310037_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

idiI { Sfli{ist�§ i� Division of Water`Resnnrces'€��
! u
Facility Number Rs j 7 0 Division of Soil and Water Conservation
Q Other Agency,.
Type of Visit: Co lance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: I Z Departure Time: J v County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7.9 ^ec
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: 91 75-,r6
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop Cattle- .. Ca aci Pop.
Wean to Finish
We o Feeder
eeder to Finish
11 'Ib
&—Z-P9
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
"MIN=
m " ,Other
Other
Layer
1 Non -La er
Design Current
—.Dairy
Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ Na _NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: _57 jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "� s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�E] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]' 0 ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0-110 ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q-1qo`_❑ NA
❑ NE
maintenance or improvement?
1 l . 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 > t0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o D NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes pro NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Io ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
L_�l 5:bNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D' O ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q New❑ 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 040 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D 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? ❑ YesNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesgNo'�E] NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: • - Date of Inspection: 7 IZ q a-7
"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 0 Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [-]No Ej NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 EfNo ❑ NA
❑ Yes rNo❑ NA
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes ❑ o ❑ NA
❑ Yes ❑ NA
❑ Yes No ❑ NA
�] NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: ----- ( E Date: f�/o
Page 3 of 3 2/4/ 015

U Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
• 0 Other Agency
Type of Visit: (0 Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance v
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: UU t Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ��REHA0 f 1 L. A— Integrator:
Phone:
Certified Operator: Certification Number: J q r7Y 76
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I FLayer
INon-Layer
Pon
Other
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes (/No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes WVO
❑NA ❑NE
[—]Yes ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection: ID ARG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P40 DNA ❑ 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: LACrouO l A6raoJ ,1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): el 2 Lev
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F,,17No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 490 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6/N(o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:k ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [No ❑ NA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below. 0 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:3 Yes [eNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
eNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L3"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R]"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I__l '� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � l�o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: q I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
/o [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? CD Yes Eallo - ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard.problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑Yes 2<o []NA ❑NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes �'11O ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional. pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: (p
2/4/2015

-:.kr a r' w a } -.,a. c -ktc...,x .fit° y -•+
' _ .,,, ...-i:•+* tom.' D1 ISIOII Of, WSfef4R i6q,CCe5
Faciiity Number / 1 O D�visioII of`Soil andWater.Conservahon ,
.', - �," �, .v' ",�,""` a,Y g '"" ^awe.s.w m,'ww �": -•y„ -. a *^ °"*,c "a arm
•�G"'Other Agency , •� , . �
Type of Visit: Co liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:, '►J Arrival Time: Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Svine
Wean to Finish
Wean to Feeder
X Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Pullets
Phone:
Integrator:
Certification Number: �q
Certification Number:
Latitude: Longitude:
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Cy ow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ YeseNN❑ NA ❑ NE
El�zoYes ❑ NA ❑ NE
Page I of 3 21412014 Conditued

Facile Number: - Date of Ins ection: f
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAte� I Z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1E 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
ZNo
❑ 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
U 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2(No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
6No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
El Yes
IN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNj
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
-24: Did" he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0Nc ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fg4o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document (—]Yes to ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2<0 ❑ 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 E24 ❑ 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 Io ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ro(O:]
NA ❑ NI
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 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).
2) 69A0coVeA-- wdR-IC
DDkS a1 f166P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone �" 1 4 _� <a
Date:
2/4/2 I S

I�• • .. � � �J Division of Water Resources � '� -�� � � , ��
s Facility Number�`7� = lllvlsioQ of Soil and:WaterConservahon
`<_ �; � � .� �� Otber,„Ageney _ - � : �� � �' °� ��Q .:�. o � ..�;. � . ,� - � � ;.:, :5oa• `�..
Type of Visit: Cal 71toutine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: 1 i Arrival Time: LL.I�I Departure Time: County: �(. Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: J00palu� r"l (X11- Integrator:
Certified Operator: Certification Number: (cj �J}
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
U.
Design CUirCQt r "Design ""Current�s� DeSIgQCurrent?*
»Swine Capacity Pop Wet Poiiltry Capacity Pop < , Cattle C pacity FPop
r _ �-
i
mean to Finish
Jean to Feeder
eeder to Finish
arrow to Wean
arrow to Feeder
arrow to Finish
:d
,Other _
Other
I JNon-La er I I I:
: Pullets
• Turkeys
Turkey Pouets
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes U No ❑ NA ❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: 57- Date of Inspection: Gl 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes I N ❑ 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 o ❑ NA ❑ NE
t�
maintenance or improvemen .
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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�N ❑ NA
❑ Yes V ❑ NA
❑ Yes VNo ❑ NA
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13<0 ❑ 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 ZO
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �j/No ❑ NA ❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 13
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 N ❑ 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(cs) 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes rj No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 2/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E 2514o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
F❑NA ❑NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #f); Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
NO
Phone 1a
Date: it In
Page 3 of 3 1 ' 2/4V2014

' Division of Water Quality
Facility Number ©- © 0 Division of Soil and Water Conservation
0 Other Agency
71
Type of Visit: ZRoutine
pliance Inspection 0 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: l Arrival Time: l ZS Departure Time: Z o County: PL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: q -iqIntegrator:
Certified Operator: Certification Number: 9 q l 5"g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I F Layer
Non-LayerI I �:::]
Other ,
Other
Design Current
Dry Poultry Canacitv Pon_
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current' .
Cattle Capacity Pop.
Dairy Cow
y Calf
Dair
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [�❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Numbtr: Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: LA660N I lA &-MJ1i
Spillway?:
❑ Yes [:]No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ 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 ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes �No ❑ NA ❑ NE
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 [2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes C31No ❑ 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 D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
0No
❑ 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
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L'J '" ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31-Y21 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo 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 VTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA FINE
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 [rNo ❑ NA ❑ NE
❑ Yes C o ❑ NA ❑ NE
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes �Nq ❑ NA ❑ NE
❑ Yes VNo
❑ NA El NE
[:]Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional naees as necessarv).
q) [,A&-Iraw Z tsc co S D-a-C km oV In"�1T`Eu►ar k_e
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
Phone: D 113 y
Date:
/4 oll

0 Division of Water Quality.."
Facility Number - L7� O Division of Soihnnd Water=.Conservation
Q Other Agency ' J.
-
►Y.;.
(Type of Visit: 0 7Routine
pliance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f j "LO Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ,jaw "i Pki PA iLU -Er2
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current.-; Design,, Current Designr CurrentR
Swine Capacity Pop. Wet Poultry Capacity Pop._ Cattle Capacity Pop.,
Wean to Finish I ILayer
Wean to Feeder Non -Layer
Feeder to Finish 5 boo
Farrow to Wean Design Current
Farrow to Feeder Dry,.-Poultry.:�l.'-'�Capaci6,,:,,,.'Pop.
Farrow to Finish
Gilts
Boars
-Other'.._
Other
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Daff
y Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify 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
❑ Yes gZo
❑Yes
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
�ra,l
Page I of 3 21412011 Condnued

Facility Number: - Date of Inspection: 11 7,4j►'i
w �
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 1 Structure 2 Structure 3 Structure 4
CA (,-v&opZ.
L-G L4 B
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[—]Yes No ❑ NA ❑ NE
❑ Yes To ❑ 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
PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
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
CjeNo
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
ENo
❑ NA
❑ NE
�es
❑ No
❑ NA
❑ NE
❑ Yes
[3] No
❑ NA
❑ NE
❑ Yes Ld 1V
[:]Yes rNo
❑ Yes No
[—]Yes ❑ No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0NA ❑NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2-N-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ �No Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes PNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: IDate of Ins ection: It
24.,pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No, NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �io ❑ 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
0"'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 [2<No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes LQ 11U
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes [� o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes gNo
❑ NA
❑ NE
Comments (refer to question#): Explain any.YES answers and/or any additional recommendations,or any other comments.
Use drawings of facility to better explain,situations'(use additional pages as necessary):'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-4 �j G L� Phone( 9 -7 3 g(
Date: l l Z
21412011

W Division of Water Quality
facility"Number - FF77 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: C pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: fl p Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: `.,1 oN A rU'A►1 MT_LLf-iL Integrator:
Certified Operator:
Phone:
Certification Number: I % to
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
II -aver
Non -La er
Wean to Finish
Wean to Feeder
j(
Feeder to Finish
It t,
000
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Non-L
Pullets
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes] o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: [ t tt71
Waste Collection & Treatment
4. Is -storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA CrzziJ LA [ram Z/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3y 3 es
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6No
❑ 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
VNo
❑ 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 environments
hreat, 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
E/No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? `E ] Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3"'No ❑ NA ❑ NE
acres determination?
17. Does the facility Lack adequate acreage for land application?
❑Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
TT
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the 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
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 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?
❑ YesVNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Fa0flity Number: 3- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. fs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[:�rNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2"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
2(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
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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
[10
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers anchor any additional recommendationslor any other comments $n
Use drawings orfacility to better explain situations use additional pages as necessary).=`.
x
( 5, ) nJeep Am Lim C-_ ro SE 6"cZ x6t_.DS.: SP9,WGi -rime 9t~ fop+ IacruvtvA
STA 2`s.
Reviewer/Inspector Name: J6 14 �_j rA dZ►.1 �_-CA_ Phone: (C'1D)79 t —13 0
Reviewer/Inspector Signature: Date: it 11 f
Page 3 of 3 21412011

I
Division of Water QualityY'
Facility. Number 3 � � 3 � � 0•Division,of Soil and Water Conservation,';,
0:Other, Agency .:
Type of Visit ,Coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C9 Routine o Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t it7 Arrival Time: Departure Time: County: -I>UPCAMi1J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: VON,Aerpad r►')T'I.( Co._
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o = I =" 'Longitude: = ° = L = "
- Design - .;Current Design Current
Swine Capacity. Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
i D t
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
—]Other
❑ Layer
❑ Non -Layer
Dry -,Poultry", -
El 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
N umbef(if 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 Z/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
No ❑ NA
❑ NE
❑ Yes
El Yes
,❑l
NNA
❑NE
ElYes
�No❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility. Number: 31
Date of Inspection I ! tf ID
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: (A(7-y0+-1 I LA6-d-SiJ L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LJb oZ�
❑ Yes 0No ❑ NA ❑ NE
❑ Yes &o ❑ NA ❑ NE
❑ Yes E�rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA FINE
Structure 5 Structure 6
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?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D o ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo ❑ 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
El"No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo ❑ NA
❑ NE
"Comments (refer to'quesE�orr'#)' _Explain any YES:answers andliir any recommendations or any other comments
- .
:Use dirawings of facilityto,.better explain situations. (use additional pages as-nec ssary); =�
T
Reviewer/Inspector Name.
Phone: !0
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 12/28%04 ' Continued

4
Facility Number: — Date of Inspection
t 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 dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L"J No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 6�i ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L`J No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErlNo
❑ 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
IJ 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
eNo
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�(No
❑ NA
❑ NE
Additional'Comments and/or Drawings: '
Page 3 of 3 12128104

m
Nil
,y
�D Vision!of-VI
FactLty Nutllber 3 37 '0 Division of Si
' �y `- �. OtherkAgenc�
iter Quality A
Iand Water Conservahon
Type of Visit Ca liance 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: /G G l Arrival Time: / O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: tf 14 A-N.( Wk _ _U=t__ (_—
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 o = ' = u Longitude: = ° 0 6 = it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
/0
jja
❑
Farrow to Wean
❑
Farrow to Feeder,
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Yes
❑No El NA
❑NE
❑ ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

�s
Facility Number: X -3 Date of Inspection
Waste Collection & Treatment 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA LcyM LA Zi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): on 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta719C
at, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
❑ NAEl
NE
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O�No
[I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
L� N
El NA
E] 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�IN9,0Yes
NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Reviewer/Ins ector Name 5 _ v� gip`" �' �t a (,
P � '�� Phone
Reviewer/Inspector Signature: Date:
12128104 Continued

r
a ,
it Facility Number: C — Date of Inspection i L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZf ,, /No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ek<. ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EiNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
['/ o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C1
yuo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
hio
❑ 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
L2I 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
CfNo
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
12128104

Did Sion of Water Qdahty
3 Nilri3bet--; Q Drvisfon of Sorl and Water Conservation �
Other Agency ;
Facility.
Type of Visit
Type of Visit
Co fiance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other [I Denied Access
Date of Visit: 0 3G O g Arrival Time: bo Departure Time: County: QVPLTJJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: .� „n Title: Phone No:
OnsiteRepresentative: czoAlJQENAJ ►+' lt-Lc2 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: =o = [ Longitude: C
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey Poults
❑ Other
0 = A = Ai
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑
El Yes
L N
El NA
❑NE
El Yes
LQNo
❑ NA
❑ NE
12128104 Continued

l ,kility umber:31- Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: G6006't_1t to (for/ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(iel 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ElNA ❑ 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 ElYes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
"/ ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Siudge 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 ❑
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes L'I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes IJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WN o
❑ NA
❑ NE

Facility Number: — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�b 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 appropirate 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes � N ElNA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes � ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El
�,/
ld'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
❑ NA
❑ NE
ko
33. Does facility require a follow-up visit by same agency?
❑ Yes
L�J No
❑ NA
❑ NE
Page 3 of 3 12128104

(Division of Water Quality
Facility Number "j Division of Soil and Water Conservation I
Other Agency
L
f Visit (XCo fiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
n for Visit Routlne O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative- Jom7i N integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 0 0 g Longitude: = o =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
HOC
DO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
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 -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [2(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�T o
[]NA
El NE
El Yes
IL1 No
❑ NA
❑ NE
12128104 Continued

Facility -Number: I Date of Inspection
f`
Waste Collection & Treatment
44. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,,(
❑ Yes E' 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: L14GrlJ Z.
Spillway?:
Designed Freeboard (in): ! q
Observed Freeboard (in): 3 will
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [I/No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ll'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 El Yes E2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EKNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'J 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
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OINK
❑ 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):
7) Q eArL .?w rpl✓ oTt✓e, v uS .
� ,) kalk,47d 30 OJT `Yf 1 AV 6 r4 L1*14 7J ,#A) &A✓E .
lVcmp /PoAl A4 &AGE z- 'rL 11P CIE.
a
Reviewer[Inspector Name Phone: / X 1�
Reviewer/Inspector Signature: Date: o
12128104 Continued

4
Facility Number: — Date of Inspection [ b
Renuired 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 ENo ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElL Yes
"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ es
ENo
El NA
El 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
ENE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[fNo
❑ 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
Oo
❑ 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 N
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
/�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
DIN.
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 10 Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit I$Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 1
Date of Visit: I 6 Time: %� A004A
Not O -rational ^BelowThreshold
® Permitted M Certified [3Conditionally Certified 0 Registered Date Last Operated o Above Threshold:
Farm Name: ad County:
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: !(�—I D&400IJ u
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator: M4.r� q _
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 OK Longitude 0 & K
Design Current
awloe r_:a achy ro tuarton
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I In Non-Dai
❑ Other
Total Design Capacity
Total SSLW
LLJ Subsurface Drains Present IILI Lagoon Area ILJ Spray Field Area J
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: l _ 'Z
Freeboard (inches): 3 :3 / -
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5
05103101 Contenued

it f
Facility Number: 37 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markines?
Waste .Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hy ulic Overload
12. Crop type �� ,�/ t/P/ �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA A MP)?
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?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists. design. maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to noti fi- regional DWQ of emergency situations as required by General Permit?
Oe' discharve. freeboard problems, over application)
23. Did ReviewerAnspector 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 ❑ No
VYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
i a No violations or deficiencies were noted during this -visit You will receive no further correspondence about this visit
Comments;{i Pfe>' o queitioi4 : 'FYplain:airy;YES sns ve attdlol y i on datrons nl Y Otter tommi i C!—,
Lsrdrawings of fact7ety to_ bette eezpisin situationsse addibanal pages as n ryj : ❑ Field Copy El Final Notes ik . (u
077 IA�ooh *1 eeW5 -1yre /a eye /ft' OT h"f, 1.01
[,/l/� r]On '� 7i ��4�/C � 0 � "�- (I)'if4 � O j� />� �%�L� �`� Ads? wa /r'• -
At 1) 0 in Jr 174 Ic 16 bm e, 4 5�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 3 ) - 37 1 Date of Inspection ! O
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
05103101

—v Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance 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: �---t� Departure Time: County: Region:
Farm Name: //�(///il / UGC fC _. _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 6 = 4 Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
- �I❑ La er
❑ Non -Layer I
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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (lf 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facilityumber: 1 4 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: 2
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
[I Yes El No El NA El NE
El Yes El No El NA El NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 1❑ Evidence of WindDrift❑ Application Outside of Area
12. Crop type(s) 8P'r Uj10 ��✓ sr�j C) #�' < 1`4
13. Soil type(s)
,J - v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name v >> Phone:
Reviewer/Inspector Signature: Date:
page 2 of 12.,28/04 Continued

A .`
Facility Number. — 1 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 ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
05-Did
the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
c )
IP6 6 2. S
e g_0
0 3_©
® 3,6
'Y' 0
J 7e�
5jUdy su,"rl
S i.cr`nCO
Page 3 of 3 12128104

y; i (�Dnisi©n of Water Quaff tity
FactlttyNurnber 3 f 3 O Division of Soil and Water Conservation
" . Q Other.AgencV
�r
Type of Visit
rcompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
CJ Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 92`"Nl� (� Gam`{ f'+� -r'r� _— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Gr(-_�_ _kk-JjNx&
Certified Operator:UK1& fq' CA<FH_
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No::
Integrator: MQaPli
Operator Certification Number:
Back-up Certification Number:
Latitude: [� e [= ` = " Longitude: = ° 0 6 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i ❑ La er
i
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
I t 10 1 b
L1 OckS
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ 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?
El Yes LJ No ❑ NA El NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�❑
NA
❑ NE
❑ Yes�/No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — 3�] Date of Inspection O
'
Waste Collection & Treatment
dNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure-2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA o c>O LA GVoN 2.
Spillway?:
Designed Freeboard (in): 4
Observed Freeboard (in): 3? 3 0
_
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 r2l 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 treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes /1J No ❑ 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 ❑ yes `7 N - ❑ NA ❑ NE
maintenance or improvement?
Waste Apglication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drifl ❑ Application Outside of Area
12. Croptype(s) 6ErLrv►v0A Us') S G 0 FES�� �CA
13. Soil type(s) LUC-i Lvyv11%EC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑NA
El NE
[ONo
L� No
❑ NA
❑ NE
E No
❑ NA
❑ NE
f
El NA
El NE
❑ NA
❑ NE
5 Seq&V_f_� Ca�s=0tA 0,-j u1s:rG osl�E wALJ- "_ t✓A6r0o1.1 f . _Drsct-AP+ftA,\E PSP E,
}bAs Srr.P 2ATtrfl CLOSE To POG- N00SE,1 PtNCT-(-_ UA5 q_kr__ ! C. P-r^GT
Olt), LqG 20 Z o' , S &T6 f.tE.EOS To (�,E P_tc.JS.Ss:rCK7 &.? 5-� W ,
W ve To B( UQ0R-rf.D t-1E.w Ge_NT EV__ ?T"J cr�5 PIS
(;cljkC IJ Dd C E a6LS Tyry Ar �"Cs`Srt .
Reviewer/Inspector Name Phone: x 11
Reviewer/Inspector Signature: Date: 2�z�03
12128104 Continued

Facility Number: Date of Inspection a
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � El 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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WN
(o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E o [I NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L'I No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E1 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Vj'*No AA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes (% No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes
9No ❑ NA
❑ NE
❑ Yes
2rNo ❑ NA
❑ NE
❑ Yes
R No ❑ NA
❑ NE
❑ Yes
Q<01❑ NA
❑ NE
Adclit�onal Coiiments
12128104

Type of Visit 0compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine ,0"Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
©ate of Visit:
Permitted [3 Certified(
ted [Conditionally Certified [3 Registered
rt
Farm Name: ' y � O t � G Firms
OwV iy[ ! ' ner Name: o ,�y/ 0r- Gv
Mailing Address:
Time:
rO Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Facility Contact: j, Title: )Phone No:
Onsite Representative: ci l - y�/� l C t� GQ�`� en � Integrator: r r !y
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' u Longitude ' 6 = Cf
Design Current
swine
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacitv Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID S rav Field Area
Holding Ponds 1 Solid Traps JEJ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [--]No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

t Facility Number: Date of Inspection s 0 P—) 3 1
5. .Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
1-1 Yes
.
El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ NO
Waste Application
10. Are there any buffers that need maintenanceiimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAINNIP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑.No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design. maps. etc.)
❑Yes
El No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22_ rail to notify regional DWQ of emergency- situations as required by General Permit?
(iel discharge. freeboard problems. over application)
❑ Yes
❑ No
23. Did Reviewer.'inspector fail to discuss reviewiinspection with on -site representative?
❑ Yes
; 'No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
;. r.e ...awn:
Comments;(refer to question#). EXplan42".1 S answers and/or any r�cammenditions'ur any other. comments. r =
tine drawings of fact�tty to better ezphttu siinahons_ (use addstconal pages as tt
L _-� z ecessae3)� El Field Copy El Final Notes'
R,csffn*4 4a `: oa­rkL p)l -rr-on K; Gk _-Pnve s-Av W I'me-t %VAfI 61e
e vn D�-F eLf WctsAe , G
a►►-,Gi ID -Spi
-ritere is a 6 `4 o-F-�
Pre"', A s e,^, e v c v-i es e G Ct. + l'�'1 f i'''iC kf4 5�11 D( !'T � ' � 5
f-V45 .
3f � ; f� Yore
1, ;.;r- ne tv e1 r 4 - t�� Dr.'s c vssed � f�on� � -hem .
� P
�., e-�►'�C-�a �'' !''v �S �t cis L�LGv ✓'�P� ,�I"� !�'1,� .
..�.l,�S
r--- - .
Reviewer/Inspector Name✓# _
Reviewer/Inspector Signature: Date: l
05103101 Continued

a
I
Facility Number: ) —32 Date of Inspection `�
Odor Issu" _
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missinn or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submersed fill pipe or a permanentitemporary covcr?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
kaS eeCe$q4 ly had q pAs4ilre eze,,ee4e.- e'vn.
J,, �ouG� -� ��•cl� -1Ro �er� -The qer r'a i
pl1�p s Sen-� -�.. a14, r✓�.. 1DOve At'OCor 40 s l,ew _<C'" Peed
; -! is L,Jh % 1P � I r,.;,)a I : o n ern 4 is S-� : 1 1 G GCS �1'�"',n�
4 L,i ei4e / ,S4 w1cf
Dove ]e w D Vey,,
a fe (,� C.4teeked ®b('�" 0•1d eL r r&b IQ� was n04 •�Ound
05103101

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
IReasonforVisit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 37 Date of Visit: 4/25/2002 Time: 12:30
NNot Operational O Below Threshold
Permitted 15 Certified 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............•.•••..•....
. County: �Lu; lin............................
Farm Name:`?!'.+�]I�.�.II.d.MC.'.�':itrnn.......................................... ...................... .........
..............................
OwnerName:DAyid...................................... MrKay ....................................................... Phone No: .........................
Mailing Address: 119.1..E,aAA.C.Z4.................................................................................. Kenalt ail c-NC................................................... 183.49 .............
Facility Contact:.............................................................................. Title:.............. Phone No:
Onsite Representative: Gcjao.Xew dy............................................................................ Integrator: Murphy.Fa:fully..F.al w.....................................
Certified Operator: f tyiid.11..................... ,•-- McKay.,,,,,.............. .. Operator Certification Number:
Location of Farm:
West of Sarecta. On South side of SR 1700 approx. 0.25 mile West of SR 1701 and Sarecta Crossroads.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 Longitude • 6 L�K
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ®No
Discharge originated at: © Lagoon ❑ Spray Field Q Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Cl Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.................I..................................2..................................
Freeboard (inches): ...............Z4.............................. 2.5...............

Facility Number; 31-37 Date of Inspection 4/25/2002
Y—Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 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 R 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? 0 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Z No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 9 No
12. Crop type Coastal Bermuda (Graze) Fescue (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? 9 Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? . 0 Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes N No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes N No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes N No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes N No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes N No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 19 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes IN No
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative? ❑ Yes 19 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
7 - Oldest lagoon still needs weed & trees removed from walls.
- Need to extend inlet pipes. Getting erosion on lagoon wall.
- Need to clean up waste by back of hog houses.
- Need to remove or use the large amount of hay bails stored off edge of fields.
13 Farmer is clearing land to add acres to field #4. The WMP needs to be updated to reflect this change.
15 Field #1 needs to be worked on to remove weeds and improve cover crop.
Reviewer/Inspector Name :G
Reviewer/Inspector Signature:
Date:

05103101
Facility Number: Date of Inspection 4/25/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Continued
0 Yes 0 No
Yes No
❑ Yes No
El Yes ® No
0 Yes 0 No
❑ Yes No
❑ Yes No

1
'r
=_ D�nsion of Water. uahty
DEnsjion of Soil,and Water Coaserv-ation y?
a
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number *l Hate of Visit: ©Time: [13GO Printed on: 7/21/2000
0 Nat Operational Q Below Threshold
Permitted [3 Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............
Farm Name:............................................................ County:'�1.._.
...................... ..............
._._.....
Owner Name:
Facility Contact:
Title:
Mailing Address: ..................................... ................
Onsite Represcntative ...
Certified Operator:
Location 'of Farm:
Phone No:
Phone No:
....................................................... ..........
Integrator:....,........
Operator Certification Number:,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * �� �« Longitude �• �� �«
Design Current. Design Current' Design Current
Se --Ca Po iulattion Poultry Cao aci Population Cattle _ Po lion
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total SS.Lw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharae 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
Structu I Structure 2 Structure ; Structure 4 Structure 5
Identifier: ......... U............. .1........... ..................... ...... I ....... ...........
Freeboard (inches): '33
5/00
❑ Yes ❑ No
❑ Yes Wo
❑ Yes 4 No
❑ Yes IdNo
Structure 6
Continued on back

Facility Number: 31 — -3I Date of Inspection Printed on: 7/21/2000
5" Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) Ix
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 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? KYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )!�No
l 1. Is there evidence of over application?
12. Crop type
❑ Ex`cessive Ponding ❑ PAN ❑ Hydraulic Overload
13. Do the receiving crops differ with those designated in the
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?
aste Management Plan (CAWMP)?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
v: Iio •vioiatioris:oir deficiencies .*I� rb noted' 04ift �his:visit; • Y:ob .W111 •reeeiye do fui ftK
correspondence: abatit: this visit ::......:.:.::::::::::::.:..:::
aiiv _V VR
❑ Yes XNo
❑ Yes f No
❑ Yes] No
❑ Yes j No
❑ Yes No
❑ Yes ONO
❑ Yes X No
XYes ❑ No
❑ Yes ,K No
❑ Yes 9No
❑ Yes XNo
❑ Yes XNo
❑ Yes Rio
❑ Yes )<No
❑ Yes No
❑ Yes 'X No
AVR A,
O- ee 5��
M o'C iCl� Q �-r . Ci' ✓fnS S? C V� hP t.
� Pl
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: '< e_
5/00

i
Facility Number `3 —
Date of Inspection
Printed
on.. 7/21
/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below
i' ] Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29_
Is the land application spray system intake not located near the liquid surface of the lagoon?
XYes
� No�1�
30_
.`.'
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc_)
❑ Yes
No
31 _
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional'Comments an orDrawings: -
l
ox Sr -7
Gil S
'*-w CCC,-9 Co"
A
z �. W\ � �' -%, 1% , t (JOV__N
5100

JJR Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 30 24 hr. (hh:mm)
Permitted © Certified [] Conditionally Certified 13 Registered 113 Not O erational Date Last Operated:
Farm Name. .......i1 V..N ...._t16NI `1�4.... County: �1
�l................................................................ ... .......... ...
Owner Name:
Facility Contact:
Title:....
PhoneNo:.......................................................................................
Phone No:
MailingAddress:........................................................................................................."""............................-----------................................................ ..........................
Onsite Representative: „ , ,......I..........., Integrator:.-.,..- `�-., 1
......................................................'�1�C..................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm. -
Latitude �•�� ��� Longitude �• �° �
?Deli` Current'. Design = Cttrrent� =:Design- �'Cui rent '
11
Swine Ca` actty.:°Po tuition Poultry Ca acity --Po `ulation - . Cattle Ca act s'Po "ulatton`
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish IGtfo JE1 Non -Layer I I I❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Destgn Capacity
❑ Gilts
Boars
~.Total`-SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 113fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .........................................................
5. Are there any immediate"threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes � No
seepage, etc.)
3/23/99 Continued on back

lfacilAy Number: — TT-11 Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over applicrjf>
'? ❑ Excessive Ponding ❑ PAN
12. Crop type �90 , Sq ,
No
0
❑ Yes
9Yes
❑ No
❑ Yes
&No
%Yes
❑ No
❑ Yes
W No
❑ Yes
]�dNo
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
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20-- Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0.�'�T.0 •yiQ1a0dds'or ilefici od -.s -were We# 046fig �hjs'visit: • Ybit.
will-reoiye i fufther .....
corres otideim& a�aut this visit
❑ Yes Z No
❑ Yes )<No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )jNo
❑ Yes dNo
❑ Yes OdNo
❑ Yes t No
❑ Yes MINo
❑ Yes K No
❑ Yes {)�No
❑ Yes 9 No
❑ Yes t�No
❑ Yes No
❑ Yes No
411
ira2 ir-c, v2 rlS 'J �� L-J� C 4.,t-� 5h-�a� ► �Q
V\►-R-6- vim.
.-
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 6 — 0-

Faeiiity.Number: 3 — Date of Inspection ffQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 6�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes V 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 P(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Po
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3/23/99

0 Division of Soil and Water Conservation AOperation Review x
:` t .Division of Soil and Water Conservation -Compliance Lispeetion ,
r 7
r Division of Water Quality Compliance Inspection
Uther A enc O "eration`Review
> - .0_. g y_ P�_
Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection '2f ` j'
Time of Inspection r7=24 hr. (hh:nun)
Permitted 13 Certified (Q Conditionally Certified Q Registered 10 Not Operational Date Last Operated:
Farm Name: ...... ...................... ..........................County: ........ ................... ..........
�f
i
Owner Name: ........................................ Phone No:
Facility Contact: .............................................................................. Title:...................... ........ Phone No:
Mailing Address: ...........................................
....................................../............................................................................................................... .................... ..........................
Onsite Representative:n� �Q1.`-�C?.......
.....In€egrator:........ Mir` .............................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Ak
L� - -
..........................................................................................................................................................................................................................................................]'W
Latitude �' �� �� Longitude
Design Current m Design = Current Design Current
Swine Capacity Po ulahon Poultry Capacity_ Population CaEtte Capacity Population
❑ Wean to Feeder
Feeder to Finish
G 149
❑ Farrow to Wean,
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:Number of -Lagoons . ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area
.Holding -Ponds l Solid Traps ❑ No Liquid Waste Management System
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- if discharge is observed, what is the estimated flow in gallmin'?
d. Does, discharge bypass a lagoon system'? (If yes, notify DW ) ❑Yes [I No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3..Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EYNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .............30............. ........................ .............. ...................... ................................... ...................................'...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes $�No
seepage, etc.)
3/23/99 Continued on back

Factlity Number: 3 — 3D Bate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/impro;rement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence,of over application? ❑ Excessive Ponding ❑ PAN
12- Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: i io•vioiatigris;or deficiencies -were hkt d-during lthis:viset: You will•ceceiye'riti further ; ;
Co rres�61idence. abonit_ this visit ; ; ; .. . . .
❑ Yes KNo
kYes ❑ No
❑ Yes gNo
XYes OtNo�.
❑ Yes PdNo
❑ Yes [�(No
❑ Yes [�(No
Cl Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes A No
❑ Yes W No
❑ Yes •gNo
❑ Yes _'KNo
❑ Yes VNo
❑ Yes YNo
❑ Yes XNo
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes No
Commentsz(refer to question M. —Explain any YES answers andlor any recomn er dlions or airy 6iliiiir cotiimei3ts u
Use drawings of facility to -better explain situations (use additionalpages as necessary) -
•
0121
�� '���� � ���� ,tom. � +`� o�eY-- �- c ►-���e�, w
Reviewer/Ins ector Name = ` 0'
Reviewer/Inspector Signature:. _ p Date: -- '
3/23/99

Facility Number: — 3 Date of Inspection
Odor IlSSneS '
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [yNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 6 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes gNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes WNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes tRfNo
__ c -
Additional Comments and/or. rawrngs::
3/23/99'

#�❑ Division of Soil and Water Conservation ❑Other Agency F /:
ElDivision of Water Quality
Routine 0 Cum laint Q Fitllom--u of DNV ins ection O Follow-up of D WC review 0 Other
Facility Number
Date of Inspection
"1
Time of Inspection ; 5" 24 hr. (hh:mm)
Registered Certified 13 Applied for Permit Permitted 13 Not Operational Date Last Operated: ..........................
FarmName: .......... W.4. ..... �'..�ilL.......1AXir- ................................................. County:... �.(�1�zA..................,..............................................
Owner Name: ..............%i`......... G ............................................ Phone No:.(.?14�."'(3�[G............................................
Facility Contact: .................................... ........ ........... Title: .. Phone No:
MailingAddress ........ .. .................... ... a+ ......IOW....7A...ea. ......&?x...... t9.(....................(L�,1„ Sv�.�9�t,,.............. ' ' i.....
Onsite Representative: ........b.0.1[AQ....... C . .. Integratnr:..... .
Certified Operator:...............................................Operator Certification Number;.........................................
Location of Farm:
.........
1C�..t .....�....S43J�l.....�l. .i....{i.......�c......i�li:�:�.....................7m........................................................................................PV
.. .- ...... ........ ... .. -. ........ .......... -- .. ..
Latitude `4 « Longitude ' ' 46
M Desigri4 Current m Design Gurreiit:;Current
Swine Capacity PopulaLon, � Pauttry Capacity Pupnlation Cattle Capacetys:I'opulatiiiti
❑ Wean to Feeder
�
❑ Layer
Elairy
a'
Feeder to Finish
I0Non-Layer
❑Non Daisy
El Farrow to Wean
`
❑Other,-
❑ Farrow to Feeder
r
❑ Farrow to Finish
x Toil Design Capacity
I(0
❑Gilts
'r S 4'-• rF 3 6,
3
❑Boars
Total SS>LW
Y ..
of Lagoons f Holding Ponds
Imo
: ❑ Subsurface Drains PresenLjjjj Lagoon Area I0 Spray Field Area
ENr
-
`- No Liquid Waste Management System°
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes BNo
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 0 No
b. If discharge is observed. did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Q No
c. If discharge is observed, what is the estimated flow in 6aUmin? NIN
A. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes M No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes §3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
y maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on hack

Facility Number: 3k — 3-1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (l�agoons,Ilolding Ponds, Flush fits, etc.) ,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Structure 2 Structure 3
Identifier: ....M..l............
.............. h\ Z...................................
Freeboard ft Z
Z
10. Is seepage observed from any of the structures?
Structure 4
11, Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes W No
❑ Yes 0 No
Structure 5 Structure 6
❑ Yes 19 No
❑ Yes 'A No
EN Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes (A No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............ Sr>LVe:..................!Uf.rf od.il.....................I)A4�.�..C�t3fxtiYl
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-.NNo
18.
Does the receiving crop need improvement?
14Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[SNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[A No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
22.
Does record keeping need improvement?
X3 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
TA)No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(P No
0, No:violations or deficiencies. were- hoted-during this:visit:- Yo'diiill-recei've-no1fiirtheir-.
correspondence about this -visit:-'
JZ. Lagc:ol- JZU rJ�1 of DAI ji1aL�0 1D�'M+�W�T EVO%M Gtk aek ir%htAf �`�e W��10� iA9tiL'nS�I
La2r fiQ 01 raCal � Yts. e-j(1. 5-6rv, 4'� a1, '4. � s��] �z ��-�ro�}• i�4 �
5z� � Sl�vl� betr` ex4cv��� M Dkkz. 9A� S�� s'V'w �
tgAestok 160ix tee, ei. Gra&, ube ., by l'� o,n ru\1-
�.1� -I
Z )�i �n �arm�ttDn On 61JV6AJ 1 CCA,�'1`SWO 6e,' r �l�v� [iD S�nCW CbVC1rA�� D{ 1 Ytw
�tl1` 0 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1/ A J Date:

r_t` �. - ... w ..,�. ..�-.v: ...,k .. _✓. -3 S.u- . .o-. .�.a a.... k,=�_ �__ _ - ... .._. a Z
❑ DSWC Animal Feedlot Operation Review
s ,
.xf DWQ Animal Feedlot Operation Site Inspection 1
nk;.W.
Routine 0 Complaint 0 Follow-up of.DkV ) inspection 0 Follow-uE of DSO- C review 0 Other
Facility Number 3 1
Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
Date of Inspection
,rime of inspection I ia.q-; 124 hr. (hh:mm)
Total Time (in fraction of hours
(exJ-2; for I hr 15 min)) Spent on Review
or Inspection (includes travel and processing)
[j Not O eratiornal Date Last Operated :................................................... ................................................................................ ............
.
Farmi\Tame:.......... 4.....r.O,rx.................................................................. Coutstj:........ ��k?}ih...................................... .........,.............
Owner ]Name:........ l--.w�..............�!!�c.�.................................................................... Phone No:...��.'�.�•��.�.-.Q��(g) �� ".�.�.�.�)
Facility Contact: .......biza'J .. Title:........................................ Phone No:.�`.11.Q.... . °i. ' fit.t ({,,.............(.�...._p� Cam.......
;tilaElirtg:\ddress:.... L'S...,r�s5.....+7��(....��.:1......................................... ....� 4SafA4zl45t�iA..dy.... }I. .......... .........................
..A.3..1..... �...
Onsite Representative:.--... �iV..l.lOr.Integrator:....... A -Vr�.4......................
Certified Operator:................................................................................ ........ Operator Certification Number:, B Q 1.D..1
Location of Farm:
Ta .......... .�..LL... n,M....... 1lu�a�s�ca.11�...I.... . kim..... ni ..an.... io .... aR..r.:mQ..-........m...is... 3:.5..�tdt. �....7
U.....�.�r3c......�r�. �1'... ......
Latitude • ' " Longitude • 4 "
Type of yOperation Design Current Design Current Design.'; Cutrrenf
swine Capacity Population Poultry, '' Capacity° Population' Cattle yCapacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to FinishIs
❑ Other
`
Numbernf Lagoons`/ Holdmg`Ponds Subsurface Drains Present © Lagoon Area Spray Field Area
.. E
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes 9 No
[discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes (&No
b. If discharge is observed, did it reach Surface W ateO (If yes, notify DWQ) ❑ Yes iQ No
c. If discharge is observed. what is the estimated flow In gal/nun')
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 Wo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes (A No
S. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
4/3 d/97 maintenance/improvement?
Continued on back

Facility Number:'S — 37
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Ig No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding fonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
..... ......... 4........ I ............ ...........7:A................ .......................................,
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DIAIQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ErNo
❑ Yes
J.No
❑ Yes
M No
Structure 5
Structure 6
❑ Yes
14 No
j9 Yes
❑ No
Yes
❑ No
❑ Yes
ERNo
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
r .
15. Crop type..........COAAN1........ bAnnydf......................................... S.C.LIf...................................................... .....
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?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes M No
................................
❑ Yes No
❑ Yes > No
❑ Yes ®,No
❑ Yes Ed_No
2(Yes ❑ No
❑ Yes E[ No
❑ Yes ER No
❑ Yes E. No
,Yes ❑ No
S Lot-) cacas anb
cold` caa,� lows - �6uld 6e �') W ow//r��.t�� i-eeoVI W .
Mc- K � i s ni
ler t t11` r l w)
i VI L . em i otn o..ms
`yt
-
�n}�. -c - coyGelrYl 1Y�Ji Q m%% C. rVJUI,ITIS .
oh �u % way, evnd Gter WA a p� � Z t; (noel ��
b e" A ( 0 LJ 1* elky
0cwN. &o, att"
s6•4
be vr;Qec a). oo, w0.l�s of born. la,z►S
5�nou�d �e -ev w1cWXJ
ovxgooh
S%►(kJ�d �e eX{{,4�tQ GA4 ua r , r, 6 , I Fee S Or, l a jx
( (a�1. �� �' �°
GtJ�
� o�
0�f Wad of
ZAt SQ �ot-r)s
�
-S60
be �� b rfsec�� rur - nVlntOeY.
y
Y
Reviewer/Inspector Name z £ W
Zn.ate, r a
Reviewer/Inspector Signature: w `; _ Date: -Of' ?
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

i
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD 3 / ­ 37
DATE: -7 a"� , 1995
Time: 3 lr
Farm Name/Owner: Jr F- FCA ✓ ram— `l 4
Mailing Address: 13 s- L4 wy _ o
County:
Integrator. A j{ Phone:
X O ®w►-Gv-
On Site Representative: S x--1 Phone: 21U 9 a -'3,4 L
Physical Address/Location: C.s (Z_ t - to6 3v--\1 . -Iy-"'
03
Type of Operation: Swine.Poultry Cattle
Design Capacity: _ % I .ZO Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _° S� ' 7 Longitude: 1-7 S I ' S" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboard: _Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or too Was any erosion observed? Yes orE)
Is adequate land available for spr
ay? p y? Y�_e�s or No Is the cover crop adequate?<Zj)or No
Crop(s) ,being utilized --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling�r No
100 Feet from Wells? 'e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? r o
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 �J If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with coveFp
)? Yes
Additional Comments: �•- i l 1 1► S► �` '
b L _ S-e—t- ca c,-(� r
`r tZj KL7er' `r i K
Inspector Name
ns
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.