsand/or Drawings: �/
e Lleaf/,?4 C le �ar� M/v0l/!s a�
u�0%j ,�re�,•r!t can ce�rr�s'�' '�-t J;O«l
44ce /6/t-G&PI—ol Or GtJ a6
t`t ✓ < �vJ dF� e!i 0
l� a GZ / - s S �!i � 6/ar_
Page 3 of 3 5iAzC ;J� rL / G, }Gt,�t,/� j 0>� s 12,28/04
A /&O0v wl,!t &{

�.. __A0 1)[vision of Water Quality
Facility Number Q Division of Soil and'Water Conservation .=
- .0 Other Agency _
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up Q Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: I
L
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
?e_/ ✓al
Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
" ❑ Feeder to Finish
❑ Farrow to Wean
_'- ❑ Farrow to Feeder
s ❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone:
Phone
/No:
Integrator: /Y2. X
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = = 1 = .1 Longitude: = ° = 6 = «
a77Y�/T,
Design Current Design- Current, Design _'Curre`nta:_-
Capacity Population Wet Poultry Capacity Population.. Cattle, Capacity Population
W jl_J Non -Layer - j L
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures.-
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify, DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? {If yes, notify DWQ}
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EJNo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
12Ro
❑ Yes
JNo
❑ NA
❑ NE
❑ Yes JXNo
❑ NA
❑ NE
Page 1 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
LIA 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
9 Identifier: .2 �6 3* Z_�3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
v
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2fNo ❑ 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 P"o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �fo El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes P"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ o ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O N ❑ 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
pfo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f IrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2</o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Fe o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor any recommendations or an—iiy other comments
o.br eglain statiUse drawtngsaof facility tpy)
Reviewerllnspector Name . - , Phone: eb —
Reviewerllnspector Signature: Date: t� 1::;P1
c4.__;
Page 2 of 3
I212RI04 Continued

Facility Number: — Date of inspection ZOI
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes YNo
E{El NA [I 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�❑
/IQ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
3"No
[3 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
C;,o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
VNo
❑ 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
VNo
No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings . :" � � "' w��
Page 3 of 3 12128104

TYPe of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up , 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: %% Departure Time: County: Region:
• _ -
'" Owner Email:
Phone:
Facility Contact: % Title: Phone No:
Onsite Representative: ea l S _ _ _ Integrator:
Certified Operator: Operator Certification Number:
Back --up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E:J . E=] " Longitude: = ° E:] . [--] u
Design C•u , en
Design Curren
Design C•urreut
Capacity apulalion
Wet Po Capacity Population
Cattle Capacity Population
Mean to Finish
❑ Layer
Dairy Cow
Feeder
❑ Non -La er
❑ Dai Calf
Finish
❑ Da' Heifer
o Wean
❑ Cow
NFeeder
o Feeder
❑ Non -Dairy
o Finish
La ers
❑ Beef Stocker
Non -La ers❑Beef
Feeder
Pullets.
❑ Beef Brood Co
❑ Turke s
her
❑ Turke Poults
Ji
Other
EQ
❑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)
ZYes
❑ 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
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
XNE
other than from a discharge?
Page 1 of 3
12128104
Continued

racility Number: 3— Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes ,'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 ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A6
I
42
Reviewer/inspector Name IG Phone: -
Reviewer/Inspector Signature: Date: l j
Page 2 of 3 1I2/28104 Continued

Facility Number: — Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
1 1t p6 rj S -<3GPm - d 6J1/, G/rlde
Qrd pii'v., oop� . 6/-a,�e� wr s �u,o"lx5 �l� Plate su�fil,�p�
a � la�aah
Gry 4`4674(% ,�_ d?C je�-vj��--
�� �41,6
�GJ Q clGr �raT l� d �Sa�S `
G'OYlaJ •w �a "O k
/' i�t/�� fl�iPr /G�-
��114
f� IfJ e Q f a! �PSh W��% �2��✓'
Jo M u e- .00 C�f FYI u c Yt C"�r a l fG fir. S U�ll�/7a�
e
Page J of 3 �k/ ��/ , 7`!d✓�-� ��//1` /�'l ftI%'ce l �%Yl Cr fJ`el. �,�2G✓S Gci zl2/�C7"
(' a-4 — c/�u/c S cap_AAI&__

• Division of Water Quality
i
Facility Number Q 0 Division of Soil and Water Conservation
- ' 0 Other Agency &Z I
IType of Visit-0-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit j2Moutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: % (� Arrival Time: Departure Time: County:
Farm Name: �/!7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Stone
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Region: O/
zd
Phone No:
Integrator: /Z _
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T. ❑ Layer
^� ❑ Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑'fVo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Zf No
❑ NA
❑ NE
❑ Yes
ET -No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: —
Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: _ 1 �7_ 3
❑ Yes 2No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
V S_ l
Spillway?:
Designed Freeboard (in): LJ
Observed Freeboard (in): z Z L ad
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑.No ❑ 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 ❑*o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[o
El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
o
❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑�io
[I NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P &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? ❑ Yes
❑ No
❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes ;J110
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ,8 No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes J:allo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
❑NA El 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):
"®o - ra61- /Y
Reviewerllnspector Name Phone: t
Reviewer/Inspector Signature: Date: %
1212816r4 - Continued

• Facility Number: 3 -Of Date of Inspection
Required Records & Documents ��,,``
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E:fNo ❑ NA ❑ NE
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 ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
k No
❑ NA
❑ NE
❑ Yes
,,� rNo
El NA
❑ NE
El Yes
JEJ No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
NNo
El NA
❑ NE
El Yes
�❑
LJ No
❑ NA
❑ NE
❑ Yes -2—No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Cl Yes g No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
SurV�5 - Ga, 00,7 ZT 7--le
(�,-A l- V G I - /'7 FPS
12128104

Facility Number 3
_,,Miviision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Ofildutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / r
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Owner Email:
Phone:
Facility Contact: Title: Phon a No:
j�� /
Onsite Representative: IV l-! C� c� N o uj� ; Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Region: —v-=�
Latitude: = o o d = « Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other -- — -- -__T
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
Ef Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
[I Yes El No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Cl NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

facility umber: —
Date of Inspection n
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
Strut e l XtUr
e 2 Structure 3 Structure 4 Structure 5 cture 6
Identifier: 3 r�;T4e ` ,1:2 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Cl Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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 Soi:
❑ Outside c
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
El Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I I Phone: 17 ,Sx
Reviewer/Inspector Signature: Date: $ a47g
Paao 2 of .3 1 /2RAM C.'nnd L,,,d

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ W'UP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
5A a l n5 [G & h p a roc tz (d
-� \j -e_e4 S
le f fert ES" to
0 oarCz )( -���� 5
` CO t 644 rb C+ J
�r t Level
S u -i iz- V,:) 0- �6 A 4 eLO f a S
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation -O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral j Emergency O Other ❑ Denied Access
Date of Visit: 7 rrival Time: Departure Time: �i 00 County:
Farm Name: Owner Email:
Owner Name: ��.PP�{j� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C&11'19A_ - 06+?ie zS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
W Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = d 0 Longitude: 0 = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Other
❑ Other — - - - - - --- — -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dair Cow
❑ Daia Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F'71I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
W1 Yes ❑ No ❑ NA ❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
/XYes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
("No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
e2lNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — l Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes wrNo ❑ 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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
4 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
VNo ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
0 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
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
❑ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA
NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA
NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or lO lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
XNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[--] Yes
❑ No
❑ NA
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
gNE
7zt�'j V""Aooj'€ �f�� _ &Axe6E PIC tivzcF
✓ f
T, ed 0p� VA n J/�5L`r/�R C►�l� n � �
,O jt�ViQ �0CWeRF 0.
Reviewer/Inspector Name R" ' �' .%�� , :• . Phone: 0
Reviewer/Inspector Signature: Date:
12128104 Continued

• Facility Number: 3� —j� Date of Inspection 2 /
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
{ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
/� NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
�NE
ElWaste Application ElWeekly Freeboard [IWaste Analysis ❑ Soil Analysis ElWaste Transfers
ElCertificationAnnual 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
[/NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
IPfNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
XNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
NE
/P
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
❑ NA
ZNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA to NE
❑ Yes VNo
❑ Yes ;XNo
RfYes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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12128104

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�FactityNumbery 3 j 4' �� O;Dtviston of Soil and Water Conservatron� r
o . � ther�:Agency.�
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �O Routlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: / ounty: Region:
Farm Name: TT 100( Owner Email:
Owner Name: — -- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
-Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator: ,///U� - 20tc�i✓
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: = c
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
f❑ Layer
Ir -�� ❑ Non -La et
Other
❑ Other -- - - - -- -- -- -._.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: O
Designed Freeboard (in): 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
y No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement? ev
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A 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 ❑-1 Application Outside of Area
12. Crop type(s) ,6& �� ©y f.1e—_O C . "
13. Soil type(s) Xd O, U11, 62,6 ki u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;#No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!
❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Af I AA- X91,1Z,;45
Reviewer/Inspector Name �C Phone:
Reviewer/Inspector Signature: Date: fjl
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [To ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists Cl Design
❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tcz 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V1No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NoEl
NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
IV
/(ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
2&
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z'No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewertinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 No
❑ NA
❑ NE
12128104

g.
L _ bivtsion of Water Q hty
Type of Visit _,eOriCompliance inspection O Operation Review O Lagoon Evaluation I
Reason for Visit,/6Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: S=Tune:
O Not Operational O Below Threshold
,M'Peratitted,,dCer 'hued 0 CondidonaBy Certified 0 Registered Date Last Operated or, Above Threshold: ...- ....................
FarmName:--------..Qjreg...4t. �...................................-•-- --- - --- - - County:......�agrs............... _........... ............ ...............
OwnerName: ..... . .... . ............................ . ........ ................ ___ ......................... . ....... . . ........ Phone No: -... .........
_.. ---. .... - -,... �............ ..
Mailing Address: ..............................
FacilityContact: ---------- ------------ -.-...---------.----------- Title: ... ...................... ...................... .... Phone No:............................ .................
Onsite Representative: ••„Iv11L1 �.., 6 P S_. Integrator:..................
Certified Operator:- Operator Certification Number:__......_
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. I .................. .........................
Freeboard (inches). 4 2-
12112103 Continued

Facility Number: — 1 1 Date of Inspection
V 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 0 Yes O No
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 maintenancetimprovement? Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 77-g9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance) mprovement? ❑ Yes N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
]] Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc A -`
12. Crop type ���A CC-)
1 Sw m u r)A �� 1 SG'L -)4UDb
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes Q"N
❑ Yes
❑ Yes 9-$�Yes
❑ Yes rNq,
❑ Yes To
❑ Yes No
❑ Yes 1!J Nc
❑ Yes IKO
❑ Yes 01 o
Conirreeats {refer to gnest�an #) F.�rplaja arty YES aasweis and/or any recomaiendlstions or ajiy other oorumeQts. "-
Use drawuigs.of iac�ty to better explain s�taabons. {ase �dthgnal pages as necessary] z � ❑ Field Copy ❑ Final Notes
F-Te Lt. *3 ANn rT-C-L p - g �-XEp SOKA C COOM OtJ C OL J
a
FLA Es , S f tv* SQR A`i F-LaZ5 ,
Kc-FP COPY mF Au&)LaL C-CRT wr RccCaYLPS
Reviewer/Inspector Name'
Reviewer/Inspector Signature: Date: S OG
12112103 1
1 Continued

Facility Number: — I Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [d No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.)
Yes eNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I �o
❑ 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 To
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes imo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ff � NNo'
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes 1<N
28. Does facility require a follow-up visit by same agency? El Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Kc,
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q'NO
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes Q N
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 to
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

5
_5
Division of Water QtlSlity
a L
Type of Visit MCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine 0 Complaint O Follow up 0 Emergency Notification A Other ❑ Denied Access
Facility Number Date of visit: 4 Time: Z
Not Operational 0 Below Threshold
Permitted IS Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name:l*t County: �I
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
Phone No -
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 0" Longitude r 0 0 H
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 31 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste ARDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN' ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVrMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This faciliry is pended for a wettable acre determination?
❑ Yes
❑ No
I S. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reguired 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/ VW'UP, checklists. design, maps. etc.)
❑Yes
El No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify- regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
Gel discharge, freeboard problems. over application)
23. Did Reviewer.'Inspector fail to discuss review•iinspection with on -site representative?
❑ Yes
❑ 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 AVINIP?
❑ Yes
❑ No
10 No violations or deficiencies, were noted during this visit. You will receive no further correspondence about this visit
P , :_ - ._ _ , = � -_
Comments° refer to oestson 1:3m "` YFS attsvrpets artdior _. s
jury recotnmendattons or anv-other comments: _-T
Use drawings of facility to better explain sttnahons: {use add,ttonal pages as necessary} Field Copv ❑ Final Notes
�❑
6h -11-7, e Af- `IyG f�!!
/
D
4, s*/0'W �e
341'.4.,t �s c .a t err t J/l6cv�,C �i.r t�a� %G s �l ��A� 'A 'W 1�s7�
LI%!sS drl i t.!►rl ` s ` rs d c' / .c K
s _ __ _ , ;
Reviewer/Inspector Name ��� m �°� � '- � r/ �,�'- �*�_��
Reviewer/inspector Signature: Date: Z
05103101 4-.1 IF Cond ured

I - . =:.
Type of Visit V Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit taRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: '—=� Time:
rQ-Not Operational 0 Below Threshold
M Permitted ®-Certifiedh /Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Co lr County: AU �/ 0 Al
1 r
Owner Name: ` M�,tr/J71 _ _ Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: I)VW el �O//I,4
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° Longitude a ° 0 K
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
I
I
j[__1 Layer
I
I
I
IQ Da
® Feeder to Finish
I Al 3 7,4
1
10 Non -Layer
I
Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
I Number of Lagoons '� I iLl Subsurface Drains Present ILJ Lagoon Area ILJ Spray Field Area II
Holding Ponds / Solid Traps ❑ No Liquid Waste Manage ent System
Discharges & tream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EK No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes tgNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C / e2- C3 CT'rr/ 4Cf
Freeboard (inches): Z3T 3j� %
05103101 Continued
0�

Facility Number: 2 — /'
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
❑ Yes W No
❑ Yes [Q No
❑ Yes ® No
❑ Yes allo
❑ Yes U No
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. is there evidence of over application?? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic OvvJerload--nn ❑ Yes No
12. Crop type /!et k e% P iErr (HAr/fl[J�dOGI'S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [,%No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [KNo
b) Does the facility need a wettable acre determination? ❑ Yes [ RNo
c) This facility is pended for a wettable acre determination? ❑ Yes [5jNo
15.
Does the receiving crop need improvement?
❑ Yes
P No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[ANo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
FLNo
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
PNo
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q9 No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
EZ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P9 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
BNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
CgNo
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[!? No
l No violations or deficiencies were noted during this visit. Y.'o�u. will receive no further correspondence about this visit.
�. .; �.�'c- -..e 'i-S.iF��+--s
comments (refer to question #1} .:Explain any YES answers andlor$anyiri commendations or any other commentsn ,, . _
K
t.< , �,
Use drawings of: facility�to,better explan�situations (r�itse addiorialpages as necessary)` ❑Field Copy ❑Final Notes ..
/CPtDrGCsd' ✓,fit Zpvk �A4
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2 ��
05103101 F y Continued

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

of Visit _PJCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number !� Date of Visit: 8 PON=otO
Time: [ 3 [ 5
rational Q Below Threshold
0 Permitted 0 Certified `0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..._...
Farm Name: Go' b et- f r , ""` County: " l' ""
..............._.................................................................. ........................... h'= .._...................------•----- .... ___...._.
Owner Name: L.`^rwIS................................. Phone No:..................................................................
,Facility Contact: ............................................................................... Title:................................................................ Phone No:..................................................
Mailing Address:
Norr
Onsite Representative:..........:} C./ t*S ' l�[' n `' 1a6 �Q�..... Integrator:...�U�.
�...........................................
Certified Operator: ................................................... ................... Operator Certification Number:
Location of Farm:
A.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude l �• �° r�i� Longitude �• �� �«
= Design : Current gn Desi . Current ;Design . Current
5wiae` Capacity` Population Pow Ca aci Po ulatiott _ Cattle Ca aci =: Po ulaSon n.
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 10 Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeSI Ca aCl
❑ Gilts P
❑ Boars Total SSLW
-Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
"Holding Ponds / Solid Traps;; _ ❑ No Liquid Waste Management System
:.
Dischartres & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ YesA!TNo
❑ Yes ,fNo
❑ Yes j2 No
P1l�-j
❑ Yes 01No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j0'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: �- C ,3
.......................................Z........................................
....
Freeboard (inches): ST 2 g
5/00
❑ Spillway ❑ Yes JO No
Structure 4 Structure 5 Structure 6
G + 7-PA G `{- -Is+ GZ Is+
..............................................................................................................
Continued on Lack

Facility Number: 31 —11 Date of Inspection ( Q
• 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j2 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify-DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ZfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yesj2"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes-j2rNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes J3"No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
) ❑ Yes jZrNo
12. Crop type Be r, wyVd C' Gaze I t7lgq ve, D�c�se-!� Hard wooc(S2 . 11 cecv`h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes'EfNo .
14. a) Does the facility lack adequate acreage for land application? ❑ Yes —E]No
b) Does the facility need a wettable acre determination? ❑ Yes E3'No
c) This facility is pended for a wettable acre determination? ❑ Yes jU'No
15. Does the receiving crop need improvement? ❑ Yes Mo
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes J[31qo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W[JP, checklists, design, maps, etc.)
❑ Yes Z o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes eNo
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?
❑ Yes0"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 reviewlinspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes '0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes oNo
yiglpk(iytis'e ftfcjjenci $ yrrQt�m�visiYohi��re�ie uWhtfM0
• curies cience abatiti this visit.
Comments (refer to gnestifln #) Eirphun any YES an§vvers and/or any recomeendatsons or aay other comments. - �r
Use'drst of fi" f'.acility wbetter a tpla t:sittYatioris..(use addi onal:Pages as nece .
A.
t
Reviewer/Inspector Named
Reviewer/Inspector Signature: Date: 5100

FAcility Number: 3 — Date of Inspection 1 b 0
` Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

jd 16-6ion of Water Qua ty h
� Q Drvrsion of Soil and ;Water Conservation
Q Other Agency e
+Type of Visit '0 Compliance Inspection O Operation Review Q Lagoon Evaluation
(Reason for Visit O Routine O Complaint XFollow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date. of Visit: 1 l pd Time: f 3� O� Printed on: 10/26/2000
!? I �
Q Not Operational Q Below Threshold
Permitted [] Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .............
Farm Name: .......... . ?. ..t.[......G. `'............................................... County: D.vt- .�............................................................
............... .
Owner Name: r r ""N5
.............G4�'`..1....................................................... Phone No:.......................................................................................
Facility Contact: ..'Title: ..................... Phone No:...................................................
MailingAddress: ..................................................................................................................... ........................................................_.
Onsite Representative: .................... Integrator: ..!yi UY�4�ti ►"G
.h'►5.............................
......7.................
Certified Operator: .......................................... ........ ............................ ................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��=� Longitude �• �° �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System 11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: 3) —) Date of .Inspection IZ IZ Printed on: 10/26/2000
L
5. Ate 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? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other (ban waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application:
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination'? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio yiblati#ii ot. & cien.... were noted• during this: visit. - Y:oik will •r. eeeive iio tutther .: .
.. . ...............
Cori oridence: ahot i this vtstt�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Use drawings of faciq esi ton better explEx hain any YES answers and/or any recommendations or-aay other comet_ eats Comments (refer to u# •'
y,to
ain situations. (use additional pages as necessary)
,Spoke w;-AL, Kra, Wes4eAcek of Wit)ce A>h.d aldvi,Sed 4k,4 Z woujd '`
6C go } n� 40 4- „-. 4o 44ce •k,�.,��cS PP-P- -1olt pwv19 a' rec e»4 dtsckow5 ,
Wa4e,� JuAW sc►H.lplc c Arlo( 1A9ovh aeD -,0hkq k W^-< ltike q
I l�l
Reviewer/Inspector Name J r1 ,0- : 5
Reviewer/Inspector Signature: Date: f Z 1? QD 5/00

Division of Water Quahtyt
vO Division of.Sbil and Water Conservation .Z.
7.-- O.OtherAgency s
Type of Visit )& Compliance Inspection O Operation Review O Lagoon Evaluation
Reason tar Visit O Routine O Complaint )9 Follow up O Emergency Notification O Other © Denied Access
Facility Number 3 i Date. of Visit: �Time: 12 = �Printed on: 10/26/2000
O Not Operational Q Below Threshold
© Permitted © Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold
Farm Name: CD✓ ,e FOt re-% Countv:.VU,� b.A7 ........................................................
.................................................................................................. .....
Owner Name: J t% F . ,,,F-4, {1'v+ j Phone No:
FacilityContact:.............................................................................. Title:................................................................ Phone No:
Mailing Address: .........................................................
Onsite Representative:.................................................................................. Integrator: ... L.`.b. Cf .�.....:. �. em 'f
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine ❑ Poultry []Cattle []Horse Latitude �' �� ��� Longitude
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imeact5
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon El Spray Field El Other
L-
a. If discharge is observed, was the conveyance plan -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 gaUrnin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Ntjmber: 31 — r I Date of Inspection 12 $ dGy Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E.. !'.. yi....... ... c..n... mere notes during this;visit; Y:oit will receive .. i'...... .
cor'resp6fidei t& A6uti this visit_ - ::: ;
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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): _
Add iie.d cJd Ltvi 6; z� r- a M tr1'1o�{ Fa�rrna 4ked .T LG(jd ol-ri ec* #
s Ile Arld tie 4,P/A wt e �•o a a � i S i nS a Gri a h (44.r ocf
-1 4,ellmt fvr1 -to -ter CZ�r% D(% �r,,,e►^ �cy n ;�'t'ca loon d:Sc N'o
14s ee4forl• Fi•G4vrof Lu ffe 4,qk,-�dJr#- kc. ins e G4; ' 017
Reviewer/Inspector Name ,Sh "4CLAIA !� q �j r -,-
Reviewer/Inspector Signature: Date: 1zhV,01Q 5/00

:Dxnsxon of-Water'Qulxty a- ' ,G
Q D'evision of Soil and Wate' Conservation M x
O other Agency .
E
f Visit ja Compliance Inspection Q Operation Review O Lagoon Evaluation
n for Visit PRoutine O Complaint O Follow up ,Emergency Notification O Other ❑ Denied Access
Facility Number
llate of Visit: 01) Time: Printed on: 10/26/2000
3 jf
Q Not Operational Q Below Threshold
© Permitted 0 Certified © Conditionally Certified 0 Registered Date Last Operated orAboveThreshold: .........................
Farm Name: C. o r.. C t County:.�.1.11 _....I ....................................... .....................
..........7............................j..........C...................................I........
Owner Name............ ..U....�� .!4!�... Qi'�` ...1...... L '�.r''? 5............................. Phone No:......................................................................................
Facility Contact:
......... Title:................................................................ Phone No: ...................................................
MailingAddress: ................................ ......................... .......,................................. ................................ .........................
r i eS�e Cek irplae( Of>Ki s,
OnsiteRepresentative:,j.a.3,Ott$Iq►T�o Qti n„Qtzi,G Integrator:-07q� r^1.5
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 1 it
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Disebarees & Stream Impacts
1. Is any discharge observed from any part of the operation? J(Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................. .................. ................................... .................................... .......... :......................... ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: 3 ' — 1 Date of Inspection I t Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [:]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 [:]No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
$. 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 maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.... Yi... .t.. ..... itctes mere noted dirrtr. this:v....Y.. will reeeive do #anther
- correspondence: about this :visit.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 19 No
❑ Yes ❑ No
❑ Yes ❑ No
Corm nts (refer to question O Explain any YES answers and/or any recommeedations or_any other comments 7 t-
UseArawings of facility -to better explain situations. (useadditional'. pages as.necessary) - T
Ke s.r a rto(1,q 46 iiv7 it-�'3 Cc{T.o rn -tr o �^t M U�P� y t�c�r W,S re�YeSe��q�.�'✓e
)'• �.-; � S- �, �; o�-,a;1eA 41 wotrT _ al iSC��ar ae�arGtfr�
-�-0 r''l v � r ese y�� {�qf�e Obse�ved� d,•sckotr� �*� iy- a -
-� �r►7 -fir $ r„f d -�+' � Yee4 - LJ,9e 1,14 �
►G-�•u rC~r i.J ewe -t�"G �e�l
Reviewer/Inspector Name —qQ Y1GwG
Reviewer/Inspector Signature: Date: IZ q1 0 6 5100

J
t
)WD1v1s1on of Water tiallty
0-J5 on of Soil and Water.Conservation u
r` Q Other'Agenc
_
y
k >.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit -Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Uate of visit: t
Facility Number
© Permitted 13CertiRed 1© Conditionally Certified [3 Registered
FarmName: ............ G.Q.. .g ..I,..r'r..�..................................................
Owner Name: ................r rS
.............................................................
Facilitv Contact:...................................................._......................... Title:..................
Time: dd Printed on: 7/21/2000 lo]
Not Oaerational O Below Threshold
Date Last Operated or Above Threshold: .........................
Countj':... . ....... ............................................. ..........
PhoneNo:.......................................................................................
Phone No:
Mailing Address: ........................
Onsite Representative: ��>ri.n P% ....................!/�r l�rR �l�%24!J Integrator: - v.!� .....���.'��..
/ .......... .. .
Certified Operator Operator Certification Number:,__-
Location of Farm:
ne ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 ;i
Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
ceder to Finish ❑ Non -Layer t ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Oiher
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ 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 :KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONo
b. If dischap,c is observed. did it reach Water of the State'? (If yes, notify DWQ) El Yes No
c. If dischanx is observed. what is the estimated flow in gal/min? yt In
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes M No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;5No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes igNo
Structure 1 SU uct tee 22 SLrUC:lUre 3 �lSlructur 4 Structure 5 St ucture 6
Idcnt; ricr:...........-...... ....:............ _pi.". t e _.._ Viz. _.` ..._.'.�......���.. n ?�:'S r' ............................. ......
Freeboard (inches): r `j O 2-6 25 /J
5/00 Continued on back

Facility Number: j / -- 11 Date of Inspection Q Z� printed on: 7/21/2000
5 LAre there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El YesNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes &No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes -ffNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
5gYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
JKYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes JffNo
11. Is there evidence of over application? ❑ Excessive Ponding XPAN ❑ Hydraulic Overload
, Yes ❑ No
12. Crop type �e r' �^'t i F�/1 ZC i1.I t'p jT IJ �1/��'SG�d , �Srn� 4rw � Y?
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes SNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes Jallo
b) Does the facility need a wettable acre determination?
❑ Yes J'No
c) This facility is pended for a wettable acre determination?
❑ Yes JVNo
15. Does the receiving crop need improvement?
❑ Yes ANo
16. Is there a lack of adequate waste application equipment?
❑ Yes J'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes IgNo
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 ZFNo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes !R�No
20. Is facility not. in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ']$No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 19 No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IffNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes BfNo
0: Rio.* atidiis'oir&flciencks •were h ed during this'visit: - Y;oitt will-feceiye Rio further
.... .. .. .......
.. ' comes} &ideike. ah"f this visit. .... .. .. . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
F. 44 6ofbe4� 3 s4e, waS4& Qyf4, ever--"­Iow rlv5� k5
cq ya 41,ere if saw,e i,�a�l� 1'e4kAyle ',.�.�, cGS i ea�),1 _lt?e �ai� Glre�
d LLe el usli --�� � � s . Grads heed Aa be
14 3 q hc� 1 a�aon 2-
in s�4ll�d .
I l • -Pf1 hJ d v cv'et�° 1 caPo h o;, zeoa ha fd wafld oil "'7j5r Zone q$ -6 to j7 e
lOA 6 1.'! ibs Pn1/laZre �}.� lbx ��+N��� cts
r
Reviewer/Inspector Name k
Reviewer/Inspector Signature: Date: l d 2 bblD S/oo

FacilityiNumber: 3 t — f / Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ 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 g(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) 4
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 t2No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes "12No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 53'�'es ❑ No
Additional omments and/orDrawings:
19: Se .sV'-cr 10 vse �,�o�e�-/� dAt a Lvn� �e a"'1'0� y��s o� ,�-�,s
A.
5100

. O Division of Soli ahifwiiter. Conservation .'Operation Review
a 0 Dtvtsion of Soil and Water Conservahon Conigliance liispeetion
�Devision of Water Quality ComgLanee Inspechon s.
r _ r
Other Agency Opei
JR Routine Q Complaint Q Follow-up of DWQ inspection 0 Follow-up of DSWC_review Q Other
Facility Number Date of Inspection
Time of Inspection 3Q 24 hr. (hh:mm)
xPermitted © Certified [3Conditionally Certified E3 Registered [] Not Operational Date Last Operated:
Farm Name: ..... ...- ..._... County: ........... 0 1
OwnerName:....... ............. .... ................... ..........:...................._-........__.........-....._..._-..... Phone No: ..................................
..........._...-.._...._..
FacilityContact : ...................................... ....................................... Title: ................................................................ Phone No:
MailingAddress:................................................................................
............. .......--.........
. .........
......
...........
Onsite Representative:._V..._.h.i........................................................... Integrator: ....... t- ..... ........................................
Certified Operator:-.._............................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A
........................................................................••--..--.--...-•-.---....._.........................................................................................................................................................11...........
Latitude o•o� �• Longitude �• �� ��
W ry'a Design Current �e Design Current Design Current
Swine
-Capacity Population Poultry Capacity ,T6pulation Cattle
-Capacity- Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons..- ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding ePonds / Solid Traps ❑ No Liquid Waste Management System N
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [75-i CF-i GU Czg 3N
Freeboard(inches): --..--.-__. `l. -,,5 ............ ................. ...................................................... ............. ............�✓-- ._..-_..._._
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes brNo
❑ Yes Q 'No
❑ Yes MNo
Structure 6
�6
❑ Yes ONO
Continued on buck
3123199

Facility Number: 3 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I . Is there evidence of over application? ❑ Excessive Ponding PAN
It i ,
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2l. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0_ �o-yiglati6iis:oir• deficiencies •Were hofed ct&Mg ahis:visit: - :Y:ott will-t-eceiye tiq further -
corresporidence. about ti�is visit_ :.:. ..: ::
�'es El No
❑ Yes bErNo
KYes ❑ No
❑ Yes ONO
❑ Yes D(No
,1Yes ❑ No
❑ Yes R110
❑ Yes XNo
❑ Yes [�(No
❑ Yes CRNo
❑ Yes b'No
❑ Yes gNo
[]Yes NrNo
❑ Yes NrNo
KYes ❑ No
❑ Yes ONO
❑ Yes N'No
❑ Yes IRNo
❑ Yes 10 No
❑ Yes VNo
❑ Yes ONO
Comments.(refer to question #): _Explain;any YES answers atiid/or"any recommendations or any other comments:_
z.; _
Use?drawings of facility-ta-better explain situations {use add> anal pages as: necessary)
_ 'k-,.
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� �� ` Date: V)_ CY c( I
3/23199

Facility Number: — l
Odor Issues
Date lit' to pcction
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?
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ba"No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
R`No
roads, building structure, and/or public property)
``,
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
KN 0
30.
Were any major maintenance problems with the ventilation fan(s) noted'? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
❑ Yes
�N0
31.
Do the animals feed storage bins fail to have appropriate cover?
El Yes
�No
32.
Do the Bush tanks lack a submerged till pipe or a permanent/temporary cover?
❑ Yes
No
itionaComments and/orDrawings:
GCO
S(cn
Y
JA�4,7.'A
3/23/99

.Y
❑ DSNVC Animal Feedlot Operation Review
] DW Q Animal Feedlot Operation Site Inspection
Routine O Complaint O Follow-up of DAV) inspection O Follow-up of DSWC review O Other
Date of Inspection 17z7
Facility Number 11
Tune of Inspection 24-hr. (hh:mm)
© Registered ® Certified © Applied for Permit © Permitted 10 Not O erational Date Last Operated: •--„ __
Farm ?dame: � -- -���_ �.��-_ _�r - — County:.....�t
Owner Name: _... �..._ �V. — ...�m;� CT�r! �_ . _. Phone No:
Facility Contact _ ...._ ......� _... Title: _ _ .� _..... Phone No:
]Bailing Address:
Orkite Representative:_,
Certified Operator:_- — Operator Certification Number:_
Location of Farm:
._.._..... -.__... .-_-....
Latitude Longitude �• ��'
-Design _ ,Current_ ::Desi�uu Current
ISwne"Capacit}s Population: .Poultry Capacrty ,Population ., .Cattle
a-
Latitude Longitude �• ��'
-Design _ ,Current_ ::Desi�uu Current
ISwne"Capacit}s Population: .Poultry Capacrty ,Population ., .Cattle
a-
0 Wean to Feeder
Feeder to Finish
3
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
=
l7 Gilts
[] Boars
lriimber of Lagoans:I$oidrrig"Ponds' 0 Subsurface Drains Present 0 Lagoon Area 0 Spray Field Area
w
0 No Liquid Waste Management System
General
L Are there any buffers that need maintenanceirmprovement? j] Yes IS No
2. Is any discharge observed from any pan of the operation? ❑ Yes ® No
Di:charse originated at: E] Lagoon 0 Spmv Feld ❑ Other
a- If discharge is observed. was the convevance roan -made? 0 Yes No
b. If d-tscnar24 is observed. did it reach Surface Water' (If ves. notify DV4'Q) El Yes No
c- ]f disch:sr!-,e is obs rved what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes No
3- Is there evidence of past discharge from any part of the operation? 0 Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ' 0 Yes Co No
6. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenan cei improvement?
6. Is facility not in compliance with an), applicable setback criteria in effect at the time of design? ❑ Yes 16 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1p No
7/25/97 Continued on back

1'
Facility \umber: 3i — Il
S. Are there lagoons or storage ponds on site which need to be properly closed:'
)Q Yes
❑ No
Structures (Uvoonc.Holdin; Ponds, Flush Flits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate`!
❑ Yes
® No
Structure 1 Structure 3 Structure 3 Structu're` 4 Structure 5
Structure 6
Identifier. �`t ' . Z
freeboard (ft)=
10. Is seepage observed from any of the structures?
❑ Yes
P No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
cr
Yes
❑ No
12. Do any of the structures need maintenance/improvement?
18 Yes
❑ No
(If any of questions 9-12 was answered ves, 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 APRIiC26M
34- Is there physical evidence of over application?
❑ Yes
MNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ._tkigL_^.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack- of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?.
Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
® No
22. Does'record keeping need improvement? M Yes [INo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 50 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? Yes ❑ No
'01 25. Were any additional problems noted which cause noncompliance of the Permit? Yes ❑ No
❑ N-o.violations or deficiencies were -noted -during this ,visit. .oin w'i11 recei've-no fuAher :
correspondence about €his:visit::::.
g. O1d Ua�rk *4 sWd 6e c_loud pmr cr.� w1 i,, ckv aA �1,y o,, vt x%s _ + sj.�e a[�ra`i'if�v.
''-/m, EYM 1 or. avr,aS c r \ t1 ' i nrv4 aL C! i Vt wa[1s GP j T� 3 S houO 6� (j W 144,
t ` '
GUk ,F ;�se.e�4' &e-0,rtO,.S (vj%r_ �K�1 ter. c��iCk 1,.) i� °`� �o�c r� 3 r0c4dat
Should 6e- r"os✓ec� ah la-�o3�• 3, `TU ,�jvn�+n �,'�e � r. Ic,�4oh Z 3 x; �c� be uhc[N(�
lib i f 'C je_ We �re lallxr� i r� fl,�a �`r(ds .
Z' Drl`j 0" . kl M-Z Worn. Sk4')13 } e Vsej 4, eO'_t . pull Pew M, cyc (,,. 'f'� Gbrtt e PQAJ
S40�� `be. (aln2lej or, `4" S�► rcw-jr'.. V" wry -cc* (nttsi Si5 Silo'jla �� VSJ iJ�vt4-
c..`c-u ak1 ��M�oSev` barn t�eS. ►,,�c DUtjs nur�n6M .sho� fie_ Cnr\Si��c i }rfl�ct.7/25197
l Reviewer/Inspector Name
Reviewer/Inspector Signature: ./t /11
Date:

s
Facility Number:©ate of Inspection-,ZZ
Addi4onal, Comments an&or' Drawings
3
+S sus. lrrt ae+n
1 ! /�
burn. rccv,-ds .
�`��zs. t7v+�ro.���c11�,, �o►. o� n;cn iti. 5�`ro`1 ��1( �# z �t #3Y �3l�s�a� -�-91bsf�c oucr-
0.��`22� ' t'LS�CCi'iVi.�V. � e�ct.eSS ,11i'�'Y00J2t� SY�7�� '" I 101� SfrA`t�ji'Ai�.
sc�}O � w+tG ». r'W _ �e YrnU� 4. �alG�► G.
4/30/97

O Routine Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection '-Ov 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: M Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review r�
❑ Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: ,_._ .........._..... _ .... .n... ....... .
Farm Name:...`�....... .... ..._...... _....__.............. County:. ...1�V.��r�. .... ...._...... ...,_...... ....._.
Land Owner Name: _ . hQi.__.._ .. .......__. .......... Phone No: _ �r1lt� z-.'.':�.. `.. .._.... .... ...
Facility Contact: 'f
........ ......LL.........�kC)`.i e1r................W....__..... Title: _......_................._..............._. Phone No:..:�.�L6� �8:�i."�?-:��......_.......
MailingAddress:...... �1 i�S -......N.L! ... �... Y t....»....... ...... ........... W...._................ _.... 1'�Q�p.. i � . A�ty ....._.......... 5 .... ..............
Onsite Representative:.....S�Y11fi�.1!►1(..__......__.. _ Integrator:.... ...
Certified Operator: .... .€ dux. ..1... ,, ......_ ....1� s . _.... .._.... ....... Operator Certification Number: 1 3 ...... .._,.
Location of Farm:
Latitude ' ®4 ®u Longitude ®• ®` ©"
Type of Operation and Design Capacity
AU
' Design .
Swine Current; Designer Current Desk gn `° Current
r,
Ca act , Po ulanon' Poultry Ca' acity Po iilat[on` Cattle Ca acit, W ula#ion
I ❑ Wean to Feeder ❑ La ❑ Da'
Feeder to Finish c13-71, I❑ Non -La er ❑ Non -Da'
Farrow to Wean
Farrow to Feeder Y TfltathDestgn Capacity 7 t ,
Farrow to Finish e k
a x T a miot SSLW. 6�
❑ Other �` � ;
MR-
a
Number of I,agoans 1 Holdtng Ponds x ❑Subsurface Drains Present
r r,,
t ❑Lagoon Area` ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 5a No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes
09 No
❑ Yes
59 No
❑ Yes
t5�kNo
Yes
❑ No
Continued on back

Facility Numher: .._U..... ......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
§� No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
MNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
® Yes
❑ No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ig No
Freeboard (f}): Structure 1 C I Nam+ Structure 2L IoW Structure 3G-.t Structure 4C-1- Structure 5C-3
Structure 6 C_-3
L-1 l rrvclt i+45t. C- 4 Hui C-4 old
_.....
10. Is seepage observed from any of the structures? 2 _,—
❑ Yes
® 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, ARplication
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
_ - 1
15. Crop type _ -. _��i ...�.C.t?lr. _ ...._ .... ...........xA�... .............. .._..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
fig Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
Ear -Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[�tj No
24. Does record keeping need improvement?
❑ Yes
A No
Comments {refer to"questtoa`#)'Explaui ariy YES answers and/or any recommendations or any other comments:
Use drawFngs of facility to better explain situations ° (use addihonal;pages as necessary)
'.t y ' _ o. t l I3
Berms s�J be, lw w &Xo WAJ� (S 11ki'� t�� 0��G�e�r � '` wnq a)Uini'vi m `�� Q
� �1�� iQ;v\{S` Stir'wv�C) (��( tz.cao�s C�iii_tC�S.! -- iG.r� �Q .3warJt �er �txk�
& Cerbe ( olr Ukg� S(llot� b� c.l�Sed out -
�1. be- �MW JAL ale, o j rmad,
7 o SkSt d¢ C-2- sWO -de_ 916J c.'1 tii+eSe-4 O*m% SIW4�
jz• ��ri o-ran-s on `tr�A.r ��1 0�' sec
res c�• iAnaar t A1s of (ayns ---Wa rtAe4d, (not' ,te S1 ,)W 6 e 9 a i '(-inf S'�e_
boc�C side d4 to aon Wwll df 4�'nfis e (0lutO" GS sWd ice ('clndveO.
� � - .3 �S
13_ first `) G ia�Qo►�g a� G'Z C`h C-3 o)a .Adf IAl mer4,-s 4c AUr t (oyar% (t►e(' �
Reviewer/Inspector Name �. ... >H
Reviewer/Inspector Signature: Date: �q %
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -�J , 1995
Time:w+
Farm Name/Own(
Mailing Address:
County: ,DI 1 +rj
Integrator: )gQrj2 U Phone: _ 2Ba — 4Z44
On Site Representative: Phone:
Physical Address/Location: -_ 111 ubM , && 1 1 1� Zu rn Y( 4h f 114' t -F�
'N �- M; ein?)'l e--pF
Type of Operation: Swine JL,-' Poultry
Design Capacity:
Cattle /1 r
Number of Animals on Site: 33 50
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: A' S ! ' 0 53" Longitude: 11 ° S? ' j!2 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: Z- Ft. i0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray?(Ye r No Is the,cover crop adequate? Yes NTa
Crop(s) being utilized: b ejc '►7. uu ':'� 1 _t'_ 2
Does the facility meet SCS minimum setback criteria?
7S �2c
200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Lime Stream? Yes ore)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: 0(d 7F 2C f I f b4 — 3 5f'2CV-
L t'ng Z L
Inspector Name
�2LO - -
Signature
cc- Facility Assessment Unit
Use Attachments if Needed.

•
•
Site Requires Immediate Anenti n:
Facility No. T
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:_ CGrbe4 4'- C5 4-
Mailing Address: 4%S' W I I t i -ow Scyk ?ci •
County:
Integrator:
On Site Representative:
Physical Address/Location:
M
Type of Operation: Swine
Design Capacity:
u )&seWl r, hfon 19151
r �on 1 eP� o
Poultry Cattle
Phone: Zgq—
Phone: 2$9" IL4-4—
cro%et( 1911,
1 ' I - Z I-e
r.I;
Number of Animals on Site: 'Z44
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34- ' cD Longitude: 5% QS 31 " 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) 'e r No Actual Freeboard: —2, —Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o>� Was any erosion observed? Yes o No
Is adequate land available for spray?
Crop(s) being utilized: r U
No Is the cover crop adequate? Yes or No
C2 le <qr204,?cj /75 2c
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) Ye or No
Additional Comments:
0 — /L I t, d' a L'
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 2w,
Farm Name/Owner: ec" 0 e f 3 �� G 5 3.
Mailing Address: 4'1P-S, U)J I { SOn E4 . ZoSe R k 2'9433^—
County: tl2o l ; /1
Integrator.
Phone:
On Site Representative: Phone: 2�q — 4 Z4+
Physical Address/Location: Ste_ .25 (�pr b e f+ I.0'z A- 4—
Type.of Operation: Swine � Poultry
Design Capacity:
Cattle F ,,1
Number of Animals on Site: k 100
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3__-_° _' 2�.6Longitude: �° 5$ '602AU 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) Yes r No Actual Freeboard: 2- Ft_ Inches
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Poe
or�Is adequate land available for spray? Ye r No Is the cover crop adequate? Yes r ���CCCCCC
l 1
Crop(s) being utilized: Prh Vd
Does the facility meet SCS minimum
QG
criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?' Yes or N9a
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
1 to_,
Additional Comments
Inspector Name
L
Signature
13
cc: Facility Assessment Unit Use Attachments if Needed_

0
•
Site Requires Immediate Attention:
Facility 6-3 -7
DIVISION OF ENVIRONMENTAL MANAGEMENT No.
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County: _ _ 0r
DATE: 'S -3 , 1995
Time: I 1,ZS Zvi
W
secl
Z345
Integrator. 11 Orp2q. Phone:
On Site Representative: Phone:Z A - 'TZ44-
Physical Address/Location: cJ-9^e 2 5 Gar- heft 1. 3 g `//11t
Type of Operation: Swine L� Poultry Cattle F74
Design Capacity: Number of Animals on Site: jg CD O
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:54- ' SO ' 4-1jq Longitude: T� 5-7 ' S" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 3 Ft. �_ Inches
Was any seepage observed from the lagoon(s)? Yes o� Was any erosion observed? es r No
Is adequate land available for spray?(Yor No Is the cover crop adequate? Yes r No
Crop(s) being utilized: f5ermoda� 1?5 2G
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orVo� 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 r No
Additional Comments: S We+''/?' � b1l CUr bZk 1 3 814.
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Inspector Name
AfL--_
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.