310029_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 3
Departure Time: o County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: _ f Title: Phone:
Onsite Representative: Integrator: r
Certified Operator: Certification Number: ! frp i
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
�M�^ 5
Design
'
Current es]9W�101rrenUil
Design ;Current;
` wine. : Ca 4ac� Po "� w We Poult ' Ca aci Po
P tY. P rY P tY P
Cattle
Ca aci Po
P ty P
-'FWeato Finish
La erDai
Cow
to Feeder
20v' Non -La er
Dai Calf
r to Finish'
r _ �'�
Da' Heifer.
Farrow to Wean
esie
Dry Cow
Farrow to Feeder.
,ate.
D ;Point Ca P,o
Non -Dairy
Farrow to Finish
_aci _
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder.
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
TurkeyPoints
a . .0
Other
,: �rl­
Other w x
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No D NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
D<O ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facile Number: - Date of Inspection: 347
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): 34 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F,—+-5o
❑ 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
ErNo ❑ 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
[2-55--0
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-5o___❑
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
[]' Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3' l�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2 No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists [:]Design ❑ Maps ❑ Lease Agreements [3Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E]'igo ❑ 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 Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes To ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facih Number: jDate of Inspection: 3
!
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
E Yes
[:]No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List first s(,
Z
�� I
structure(s) and date of survey indicating non-compliance: _
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑' iqA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 i�o ❑ NA ❑ NE
❑ Yes No ❑ NA 0 NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes Ka
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
—..,,...,...%%% -F ....,... .
Reviewer/Inspector Signature: Date: 3 7
Page 3 of 3 21412015

vision of Water Resources
Facility Number � - ® O Division of Soil and Water Conservation l�
p Other Agency
Type of visit: pk-Cbmpliance inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: _Q"Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ao l Arrival Time: Departure Time: County:
Farm Name: ��r f �( �/,. �,, �/� Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: %2"I�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Poults
,,Turkey
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Region :LW11Z:-!
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes O No ❑ NA ❑ NE
❑ Yes (n No
❑ Yes 2'No
[:]Yes ErNo
❑ Yes Ej No
❑ Yes eNo
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [;Y]Vo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -3f— 75
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes qNo ❑ 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 P 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 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)
T
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application.
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ 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
PrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;j No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of _Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C�-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C;�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�rNo
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?
V;L�/ry
0
to better eapl
Reviewer/Inspector Name:
any,=YES answers and/or any addi
situations (use additional pages as
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
[—]Yes EdNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
ons or any other comments.
' r4r," f e Ca rd S (�f0(�) ,
Phone:Vlo 1,3 23
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Division of Water Quality" Factlity'Number W - Z't O Division of Soil and Water Conservation: ,
O Other Agency .
Type of Visit: Com -ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 10 Departure Time: p4o County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: F
Facility Contact: 4 Title: Phone:
Onsite Representative: S �� 4 L �` �y integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
'__Yr"
Design Current
�Swine,­ Capacity Pop.
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Dry routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
'Design Current
Longitude:
Design- Current w
Cattle .. Capacity 'Pop.
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Co
w;
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ElApplication Field ❑ Other:
a. Was the conveyance man-made? [3Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Page I of 3 21412011 Content/ I _';
\'.

racili Number; - 2_q jDate of Inspection: iF2Z
(—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�Io
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z— 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3` ' 5 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ 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
E31No
❑ 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
[!f—No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[6No
❑ 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
E% No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[E N�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CXNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ "No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Certificate Coverage & Permit
Yes
NrNo
NA
NE
the to the of readily available?
❑
-❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ 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 [�f_No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E]--No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

k N'
Facility Number: - 2 Date of Inspection: jaz
jzr-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ETIZ
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes ❑ 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 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?
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
EfNA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes / No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[:]Yes
No
❑ NA
❑ NE
[:]Yes
��o
L!a�No
[] NA
❑ NE
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Signature: 2 Date: SU Z
Page 3 of 3 21412014

aAaDivision of Water Quality
Facil 'Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: C�,Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name_ r��j �(,fj- e- Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: lkq
Certification Number:
Certification Number:
Design Current
Wet Poultry , Capacity Pop.
Layer
Non -La er
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?
Longitude:
Cattle
Design ,Current
Capacity :'Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes,;�No ❑ NA ❑ NE
❑ Yes ,E:f No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes ETNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ,.El -No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes eNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes PjNo
❑ NA
❑ NE
of the State other than from a discharge?
1
Page I of 3 21412011 Continues

Facility Number: - Date of Inspection.
Waste Col t tion & Treatment
4. Is storage dapacity (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 C2'No ❑ NA ❑ NE
/ Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- ^Q —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No [DNA ❑ 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 L�jNo ❑ 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 -E!r No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2-No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes effNo ❑ 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 .allo ❑ 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 ,2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes , 3-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes f:j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes je-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E�J`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 �E�-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PI -No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes {n N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 2
24. Did the,facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes EEj"No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes f5 No
❑ NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes jE:j_No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ,E]'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes .E�t1Vo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes E�'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes -E3'No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes PEYNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ED"Ro
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ja'No
❑ NA ❑ NE
Reviewer/Inspector Signature: - - Date: w L
ly-
Page 3 of 3 2141ZOIII

Division of Water Quality
Facilkty Number - L� D Division of Soil and Water Conservation
Q Other Agency
Type of Visit: eFCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &IRoutine O Complaint O Follow-up () Referral O Emergency O Other O Denied Access
Date of Visit: Zr If -Arrival Time: 7: d eparture Time: County: [ ,tt�j/ram Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator: (0, C,LA n bcicd
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Capacity Pop.
Discharees and Stream Impacts
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop. Cattle
Layer
Non -La er
Design Current
Dry Poultry Canaci
Layers
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Design Current -,
Capacity Pop." -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non:2L'rX
Beef Stocker
Beef Feeder
Beef Brood Cow
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 J;3-No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
'F�o
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes 6No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes E5 No
❑ 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?
T
Page I of 3 21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage ppacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Z�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / 12 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ c3 Z _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J;3 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 eNo
❑ 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 ,E�rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes FFNo
❑ 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 ;2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
.0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
ONE
❑ 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 �P '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?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ❑ No ❑ NA j2'NE
❑ Yes ❑ No ❑ NA dNE
19. Did the facility fail to.have the Certificate of Coverage & Permit readily available?
❑ Yes La'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
JC]�No
❑ 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 ;ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes �eNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes fZNo
25. Is theJ*ility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff No
The appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ rNo
Other Issues
❑NA ❑NE
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
ETNE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
13'NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
2rNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
01 No
❑ NA
❑ NE
33.'Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:)Yes
E�J^No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
4�]rN o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Dazes as necessarv).
��brdy r bpoGP G'"4-e"
!, 7 7z
cq�
31-711-5
2 . z S" .,,-)
.�,.�
z. s�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P DG vl bus'.
Phone:
Date:
1412011

w^
Type of,Visit T>70
Reason for VisitPi
Date of Visit:I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
E I .Ision of Water Quality
Y aCtlltypNuR7bei. L 70'r1*4ion-ofsoil and Water`Conservatton .-'� `b
Q"Other Agency y ` ;
lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Time: r parture Time: County:
Facility Contact: Title:
Onsite Representative:, f lO
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Region:
/ Phone
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm:
Latitude: ❑ c Longitude: = o = j
Design Current .`
"
Design Current.. Design argent
Swtne
Capacity Population, A Wet Poultry
Ca aci- Po Mahon° Cattle .. ° Ca aci
- p ty p p ° ty
^.+�::'
Po ulat`ion
p
_ -
- - - - -
- `m
L.°Mn.
❑ Wean to Finish
` ❑ La er
❑Dai
Cow
`
❑ Wean to Feeder
❑ Non -Layer I
11.'El
Dairy Calf
❑ Feeder to Finish
m
❑Dai
Heifer
,_�
El Farrow to Wean
r� "*
1)ry Poultry
El
D Cow
❑ Farrow to Feeder
r
w
❑
Non -Dairy
ElFarrow to Finish
❑ Layers
❑
Beef Stocker
❑ Gilts
A.
❑Non -Layers
❑
Beef Feeder
❑ Boars
El Pullets
El
Beef Brood Co
- w _
Other
❑ Turkeys
❑�
Turkey Points
❑ Other
❑Other
Num ber:of �ructure St s
--.�
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
IIPage 1 of 3
12128104 Continued

1
i
Facili Number: - Date of Inspection:
f
Waste Collection & Treatment
4. Is st,-Jage 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; .19_ 13
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures�observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ 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?
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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. , . ❑ Yes ❑ No
❑ 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 ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ N
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili , Number: or - Date of Inspection:
Z
i
24. Did,,the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA ❑ NE
25. Is 4e facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES -answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary).
Ld Ga/l 3 e��o�` Lit s CC (+��
3,��iz
�J A /\j
! - {=al�n feCorDs cso1�_ 't)OZA C,
3 a.�
tr 2-
/ I y
Reviewer/Inspector Name:
Phone: W`77 p 7
Reviewer/Inspector Signature: / (ice `r L _�(� Date:
Page 3 of 3
1

3
aeility_Number, 3 i
9-H4visinn of Water'QuaLty
O Division`ofSoil and Water Conservation �
Q Other Agency y °ate
Type of Visit J(3�e6r%tpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: II. -I Region: W/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l/
Certified Operator:
Sack -up Operator:
Location of Farm:
Design Current
Swine Capacity Ponulatinn
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator• �V_r__
Operator Certification Number: l G �•4rt
Back-up Certification Number:
Latitude: = c = I Longitude: = n = • =
Design Current Design Current
Wet Poultry .._,CapacityPopulation Cattle �Capacety Poperlafion
1.❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Poults
MTurkey
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Nurhb6f:of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ;3No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes PNo
❑ NA ❑ NE
12128104
Continued

i.
4 '
Facili .y Nurkber: — Date of Inspection
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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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 )21,Io
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes XNo
❑ 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 No
,VNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
[]NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
_L215lo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o NA NE
maintenance/improvement? /�N�
❑ El11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes XJ 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 ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Ej'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j2No
❑ NA
❑ NE
. . .
Comments (refer to -question #): Explain any YES. answers and/or. anyrecommendations or anv other comments. ,. =
'Use drawings of facility to better explain situations.- (use additional a. es�asmecessary
) -
...�--
d- re c a 1__ Pa l0 0/e5 d
0
Reviewer/Inspector Name { "j Phone: O— IFYw `
Reviewer/Inspector Signature: Date: 3
I _r 2 12 8104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Q 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ]"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;314o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes k—TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ff No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Cl Yes XNo
❑ 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 RNo
❑ 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 PNo
❑ 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 ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes YNo
❑ NA
❑ NE
Additional Comments and/or Drawings
w ter.-. ---3^k§.- . -
•^"�R n
' ;: fy� .ram ...-i��_.�>_ .Y.,d
t/
I
f / ' o
f/
/1 �
f1rc.4c -f &;t,�
2_
Z.
�e
Page 3 of 3 12,28104

Facility Number--�--1� -
O'Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: Co
Hance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I It Departure Time: 2 5 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: L f� �a
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
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
1 Non -Layer
Non -La
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
L 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
' No
❑ NA
❑ NE
O Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

acili Number: 3j - q Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [/] No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): _
Observed Freeboard (in): 7 3 [
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:]Yes [7�0 ❑ 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 ❑i o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E3"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 ffNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [?fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3/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
[2140
❑ 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
LJ ''lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
KNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes WNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

ti
acili Number: - 2-1 jDate of Inspection: rZlr&
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes <o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No [ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
['No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
❑ Yes
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
T-
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
El Yes
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
D NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EDINo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
0 NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any'-additional'recomine"ndktians-oi�-any: othec.comments:•-
Use drawings of facility to better explain situations (use additional pages'as"necessary).
�rC7i-(S
�{ � 2 c c Sa f, S � � 7, r { � S 4 � j0,4 l'✓_u • /� ,
SPec ru (r5t to rt4-,e �-4., S +�S�� �ael 0 cn Jet rrotee
c #r✓C­ -1 V- --, C r d.J
DLL
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: - l �� ? 730 f�
Date:
21412014

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit, Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: y C� Departure Time: County: / Region: [L
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Phone No:
Integrator: � d
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 = Ii Longitude: = ° ❑ , = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes --;g No ❑ NA ❑ NE
❑ Yes
La No
I❑
[I NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104
Continued

Facility Number• z:2aj Date of Inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
WNo
❑ NA
❑ NE
Structure 1 Structure 2 Stricture 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
QrNo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[I Yes
,,�� jf'
El NA
El NE
through a waste management or closure plan?
�No
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 ;TNo ❑ 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 P-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;NNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes q(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 VNo ❑ NA ❑ NE
Comments (refer to gpestEotia#) Explarn'any,YESanswers and/or anyrecommedatian o nyofher comet F�K
Use drawings of.facthty.to better explain situations: (use,additibnal pages as_necessary}f e m09
Reviewer/Inspector Name .f Phone:
Reviewer/Inspector Signature: 1y'00011? Date: Z@ ,
12/2R/04 ' Cantin►eed

Facility Number: d2 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. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p 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 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
❑ 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
11,5V Q eor e A Gvaxle - IyVA
rrl-id2 f
12128104

� � ` � �y�Drv�ston of Water�Quahty�. `�
ci ity' Nuttlber 3 29 Q D1V1510A of Soil arid�water Conservation
Type of Visit GYCC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: 1 960 Departure Time: County: Q ✓PURegion:
Owner Email: _ _ _ _.
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: STcu E 4)
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title: Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
0
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
17,400 0 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
[I Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars .
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets.
❑ Turkeys
[EllTurke Pouets
❑ Other
Longitude: = o = , 0 «
Design Current
Cattle Capacity Population.
❑ DairyCow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2f�❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — 2�
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 1
Identifier: LA 6�0 J 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3k4
Structure 2 Structure 3 Structure 4
ILA G c c+.i z- LA C od„ 3
33 30
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 LI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [J Yes C�'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ENo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes [2N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
1771
'Cornments (refer to question #). Explain any YES answers and/or:any recommendations or any ot6ercomments ?; �" ,
Use d"rawings'of facility to better explain situations {use addition aI:pages asmecessary)
. r_
Reviewer/Inspector Name r o �b.1 i4 atj �� Phone:���Q +139
Reviewer/Inspector Signature:qV& Date: 1 D
a•'sc. J ✓

Facility Number: Date of Inspection 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [21/No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ILl No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ly, o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'L! 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
ZN o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�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
E�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�(
LEI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Add itiooal:Comments and/or Drawings:
Page 3 of 3
12128104

d Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit SO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `f 7 6 Arrival Time: ivs9 Departure Time: County: Dt 1,r-kJ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: „ , SIC -of &CADy
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: =] e = ' 0 Longitude: = c
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
17,06 I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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: E]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
TNO
❑ NA
❑ NE
ElYes
❑ NA
❑ NE
12128104 Continued

Facility Number: ( — Date of inspection d
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. (Ar.,ra,J t cil Gvw __?'_ u4&yv-�J 3
Spillway?:
Designed freeboard (in):
Observed Freeboard (in). 2 (.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) WNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [(o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
[JNo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F o
❑ 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 Phone: Jg10) 7n - 70 98
Reviewer/Inspector Signature: Date:

Facility ' • umber: 31 — 25 Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes d/No ❑ 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 VNo ❑ 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 InspectionV1,0
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
El Yes
❑ NA
El NE
❑ Yes
7N-p❑ NA
❑ NE
❑ Yes
C No
El NE
El Yes
El No 7NA
❑ NE
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 N�o❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ek;ro ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes�No
❑ NA ❑ NE
[Additional Comments and/or Drawings: l
12128104

.r
Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (7f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
`
Date of Visit: S 6 Arrival Time: ; �0 Departure Time: County: iln `Z M/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: flkeoT flA=(-1,Eu 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
Other
❑ Other
Back-up Certification Number:
Latitude: 0 e 0 c Longitude: =°= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Z$4 6 I PW 1 10 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
D-escharp_es & 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 Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNlo
❑ NA❑NEElYes❑ NA ❑ NE
❑ NA ❑ NE
12128104 Continued

I _
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: LA CC'
`/ tI Gji6-ntJ 7-
�(s�Q►�+
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 t( 33
❑ Yes C2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 T - - ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2, o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance altematives that need ❑ Yes u No ❑ NA ❑ NE
0
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CkfN ❑ 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?
❑ YesEl"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN-a
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of operating waste application equipment?
❑Yes
El
�7rNp
El NA
❑ NA
El NE
❑ NE
properly
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
pC60
sin
(4rr
OF
0XC
Du0
-ywa.
SENh
�P `1'
bt
ANJVU�L
ER�T
/ K.0 ElF' C001" w/ ke L"S
Reviewer/Inspector Name J 0IA—) Phone: � /0 (, — Y
Reviewer/inspector Signature: Date:
lL/LdIU4 connnuea

f
t
Facility Number: Date of Inspection S
Required Records & Documents �,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /N0 El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropriate box. WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ,!
21. Does record keeping need improvement? If yes, check the appropriate box below. L,—' kY es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers eAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
['No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�10
❑ 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?
E Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,❑]Noo
T .
[R<E
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
L/J 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?
El Yes
,��
L"J 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
ETNo
❑ 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?
ElYes
:No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

IJ
Q Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- -- - 0 Other Agency
Type of Visit' 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (4 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 j 11, bO Arrival Time: D a Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ST'6 V& Gs 2e1 t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = 6 Longitude: = c = = 11
Design Current Design Current
Capacity Population wet Poultry Capacity Population
[I Lay er
/ 67S Da ❑ Non -La er
❑ Wean to Finish
® Wean to Feeder
ElFeeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
Non-L
Pullets
Poults
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
ElDai Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
Non-DaiTy
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
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 (gatlons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
P,4o
❑ NA
❑ NE
12128104 Continued

FacilitjNumber: Date of Inspection ETYWMI
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�f
IJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: i AG-m 4 f LA lkahl Z- lA (7 00) 3
Spillway?:
Designed Freeboard (in): J1. S 1 �1.3 19 • S
Observed Freeboard (in): 33 a-L 3 �J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LQ 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
eat, notify DWQ
environmenta7No
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application L
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P4 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,�,�
L� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) OA)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
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;/No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
21• j SEA CAP � ro L)L-J Q wXTH
C"e i X'o-ZS.'&
ZA rW [At(, 1 j " R-AztvFw_(, .T JSPEcr Top�1 A 0!)
ReviewerllnspectorName _ '3�� aHp_A)Phone:
Reviewer/Inspector Signature:,ALAIAIV Date: 3]{
ruge c uj -7 116/160MV a,ununuea

t Facility Number: 31— Date of Inspection 3 iD
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
2Yes
❑ No
❑ NA
❑ NE
❑ W to Application ❑Wee Freeboard El Waste Analysis El Soil Analysis
❑Waste Transfers
El Annual Certification
Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections 21monthly and
1 " Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
C No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El YesEl
7ZO
NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
]CIA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
d No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ca o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E'J 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
210
❑ 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
EJxo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[2"No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

M C17aP•1
GFIOP YIELD RECORD
•.••.•• _::)alE�...' _„ f'191ia1 null 3i)
7'
4
k
,
I
t Yielc/Acre T ('I; Ylc,ld divided b), (2) : EaIalPull Size. i3)=(1)!(2)
F,,EGEIVED
MAR 2 3 2006
Facility Number / 1:9,:?
V 4103

s — — •4 .L — s
Waste Structure Freeboard and Daily Precipitation Record
Farm Owner sAe+Z,
Operator
Few,► tVumbe 3/ - 9
c+baryy}
S /o to .-
—Waste
Structure Freeboard etches -
'Precipitation
(�rtctt«x;}
-- lnitiats
:.f
-
s
3 I#
_
— .— - -
3
M
_ ..
4
An
/aLP
y
-2 L
q2 020
R 3 3
r 4PIS
z 1 r
.2
3 :.
I
1
- i
.
I
4
F
g�
l
p
a
1. Lagoon freeboard is the difference between the lowest point of a lagoon erttb v*ment and the level of liquid.
For lagoons with spillways, the difference between the level of ikpW and the bottom of the spit n sii� be recorded.
2 Freeboard plus available storage capacity must be recorded st least weeidy.
3. Rainfall must be recorded for every rain event.
3/14/Q3
t•

Waste Structure Freeboard and Daily Precipitation Record
Farm owner —
Operator
Facility Number
1. Lagoon freeboard is the difference between the lowest point of a lagoon embanionent and the level of liquid.
For lagoons with spd*aM the difference between the level of liquid and the bottom of the spillway should be recorded.
2 Freeboard plus available storage capacity must be recorded at leastweeidy.
3. Rainfall must be recorded for every rain event.
3114103

Waste Structure Freeboard and Daily Precipitation Record
Farm Owner �Sfc 2
Operator
Facility Number �
___ __ _
•�•�.�..Il■al�—ter
�,_��
_,..-.
•��
1. Lagoon freeboard is the difference between the lowest point of a lagoon embankment and the level of liquid.
Far lagoons with spillways, the difference between the level of liquid and the bottom of the spillway should be recorded.
2 Freeboard plus availabie storage capacity must be recorded at least weekly.
3. Rainfall must be recorded for every rain event. 0

t
Waste Structure Freeboard and Daily Precipitation Record
Farm Owner
Operator
Faulty Number I
1. Lagoon freeboard is the difference between the lowest pant of a lagoon embankment and the level of liquid_
For lagoons with spillways, the difference between the level of liquid and the bottom of the spillway should be recorded_
2 Freeboard plus avaAabie storage capacity must be recorded at least weekly.
3. Rainfall must be recorded for every rain event.
3/14103

I _ • MI iAI • I IY�' i
Waste Structure Freeboard and Daily Precipitation Record
Farm Owner Q "
operator
Facaity Number 3 / - 9
M=M
S
•
W Jos
1. Lagoon freeboard is the difference between the lowest point d a lagoon embanlunsn# and the level of liquid.
For lagoons with spillways, the difference between the level of liquid and the bottom of the spillway should be recorded.
2 Freeboard plus available storage capacity must be reoorded at leastweeldy.
3. Rainfall must be recorded for every rain everd.
V14M

Qf Division of Water Quality
Fidi ty"'NuMber. 3 O Division of Soil and;Water Conseryatign �.
O Other Agency
F
f Visit f[j Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit lO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (p Q 5 Arrival
1 Time: p,FO I I Departure Time: County:
Farm Name: , �(t�!/i5 (/OeAX2 S/ /VAC /L<Ze Owner Email:
Owner Name: -/rfj�f� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: 44 Phone No:
Onsite Representative: l � � �� � Integrator:av_u2s6oef 0
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Region: "A
Latitude: = o ❑ I ❑41 Longitude: ❑ o = 4 ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
DO g� ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non -
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifei
ElD Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
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 / No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
12128104
Continued

1%
Facility Number: j5
1-2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
PS CAG
S ctu� Structure 2 Stru ture 3 Structure 4 Structure 5 Structure 6
Identifier: A Zg
Spillway?: O
Designed Freeboard (in): (. fr_'5�
Observed Freeboard (in):J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ElNE
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 9. No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 kes ❑ No ElNA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance/improvement? POW
11. Is there evidence of incorrect application? If yes, check the appropriate box below. /Yes XNo ❑ NA ❑ NE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drill ❑ 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 1" No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes X No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes X No
17. Does the facility lack adequate acreage for land application? ❑ Yes ' No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ,,�No
El NA El NE
❑ NA ❑ NE
❑NA El NE
❑NA ❑NE
❑NA [I NE
�Somf i}s,� A
Reviewer/Inspector Name xf +' 4 — CH
a��., Phone: /O
Reviewer/Inspector Signature: Date: b
12128104 Continued

I
r Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ 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 7 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
0 Yes ❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes gNo
❑ 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 .0 No ❑ NA Cl NE
29. Did the facility fail to properly dispose of dead animais within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'V
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? (ic/ 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
PfNo
❑ NA
❑ NE
Add�honal Coinmentstancllor Drawings _ _ ,_ , .w � � � ,� -
1*40 e;'d' /�0 CAP rr4FIO As s .
APU 71 rC /l fv
Q � %jJ" ";X W G 6041,t=�C "F O /47- ��ft/Zs I7rZs✓G. �i1J'1 �i3 flu r
�rf_) A16,
���
c� Coen Goo �f��p 1�
12128104

Y
y r DMi6 of WaQualtty 1 #
ter
I--Q',Thsnsmn.of pc►B a w aier Cflnservabn� :
`Agency �" _ = a a . x
Type of Visit odCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
1. Facility Number �
Date of Visit: .0 e p Time:
Not O erational O Below Threshold
13 Permitted © Certified 0 Conditionall�y
/Certified [3Registered Date Last Operated or Above Threshold: ..... ...W .. ..
FarmName:-S.-L.Va.-dr a j. 1 • ...."46c e.-Y............................. County: l Y�.............. ......... ....... ..._.......... ...
Owner Name:.. J4!fr....L.21 41..�1..............._..........�........ _.... ...... Phone No: _... .........
_..................................- -
Mailing Address:
FacilityContact: ........................................................................ Title: ... ................ ...................... ......... .......... Phone No:..................................................
Onsite Representative:. rI-{l,�,�,(71, _ Integrator: .�....__.... __„ „ ....
Certified Operator: ... ......................................... _......._...................... ........... Operator Certification Number: ........ ......................... ...
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • �� �«
D Current Destgn Czsrr�ent Desr Cnrient gn
Swine -.Poultry; ciPo 'ulatrat> rPoNaiatton
Ca
Po ulation Ca" acr
Wean to Feeder
Z500
❑Layer Q Dairy
- -
x: ❑Non -Layer ❑ Non -Dairy
Feeder to Finish
E
Farrow to Wean
Other
Farrow to Feeder
Farrow to Finish
Total Dt ,Ca aclt
Gilts
Boars'Tota13SLW:r
Y
Number of Lagoon_
}
} � f.
•.. CT" Y.y.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes eNo
Discharge originated at: Q Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZIo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gTNo
Structure I Structure 2 Struc
ture a Structure 4 Structure 5 Structure 6
Identifier: =_:eer_.......... .ff`...... ----........] . ................... -... ................... .•-... •....... ---............... -..... ...................................
Freeboard (inches): GY
12112103 Continued

1,
r%ac , Number: 3� — ZL� Date of Inspection
v
05. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
IV
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ;2(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 maintenancelimprovement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
❑ Yes JVNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes INO
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes XNO
❑ Excessive Ponding ❑ PAN ❑ Hyyddrauhc Overload ❑ Frozen Ground ❑ CopperZinc
and/or
12. Crop type Or+j �Z C/ UEi25E
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ es No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ZNo
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes 'A No
16. Is there a lack of adequate waste application equipment?
❑ Yes XNo
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ANo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes XN0
roads, building structure, and/or public property)
20, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes �No
Air Quality representative immediately.
/
s� �7
Comments der to qon #)- any YF.S answeks anrUor any recammenda3rons flr.,any other comments.
a� -
des
Use dra of f�za►bibk6 srtut�ons risedahbn 1 asaecessa ry) Field Copy ❑ Final Notes
{;
27-1041p N!-4OS
AL
l
- f Al �/h� u- 9-z� �D,• ,es�,�a� Q t'�e'e-ej �� ��Q PN rsW`Z_s
sue?
A o! ���✓yNeti- �H �-G� ��f1s� G l�f� �Cf!-,
V✓ ►T7/ // ���G-sic.., �/ ! �0/V s � �� � �� �4
17 _ �;---
Reviewer/Inspector Name % - _; f.dt
Reviewer/Inspector Signature: Date: o
12112103 r Continued

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

_ Q
ci Division of Soil and Water Conservatiott �
Q OtliermAgency 3 m �`
Type of Visit (2)-Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number l Z Date of Visit: l / Time:rO d-�^
Not Operational 0 Below Threshold
0 Permitted 0 Certified © Conditionally CeerrCertifiedO Registered Date Last Operated or
Above Threshold:
Farm Name: 114w_ e/r/ County: /✓ic���.t
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: �iya Pe!:�: Integrator:
Certified Operator -
Location of Farm:
Phone No:
Operator Certification Number:
[]Swine ❑ Poultry ❑ Cattle []HorseLatitude 0a u Longitude • •
_.
Design_Current Des�gtt Current Design- � - Current
Swine _ Ca»aciri Potiutation--Poultn Canacitv..POD' ulation _ Cattle _ " ... Cauacitf Pounlstion . .
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
,w Non -La er Non-Dairy
�x
❑ Other
.Totai Design Capacity
Total SSLW
Number of goons,.- i ❑ Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
H91ding'Runds-f Solid Traps 10 No Liquid Waste Management System
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)
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 -57 _-
Freeboard (inches):
05103/OI
❑ Yes 9-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes ETNo
❑ Yes ® No
Structure 6
Continued

Z
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,
seepage, etc.)
b. 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 evidences of over
/application? ❑ Excessive Ponding [IPAN ❑ Hydraulic Overload/J
12. Crop type 04/'4 , /!
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes 0 No
❑ Yes M No
❑ Yes W No
❑ Yes EINo
❑ Yes X[No
❑ Yes ® No
❑ Yes O�Lvo
❑ Yes MNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P}No
❑ Yes ffiNo
❑ Yes CgNo
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes CR No
❑ Yes ® No
❑ Yes 14 No
❑ Yes [ENO
IRL No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
_ .
Comments (refer to questrori #} Eiplatn mivrYES ansr�ers andfor any recommendations or any othercomrnenEs.
-
_ �zne6
i3se drawttgs of fariltty to better expla,n#uations (sse addttrotrp! pages ss necessary) ❑ Field Copv ❑ Final Notes
-
A y' 7crXt GAD+ col,
Reviewer/ins ector Nameal
Reviewer/Inspector Signature: Date:
05103101 v Continued

Facility Number. % — Date of Inspection 0 D`
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?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes TR No
28. is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes RJ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.) El Yes 91 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1KNo
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes RLNo
0510310I

r,• - ADivision of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit p1compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit KRoutine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: - Time: Printed on: 7/21/2000
3
Q Not O erational Q Below Threshold
Permitted 13 Certified © Cond' 'onally Certified © Registered Date Last Operate r Above Threshold
FarmName: ....... 11..5............. r.................................................... County':.... %/. .................... .....................
OwnerName:....4�1.'...G :ll. `.......... �.]� . ......................................... Phone No:.......................................................................................
Facility Contact: ............. Title:......... Phone No: ...................................................
Mailing Address: .............................................
........................................ .......... .................... ..
.77
Onsite Representative: r Integrator: ,.,,., ,1�
-`L-e
Certified Operator: ................................................................................................. ....... Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 .4 Longitude 0 & «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle apacity Population
Wean to Feeder ❑ Layer I I 1E] Dairy
❑ Feeder to Finish I JE1 Non -Layer I I JE1 Non -Dairy
l I
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag—n Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation? El Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance rnan-made•? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. II'discharge is observed. what is the estimated flow in gal/min')
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard p us storm storage) less than adequate? ❑ Spillway
��,,,�a
Strt ali-c i StrUCLure 2 Struc"titre 3Z Structure 4Structure 5
y ,r yy " ,�,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ANo
❑ Yes gNo
Structure 6
Frechoard (inches):
5100 Continued on back

phacility Number: — Date of Inspection Printed on: 7/21/2000
1V._ PLC
5. Are there any immediate threats to the integrity of any of the structures ob erved. (ie/ trees, severe erosion,
El Yes
jNo
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
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
qNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11 _ Is there evidence of over application? ❑ Excessive Ponding []PAN []Hydraulic Overload
❑ Yes
%No
12. Crop type 0
13. Do the receiving crops dif er 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
NNo
b) Does the facility need a wettable acre determination?
❑ Yes
MIo
c) This facility is pended for a wettable acre determination`?
❑ Yes
J�rNo
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
;(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
( dNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) El Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
0: Nd -yiolati6 is :oir- deficiencies •were poted. during this'visit: - Y:ou will teeOVEe Rio: lfutlh& - : .
corres�ondeirce. abaut� this .visit. .. .. . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better expWn situations. (use additional pages as necessary):
AL
OV la eAl�f 0/7.
J
Reviewer/Inspector Name l0
Reviewer/Inspector Signature: Date: 9 ,2/049 5100

Division`ofSoil and Water Conservation Operation Review
_3
m -- DiVEslon of Soil and Water Conservation - Comp fiance-Insp echon
f� Division of Water Quality -Compliance Inspection
Other M ency Operation Review
_-,--'
Routine 0 Complaint 0 Follow -tie of DWQ inspection 0 Follow-up of DSWC review 0 Other �
Facility Number fate o1' Inspection
Time or inspection E— 24 hr. (hh:mm)
Permitted ❑ Certified [[ Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
`�- ..........................
FarmName: ........... [ \�... County:..................'l_........._..........................................
......................................................
Owner Name:.........+- ...:.---...---. Phone No: ............
FacilityContact: ........................---..---- Title:....-- ......................................................... Phone No: ...................................................
MailingAddress:................................................................................................................................................................... ..........................
Onsite Representative:.ln�!'�� ✓.... Integrator:...+Sv?...........................................
..... ...... ..... .....
vw�
Certified Operator:............................................................................... Operator Certification Number:...... d,,,,,.
0�06
cf ati of F m•
.....ri................lG.!-.......!..................................................... _
Latitude 0 • ° .4 Longitude ' i �4 '
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
1D,1966
'd.Gp
10 Layer
Dairy
❑ Feeder to Finish
❑Nan -Layer
�JEINon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Soars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nian-made`!
b. II- discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. [f dischar e is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3_ Were there any 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches): .......... �
❑ Yes X No
❑ Yes % No
❑ Yes ENo
❑ Yes gNo
❑ Yes LNo
❑ Yes % No
❑ Yes XNo
Structure S Structure 6
1/6/99 Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate; threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El 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 tchl
No
$. Does any part of the waste management system other than waste structures require maintenance/improvement. ❑Yes XNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes 1KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? XYes ❑ No
11. Is there evidence of over application? _ ❑ Ponding ❑Nitrogen ❑ Yes j�No
12. Crop type ...6SY �-� . [..SG.�!...�..(J:ljz�. ........
...
B. Do the receiving crops differ with those desi-nated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes tZNo
14.
Does the facility lack wettable acreage for land application? (footprint)
Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
DdNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
dNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation. Freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C�rNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
;4 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes NNo
- : N:o:vWations-or. defciencies.were noted during.tfiis.visit.. Y.oti will .recelve no further... -
correspbridehce; about: this :visit.; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;
Comments (refer to question #): Explain any YES answers arid/or any recotrimendations-or any other comments.: ,
Use drawings of facility to better explain situations. (use additional pages as necessary) ;
�a
5L,5 - fieWe _V�
e
5 •
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� Date: ! 9
1/6/9!

c,
h � vp �4'L:e�'�.'�i`�a�ii:o„s3:k�:. ': _ r�.. �t`z,.�seN»�c»N, rr<i;:a:,c,as ,w.,st'>i.;�;.�y,w.atu-•:; w.e ��-,,. x k�, �-��, �,� :' °� ✓ `' „fit,
E3 Division of Soil and Water Conservation ❑ Other Agency`
.;
0 Division of Water Quality'
y�
DO Routine O Complaint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Facility Number Date of Inspection I_ 1LJ •"
Time of Inspection E= 24 hr. (hh:mm)
Registered © Certified PlApplied for Permit E3 Permitted JE3 Not O e,rational Date Last Operated:
l�
Varna Name:..... { ..... wCounty:.......... ......... \�~..................................................
................. ....... C� 1 ....V ..
OwnerName:....... .... ....................................................................... Phone No:....4 4 .. �Q..~ � ...............................
Facility Contact: .... ................................. . Title: ................................................................ Phone No:
Mailing Address: ..I.7.. ..... / ....... .......................... ..........................
Onsite Representative:.. G.! 21� G.. .`................ ....................................Integrator:....�z 5 .. S ......................
Certified Operator:............................................................................................................... Operator Certification Number:............................
ti of F ran:
........ G.... 1 ..... .....i.1.! Q..... �........lI1YL.ti .. i!1� .......... fie'- .. ............................................ �^�............. ........ A ............. �
u,.....sS.. ..tW$.�.�.. Q...ft..,,.. .......... ...............
Latitude 0 6 46 Longitude ' 4 0"
General
1. Are there any buffers that need maintenancelimprovement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes 1 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 Surface Water? (If yes, notify DWQ) ❑ Yees1 No
c. If discharge is observed, what is the estimated flout' in-at/min? 1�
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? ❑ Yes 19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5_ Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes � No
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 5(No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes allo
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsfioldinE Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2
Structure 3 Structure 4
Identi Fier: A-
...............................
a
............. ......................
3
.... ................................ ........................... ........
Freeboard (ft):........... ".1.e...................
............. 1i�
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes allo
❑ Yes 0 No
Structure 5 Structure 6
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an irnmediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of W , o runoff entering waters of the State, notify DWQ)
15. Crop type ....... �C,
....... �........................................................................................................................................,
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vitilationsar deficiencies:were-notedditriiig this:visit: Y_ ou:will recei�_e•no•ft rtlier, : •
c0r p0Wek6 AWA this:visit:
A-- A, eft- � g' �e� � ►� �t�
❑ Yes allo
❑ Yes [�No
Yes ❑ No
❑ Yes O No
❑ Yes birNo
❑ Yes 0 No
❑ Yes ErNo
❑ Yes No
❑ Yes No
❑ Yes ONo
❑ Yes `0 No
❑ Yes J&Nq
❑ Yes 0 No
❑ Yes No
❑ Yes No
7/25197
Reviewer/Inspector Name
IReviewer/Inspector Signature:
liiiWMIW

a
�� Division of Soil and Water Conservation Other Agency
�u�,
U.
U Division of Water Qualit10
y
,,.
O Routine O Com laint Follom--upof MV0 inspection O Follow-ue of DSWC review O Other
Date of Inspection 4 2Q
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered MCertified M Applied for Permit 0 Permitted 13 Not Operational Date Last Operated:..........,
Farm Name:'`''. �....`tr................... County: .....1}l<is^........................................... .......................
Owner Name ....... K,�i1 �.... h11.,......... ...... L y 1........................................................ Phone No: .�`�1��...�e�.-.n7.3�..........................................
Facility Contact: ... t4y.w, �1c�..... ? ................Dt?5. .............. Title: .......................................... Phone No .......
Mailing Address: .... 15-7........ ... P--�........................................... ...... Ak ................................. ga...........
OnsiteRepresentative:.....>7Y1�1..._F�S.............................................................. Integrator: ....�s............... ........................ .................
Certified Operator,.... ...................................................... Operator Certification Number ;...Z .z...................
Location of Farm:
Latitude C®« Longitude ' ®4 ®64
' 111V n €
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Poultry
MINE
Subsurface Drains Present
] No Liquid Waste Managen
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 gaUrnin?
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?
N
Lagoon Area I❑ Spray Field Area
System
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125I97
❑ Yes 9No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes U1, No
❑ Yes [9No
❑ Yes V] No
Yes ❑ No .
❑ Yes KNo
❑ Yes %,No
r
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
® Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ! L
Freeboard(ft): ............ Ir 4........................... Z7................. ........... 3`..l'p.,............... ............................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
[3 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 maintenancelimprovement?
® 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
V No
lVaste Application
14. Is there physical evidence of over application?
® Yes
❑ No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type C.Ct� ....................... ..................... :50.yw. ..........
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?
❑ Yes
®No
22. Does record keeping need improvement?
10 Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
0. No.violations:or. deficiencies:were noted_during this;visit.. You.4ili ieceive•no•ftirther-
correspondence Ahout-this.visit:: :. :. .... .
ri- ra[jj �,o� .,�,1,,,, cawl �c ; ns �� • `� �2 e� q�. uk I 1 /� Q'
G1it.il �1 iJI� CiL�i�i"� ii i� r f T tq
�b-r'�nSaOVdQans s�c,u�� be, A� ec� I WgSSt �G for Vtewitt J E� ows.
Z� r4ta Avg&" S64 LW k'-- S1 bn rtcoq&. wo,4t_ ewvAS -4,wo 62- Cl'�
►� �� Intat s� S� a� �ie�� z thr� �,•! k p(c�,. `t t�� AM), �t�,.4 [o.� cJdJ
WAS Durn7/ 5197
:�tvar haaoli,AW dWL. n,nd1 Inarr►►,i�J 4L, � ,, -to n t[ ,lzl._ rt1 �izc�.t}►ne • l+�tis ae
Reviewer/Inspector Name
Reviewer/Inspector Signature 6�
Date:

Facility Number: Date of Inspection:
AdditYonal'Comments and/ or.Drawings r.
� 6.c- i rAD � p,gbai. r �, rA� Se � k0�ooti #i i b� vOx
4/30/97

❑ Division of Soil and Water Conservation ❑ Other Agency
Ug Division of Water Quality
0 Routine df Complaint O Follow-u of DW'Q inspection O Follow-up (if D,SWC review O Other
Date of Inspection !
Facility Number 7q Time of Inspection Ij'` 24 hr. (hh:tnm)
©Registered. A Certified 0 Applied for Permit ©Permitted [] Not O erational Date Last Operated:
Farm Name. �� ....... lrCtY1................. County:...... .4 �.1.k1......................................�!�%4.. Si....
Phone No Af0 3
Owner Name: ..............YY1�S.......��..}}.........P!�.,.... ��...........................................................� � �i�. .ct...,7
Facility Contact: .....&I(!!CY`................. ts+ Title: Qta)r441' ... Phone No:
MailingAddress:.............!in��i Lk... a�..�s...:.......................................... :....Q..i.V....r...}......r._.�.-............................ �..
Onsite Representative: ..... t4onIli............?ca<..................................................... Integrator:....G.oMx �Y.9.......
Certified Operators.... ..........L!T..... .....U;f..........................................Operator Certification Number:.........?
Location of Farm:
.rr.tn......L ..... ac.....C—IT, ...... �A., r, iI0."....c........ct....1.0a4 �'�...... 0 .......S.L.! .0-'r1A- ..r.....
.,.. ........ ....
Latitude ®• ®' " Longitude =• ©4 «
-� Design'"
.Current Design Current 'Design 'Current >
Swute .t Capacify Pbpulation 5 Pauitry Capacity PopCattlePPopulaE on
® Wean to Feeder
Layer
_
❑ Dairy
„
;'
❑ Feeder to Finish
'
❑ Non -Layer
, '
❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder
❑Other
9
-
❑ Farrow to Finish
J r
Total Design @apathy
j Sr�v
❑ Gilts<
:
[I Boars
TotaI.SSLW
Number of ° Dons l HoldYn ".Ponds ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System^ l'
v ;._ .,.
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 ij Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade?
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 gaUmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance- improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7_ Did the facility fail to have a certified operator in responsible charge?
7I25/97
❑ Yes
❑ No
® Yes
❑ No
❑ Yes
® No
Yes
❑ No
1o5At. l
[--]Yes
,® No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Continued
on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures (Lagoons,tiolding fonds, blush Pits, eta
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: #j .........................
......................................................�. ....................................I....................I.....................................
Freeboard (ft): ..............( ........... .................z .. Z.................
10. Is seepage observed from any of the structures? ❑ Yes ❑ No
I I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14, Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 - No.violations• or deficiencies were noted- during this;visit.- You.,wiu eecefve- no' , Airther
correspondence about this:visit:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CK Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
19 Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
IM Yes ❑ No
❑ Yes ❑ No
Ganiments�(refer'to questaan #) ; ExpIAt arty YES answers andior at y :rereimmendattons or any* oilier ctinnirnents
Use drawttgs a[ facthtvici better expiate situahnns (use addtttonal pages as neeessairj+}�
`
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7125P
Re-tiewer/Ins ector Name t • � " /y `$ F "
pi
Reviewer/Inspector Signature: Gate: Z

❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
10 Routine O Conwlaint O Follow-un of DWO insncVtion O Follow-un of DS%VC review O Other
Facility Number
0 Registered 13 Certified © Applied for Permit E3 Permitted
FarmName: ........M*-a.............. I...........................................
Owner Name:......ntu ......gam+.
Facility Contact: ..... .:41.Y1YtA. ...... 5 ........................
Date of Inspection
I Time of inspection L /a: 60 24 hr. (hh:mm)
0 Not Operational I Date Last Operated :..........................
County:
........... Phone No:.. 110(is.°..'..34P..............................................
.... Title: ........... 6jjr.tr................................... Phone No: Uk9j.651--.�W .............
IMailingAddress: ..... 15-? ....... 4hn�lf ;tin, .. .f5 ".......F.......................................... .....�!) T...... l.f.v��.. . ...................................... alas.....
Onsite Representative......... ��R.11i7�.14\,....gcs........................................................... Integrator:. �jp�.�.�kllJ!rD.....4,
Certified Operator .......... V'Lrl1'us�+ .....................................•...................... Operator Certification Number; .... 24W.z......................
Location of Farm:
lava ....5.....l.3. ....� ....... in......wa...w.......... ... ......GR.. 1 ......%um...
r. .....�a .....1 ......g.R...l :,...'Fi r..m.............cs..l..m�..........rm..... t---.-�.i.�.G.... 1,ofl.........................-.....-....................... .
Latitude • " Longitude • ©4 .4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity. Population
Wean to Feeder
gGo
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I JE1 Dairy
❑ Non -Layer ❑ Nan -Dairy
❑ Other
Total Design Capacity., ► zi gc
Total SSLW
Number of Lagoons / Holding Ponds ❑ Suhsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
tA No
2. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
P No
b. If discharge is observed, dill it reach Surface Water'? (If yes. notify DWQ)
❑ Yes
[P No
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system'? (It -yes, notify DWQ)
❑ Yes
(p No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of desi,n')
❑Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes,
No
7/25/97
Continued
on back

Facility Number: If — 2.5
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La2oons.iloldine Ponds. Flush Pits: -etc.
❑ Yes P4 No
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes P No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .--.. ............... ...... ......... ��........_.............._..#............
......._....._.............................._................_..._...._................_....................
Freeboard(ft) • 3 ............ ........ ...........7,..........................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes 14 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? i�A 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
ANo
Waste Application
14. is there physical evidence of over application?
❑ Yes
5d No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Cp(l........................................ � .( ta...............--.._..... .......ATL ........ ..................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
W No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
I& Does the receiving crop need improvement?
❑ Yes
JR) No
19. Is there a lack of available waste application equipment?
❑ Yes
'XNo
20. Does facility require a follow-up visit by same agency?
Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X No
22. Does record keeping need improvement?
gg Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
W Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
& No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
MNo
0 No.violations or deficiencies. were -noted during this -,visit. Nou4ill receive no further
Correspondence about this'.visit:.:. ..
Comments{refert question #)-. -Explain any YES answers and/oraity rem comendations oir any other co uments
Use d"wingsof facrltty to better explain sttuaitons (use additional p ges 4s.necessary} E
S&M-- e bU4 OrMQ hyc % IMAW wta_r Add rJlkl-LS. }
kf-/12- 67 iMTbn 0^(GS Or. 4k iIIYU.( ►V&1j pt I�Cen #3 ��aUi� he 4,1tj !�}IY`^i L-�1� aj rtlefiJ.
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rt-seeW. &rm <61.ink bj, 11 "vj buot}era„ (r aj., 9 i -
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5wh b' e. , r, ax-k1 jY ?6 . 1Vr Doi f tyx evv � Veti + S S� Oao be a, Sir[
l3,Cc �tes Pan S o��L be ert si . 1\l0 1, im caa:JAL r raw houus-
�" i . S,,m nms 5kavlJ YLi� i e-X ce-4 1 Z hours . 7I25197
Reviewer/Inspector Name EKIN
Reviewer/Inspector Signature: Date: C4 113A 7

0
•
Site Requires Immediate Attention:
Facility No. 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �— , 1995
. Time:
Farm Name/Owner: lC S t3rev, do 6e 5 H 8
Mailing Address:
County: Do 00 i n
Integrator GoI 5 �Zro � F m Phone:
On Site Representative: Phone: (O DZ — 9 320
Physical Address/Location: r--rbm VCAG� '103 . j e-PToo kUU4, 10 m, ` c n rf, ht
Can t k myhecl( �- e e44 -, A, '� em e11 �� C2.
Type of Operation: Swine v"� Poultry Cattle tiv�s vrr.G 2
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: ' it Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. 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? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?I Yes or No
Additional Comments: � 2nO+. Can lu , C-40 5 kacl
L_ L t7,u a 3
Inspector Name
I A?��
Signature
cc: Facility Assessment Unit
. Use Attachments if Needed.

OPERATIONS BRANCH - WQ Eax:919-715-60 8 Jul 13� "95 9:18 P. 17/17
•
Site Requizes liruned-iate Attendon .` --
Fac ility ur:3ber:-) ! -2l__.__
SITE VISITATION RECORD
DATE: 9 --��, 1995
Qwoer: Farm Name: -- -- —
C4iItiC�J:_
4b nt Visiting Site, t —7,716
r��- Phone: Q't.--
Operator: — �. _ _ - Phone. _
On Site Representative: --
Physical Address:
Mailing Andress:
Type of Ovu.ration: Swine [.
Design Capacity. 0 6 D�
LailLt�tle: °
Type of Inspection: Ground
F Qultry �.. Cagle --
l , L mbt,-z of An3lAlads Qij Site:
,FLUC " _�
Aerial
Circit Yes Qx No
m
Docs the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour stoma event
(appro:,irnately I Foot + 7 inches) Yes ore o Actual Freeboard: Feet 7rlclI
For facilities with more than one lagoon, please address the ocher lagoons' fr-eboard under the
conunc:nts Section -
'bias any seepage observed from the lagoon(s)7 Yes o s Was there erosirr. of the daru?: yes or -No
Is adequate land available for land apphcation? Yes or No Is the cover crop adequate? Yes c. No
Additional Comments:`1
Fax to [phone] Simatura of Agent