310050_INSPECTIONS_20171231

�V
NORTH CAROLINA
Department of Environmental Out

` Division Of WateC RCSOnCCeSr� s =� a
Facility Number ©- Division of Soil andWater Conservation
O Other. Agencyp ...
y
Cype of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
teason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
1 A
Date of Visit: Arrival Time: � Departure Time: 1 16 3 57 County: � Region: W 1 K-0
Farm Name: FOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 13i Z� V O/A V 15
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: 'f �a 3 S
Certification Number:
Longitude:
Design Current : Design Current„ .44DesignC
Swine Capacity Pop Wet Poultry Capacity Pop Cattle apacty Pop
..,.. ,n _,. - �. .,,.-.... ��� _ � C �
Wean to Finish
Wean to Feeder
Feeder to Finish b
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
La er
Non -La er
ryn�
Design
Dr foniti CB. acid
La ers
Non -La ers
Pullets
l urke s
Other y Turke Poults
Other Other
Dairy Cow
Dairy Calf
Dai Heifer
D Cow
rent ;.
U r y
d • _=
Non -Dairy
-71
Beef Stocker
Beef Feeder
Beef Brood Cow
„ems
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
krNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -so Date of inspection: tL1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 2 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 Z 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situations poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes WNo
❑ 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 [gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes XNo
❑ 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): bu
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes rallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes t No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo
❑ NA
❑ NE
Reauired_R_ecords & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faeiili 'Number: U Date of.inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
No
❑ NA
❑ 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
�CNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
KNA
❑ 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?
❑ Yes N No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: ! 3 t
Page 3 of 3 21412015

FT_ —
R gCDivis�onlofWateiResou�ces
Facility Number: a�Drviseon�of;Sotl%and 1�Uater Conservation F
QOtberAgency
Type of Visit: Q Co=outine
ce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emerzencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 O Departure Time: I?J County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ( z Z_t l [ 4AL�-/ �
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number: 1 �e% 3T
Certification Number:
Location of Farm: Latitude: Longitude:
°: Design Current
ign DesEgnCurrentDesCurrent
Swine Capacity Pop Wet�l'oultryCap crty , "�; ` Cattle Capacity« P,op. ,
�_-
Layer DairyCow
Non -Layer Dai Calf
��=� `'� Da Heifer
°Dn Current- D Cow
j. w,D;l'oulYCa aci Po Non-Dalry
La ers Beef Stocker
'`
Pullets Beef Brood Cow
Turkeys
-j
Other Turke Poults
OOther ther
Non -Layers Beef Feeder
`
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
No
❑ NA
❑ NE
Discharge originated at: ❑Structure [3 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
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes
ffNoo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/20I5 Continued

Facili Number. JDate of Inspection: -Z
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: Z_ — 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l_J 110 ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [T—No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�Ko ❑ 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<o ❑ 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 [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 ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA �1
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [] No ❑ NA ❑'1 TEE
❑ Yes ❑ No ❑ NA []['NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
E rNE,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[:]No
❑ NA
ra IE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ No
❑ NA
NE/
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
❑ NA
E-NE
Page 2 of 3 21412015 Continued

Facility Nunlber: jDate of Inspection: L.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA NE
❑ NA E NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑-go—
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
C�J'1QA
❑ 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 eNo ❑ NA ❑ NE
❑ Yes ] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA E],WE_
❑ Yes ❑ No ❑ NA NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
((Yes [] No ❑ NA ❑ NE
Comments .(refer to question #,) Ezplain any YES answers and/or any additionalrecommendations or anv,othKer comments - �- :_
r,
use drawinQsAffacfli th'hetter.exnlainsitn a. - A_ ..
„ Coe,- n,0 r r-�a .�s
C�.L rr'C k i, r"C4z fv— Ko�_J4h 4
I,.,--C,4 ro"4/5 <r- &�
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

1/
Facility N�inber © e ' ` DIV15ion of Soy! `and„Water Conservation
"t*-,sue,.. ,.a •.� y .:r�¢ a � -»�Y�' �rc'�a k � »� 1 rrt
s yx OtIko 9eney.,„s..,e.,;;.� 4 �.
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: jOloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County:„O//`, Region:
Farm Name: �� D L Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 7a Integrator: M/z 3
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Desi Current ' Desi Current
g Desigp
n n
g �..
; =k Currents ,
Sw,ne Capacity .Pop.'=' Wet Poultry ; Capacity Pop -�- Cattle ,; Ca aci Po
p h . P•
�..qs
Wean to Finish
" Layer
y' Da" Cow
_
Wean to Feeder
��,j INon-Layer I I
Dairy Calf
Feeder to Finish
3 a� ' ` Da Heifer
Farrow to Wean
F „tl
esign {Crirrent.
k Dry Cow
Farrow to Feeder
D . P,oul E1�Ca - ace , � 1'0 Non -Dairy
Farrow to Finish
Layers
.
a Beef Stocker
Gilts
Non -Layers
Beef Feeder
' Boars
Pullets
Beef Brood Cow
Turkeys
Others E,
7 Turkey Poults
U
r Other
Other
...; :..
Discharges and Stream Impacts
f
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[2j No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[JINo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: z
r
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
No ❑ NA ❑ NE
[ ].No ❑ NA ❑ NE
— Structure 6
❑ Yes P No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VI No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes nj No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes wr 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
9,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ili No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
G4 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T ansfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes�rNo
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24.)id thelfacility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑/ "No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes .,0 No ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[:]Yes Z No ❑ NA ❑ NE
❑ Yes ?No ❑ NA ❑ NE
32. Were 'any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VrNo ❑ 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 ft Explain any YES answers and/or any additional recommendations or` -any other.comments
Use drawings
� of facility to better explain situations (use additional pages as necessary). xu
t a 1 Y�'
31 ;.o 1 I
62,v 2 z
3
Reviewer/Inspector Name:
Phone: lAo';Pw ':X3 e3
Reviewer/Inspector Signature: Date:
Page 3 of 3 VV20I4

Div'gioof Water Resources
n
aCl)(Iy,Number " 0 D1v�Sion of of and'WateryConservahon>
�, 't .., 0. air a r xx "t.✓ x a, ,x-d+ss'aa4. 'E:*.F sl: xi' .�x''4m..
��„ �.�<s �,� �»-�° ..,w � �� • re..�,: t�;,Uthe['
�, �:° `ware.-' :a.,••�"s. .»�sec«n.. .r.rwe ixrrw «azv . a ,� .:.ra. .,4�'�r. a�
Type of Visit: Co pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: S Arrival Time: ® Departure Time: i r r County: C�Xaw Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:Integrator:
Certified Operator: Certification Number: 'Fo 35
Back-up Operator:
Location of Farm:
Wean to Finish. p
Wean to Feeder
M-L
Feeder to Finish ,
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
I 113oars
Other
Other
Latitude:
-eurrerit` Design 'C
.�
Pope'
Capacity '
y"',
„Wet;Poultry
.:x^-"Pr _, :.. o.+ �...... N+"a9�kf s'•. .. — _.._xca
1..-n-e✓x- _s
iNon-La
er 4
':=j
Desfgn�
aci- -
La ers
Non -Layers
-'
Pullets
:ry
Turkeys
Poults
w
�-iTurkey
Other
Certification Number:
Longitude:
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 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ❑N ❑NA ❑NE
[]Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - `� Date of ins ection: 10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA &cd)) (,iC Pz
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes Ln No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes En No
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes r
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes to
❑ 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?
1'i`0
❑ Yes LYNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall O Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes To
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24..Did the facility fail to calibrate waste application equipment as required by the permit. ❑YesgNo
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 to provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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?
WNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Rio/
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑✓✓✓No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ Yes
FN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
I
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

ivision of Water Quality Facility Number ^� - O Division of Soil and Water Conservation /001
O Other Agency
type of visit: $Compliance Inspection p Operation Review O Structure Evaluation Q Technical Assistance
Zeason for visit: �? Routine 0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of visit: � Arrival Time: Departure Time: .11 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 61�,�
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
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Discharnes and Stream Impacts
Design Current
Dry Poultry CaOaCity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current:;:.`
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Doi
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? [:]Yes [XNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: TT
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ZTNo
❑ NA
❑ NE
❑ Yes
2fNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

)~ acili Number: - Date of inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes kTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? .❑ Yes O'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 7�qo ❑ NA 0NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes FI-No [:]"NIA ❑ 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 )ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Vj No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes V_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes P No ❑ NA ❑ NE
[:]Yes VTNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
9No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fiffNo
❑ 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
4No
❑ 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
V'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CdNo
❑ NA ❑ NE
Page 2 of
21412011 Continued

FaciliNumber: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g�JNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
VTNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: r`}i 50
Reviewer/Inspector Signature: L
Date:.:i��'�
��:
Page 3 of 3 <7
�.
21412014

Division of Water Quality
Facility Number = ® 0 Division of Soil and Water Conservation = "
0 Other Agency
a�
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 0 Denied Access
Date of Visit: 1(01-41 Arrival Time: 5a Departure Time: County: TI
Farm Name: � V___- _#1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: sl:' au— 't�f}U 1 S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Cert!Ticaiio'Sumber:
Certification Number:
Longitude:
Design Current Design Current
Swine . Capacity Pop. Wet Poultry Capacity Pop. Cattle
Layer
Non -La er
Design Current
Other
Other
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?
Region:
Design- Currentry
Capacity . Pop
Daily Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Doi
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0,'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
❑ Yes P No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Faclili Number: - p I jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1 Structure 2 Structure 3
Identifier:
��� p• _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
Z
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes V No ❑ NA ❑ NE
❑ Yes 91_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 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 ❑ NA ❑ NE
maintenance or improvement?*No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et, .
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
`IjCropp�Windonw (� ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): SL , �&iz cp:E�SCCAC OP�)
13. Soil Type(s): (A L3 ] LLE S S q_0
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?
❑ YeslNo
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
R_enuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
[.] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
Q 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 Q Waste Analysis Q Soil Analysis Q Waste Trans ers 0 Weather Code
Q Rainfall ❑ Stocking ❑ / Yield 0120 Minute Inspections Q Monthly and I" Rainfall Inspections Q Sludge Survey
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
Page 2 of 3 21412011 Continued

Facility Number: - Q Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I x I No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes. No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes idNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No [] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
LAD. A . 1
(0-1
3
s))C'lla D.L4
D. s
D.
s
,pla4pQ D.
3. a
-3.
0
1110/1 I.q,>
).o
04
a1jff1 /1 1. s
i. 5
I.
s
5)13111 P c)
P-C)
D-
o
�PC-ti G(ZAT) WV
ZLA �
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412011

Division of Water Quality
Facility Number l - ® 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: QUoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /® Departure Time: County: IA/ Region:
Farm Name: � AA 1— Owner Email:
Owner Name: e (_L— �_h64 tj) �' Phone: q
Mailing Address: a d L,�N� l t`� lA_�) QQ_3 ALA-'S , �(Ic �QS E9�R-
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 6z-'2eu- bpuvs
Certified Operator: �j J E(-t— S • )6U 1 S
Integrator:
(9d 1 1
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Paultry C onacity Pon.
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? (1f 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?
Longitude:
1"S
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes kNo
[-]Yes ❑ No
[—]Yes ❑ No
[:]Yes []No
❑ Yes No
❑ Yes ' o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

F#cflity Number: - Cj 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:
Spillway?: p
Designed Freeboard (in): S _ 1 1. S
Observed Freeboard (in): 3� S � 31�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement? 7�
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 (Go, 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): L (Z C P� '1� &_S C- A [r ( i
13. Soil Type(s): �LA l N S 60CA) SG309-Ca
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 QChecklists 0 Design 0 Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes tNo
o
Yes
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No
Q Waste Application Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis Q Waste Transfers
�] Rainfall ❑ Stocking ❑ C/p Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 • 21412011 Continued

Facility. Number: 3 J - SC> Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ 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] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
j No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T[!
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
4
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations, or any other comments. ; t
Use drawings of facility to better explain situations (use additional pages as necessary).
CQ r.a
�s}�3��v �• � 1.5 �. S
2C(�i onJ del 1c,
Cr�N asp �
TO
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]
Date: 5/ 5�/�
V4/ZOII

Division of Water Quality
Facility Number 5d O Division of Sotl and°WaterVConservateon -
O .,
Other Agency °
Type of Visit gCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: y (,�� Arrival Time: I / I Departure Time: County: �-J �✓ Region:
r
Farm Name: t�� Y' a Owner Email:
Owner Name: l JCL/L,,� �(-}U1^�{�� Phone: 9I6_,r ggy3`y3&3
Mailing Address: 1� OO CANE RECS ��Q(LSPLA , /YC p�0 Jg "
Physical Address:
Facility Contact: Title:
Onsite Representative: SLI `7_-7eLL Ul
Certified Operator: 2, .f--_,Z_ZSL-L S. U1
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
olo
Opera or Certification Number:
Back-up Certification Number:
Latitude: a U = 4 Longitude: = ° 0 1 = i[
Design CurrentDesign Curret Design xwurrent�
5rvine Ca aci Population, Wet Poultry.
P h P ry Capacity Population ,Cattle Capacity al'oputationk
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Cj
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry.
Non-L
Pullets
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
��� •_.
Poults r-
Number. of Structures.-L
Discharges & Stream Impacts
I. 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?
F,
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
12128104 Continued

Facility dumber: 3 - 5C4 Date of Inspection EARMI
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: }
Spillway?: Q Q
Designed Freeboard (in):, 7• S �� • -/ .
Observed Freeboard (in): r9 LP 'Q'_3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes OfNo
❑ Yes ❑ No
Structure 5
❑NA El NE
[I NA ❑NE
Structure 6
❑ NE
❑ Yes
No
❑ NA
❑ Yes
JNo
❑ 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 A 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 JgNo ❑ 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) "(A
14. Do the receiving craps differ From those designated in the CAWMP?
El 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
JUNo
❑ NA
❑ NE
Comments refer to question # Explain an YES answers. and/or an recommendations or an other comments
. ­
.Use q ) P Y y y
.Use drawings'©f facility to better explain situations (use additional.'"-'paes as necessary)', ,
k_). 44. 1 �?L 'S
g)JJUI)o 1'q J.b ,. y
ReviewerlInspector Name Phone:
Reviewer/inspector Signature:
Page 2 of 3
Date:
12/28/04 Continued

.Facitiq Number: Date of Inspection T IQ
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. 0 WUP Checklists 0 Design E]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑ Xnual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 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
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
� J 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
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
#No
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:..
j/V T
Page 3 of 3 12128104

Division of Water Quality
Fidllty Nunnber 3 Division of Soil and Water Couservatton
�
©they' Agency p �
Type of Visit , 0 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: ® Departure Time: County: 1 A/ Region:
Farm Name: �Ai2 n1 Owner Email:
Owner Name: G L-�. Q {� �1 1 S Phone lCa- 93�- y3�
Mailing Address: / LA�r�� r L � �2Sq vC /p` &�C! Ca
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 �� Q n U Ig3
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 0 u Longitude: =° 0=
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ]of 3
A
❑ Yes )� No ❑ NA ❑ NE
El Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes �rNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 J — SU Date of Inspection L5P1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
!!!!!!❑ ��`��`No
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ NA
❑ NE
Structure I Structure 2 StrTe 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes *o ❑ 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 lNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �Alo ❑ 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 ye�� k the appropriate box below. ❑ Yes YLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > i0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) '36 Z ��.CQ� rE g ct& C 1
13. Soil type(s) (4T(C to V! L (_E "t N S ��c�e_o 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?
❑ Yes P�No
❑ Yes RNO
❑ NA ❑ NE
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
JqNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Rt4o
❑ NA
❑ NE
w./1 . 1
0
3
P/1-4/09 D_ y
Cl
�. y
!l/a/ a S /. S
/. (0
- S
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
1 J{f E Phone:
., Date:
12/2&04
Continued

Facility Number: 7j — SCE Date of Inspection
Required Records & Documents
hA
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes )N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Dj No ❑ NA ❑ NE
the appropirate box. ❑ WUP 0 Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ V/aste Transfers ❑ Y'llual Certification
0 Rainfall 0 Stocking ❑/op Yield ❑ 120 Minute Inspections 0 Monthly and V Rain Inspections Q Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes oNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments andlor Drawings:
CA(. tarn csN
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
J!RNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes LNo ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes -4 No
❑ NA
❑ NE
❑ Yes KNo
❑ NA
❑ NE
❑ Yes /� No
❑ NA
❑ NE
❑ Yes 6No
❑ NA
❑ NE
Page 3 of 3
12128104

! Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
--- E — 0 Other Agency
Type of Visit KCompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
4SfRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 15F-4 ] Arrival Time: © Departure Time: County: Region:
It
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1 E LC_ y 1 S
Certified Operator: F LQ 'S 't�,N!q Q
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: 1 $03S
Back-up Certification Number:
Latitude: ❑ o = ' = Longitude: = ° = 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
_ ❑ Non -La er
Dry Poultry
Pullets
U Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes % No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
ElYes
lo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — Q
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 pStructur/e�2 pStructure 3 Structure 4
Identifier: !�� 3 Y b l cC
Spillway?:
Designed Freeboard (in): ) L,_. )9 . 5 1 . S
Observed Freeboard (in): '9 L-( 3y (Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ca�o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
C<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 J�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes il'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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,�To
`�'No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes _6� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 1kTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,ZNo
❑ 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):
N C,_lGt� A, L ITTI LE 'b k i-T ,* u cG F.1- 4 T r cam o 14 1> I NC r-_ w 4 L_ (y F Y5S 1'� t
)V (;- eb TO S A L 1-r7- L_ a � E_ralS C O nt T na C_
Reviewer/Inspector Name 4AtQ,4 6 s4ilvc-11 Phone: 9/1J9&- 3d�
ReviewerAnspector Signature: Date:
Page 2 of 3 12128104 Continued
I

Facility Number: — Date of Inspection
Re uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XINo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
56 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
AVNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
qNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
.� No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ON.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t�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
ElNE
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
WrNo
❑ 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
qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J;�No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

1 '.t
r•
Division of Water Quality
Facility Number Q O Division of Soil and Water Conservation
- - — - _ -- O Other Agency
Type of Visit QlCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: OArrival Time: 1236, Departure Time: �O ounty:
Farm Name: Q n Owner Email:
flw pr Mama- phnna.
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��Z��LL ,I)Q L2g-5
Certified Operator: "04y's
Region: V KC/
Phone No:
/�/%
Integrator• , ' `A�'�`i�
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 c = 4 = Longitude: = e = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
p
019
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - T
Dry Poultry
❑ La ers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: p
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/11No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes;of_fNo ❑ NA ❑ NE
12128104 Continued

i. -
e
Facility Number: —
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 1 i _ I /
Spillway?: Ab
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑ NA ❑ NE
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 oft he 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 ApMication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ElNA ElNE
ElExcessive Pondmg ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El
ElEvidence of Wind Drifl El Application Outside of Area
12. Croptype(s) ri�CU� C/�C ,tt �v�4.�
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? ❑ YesNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes No [I NA ❑ NE
IT Does the facility lack adequate acreage for land application? ElYes/No [INA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes INo ❑ NA ❑ NE
Commnts,�(refer�to gnesaon,#) �Expla�n,�any�Y�ES�a�nswersandlo�rfa� **�omm` endations or any other comments.
Use drawtngscofafacilttj% tok6etter„explatn�sr#nahons�(usetaddihoaal=pages aslnecessary):
15� f�12-1 a(O S� s� �,�iz- ,' &ram - -/. •�h,�=ate/mac ,
R5%F' S 3411
?a�/o /' jX �. I ,
�G
�y
Y^7 •
%l,iIIGCO d%•�'I Q7r �' T V
Reviewer/inspector Name , p ' } a Phone: C9/0} "��— �32 �
Reviewer/Inspector Signature: Date: O
12128104 Continued

Facility Number: — Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
// ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes f�No
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes 0 No
X
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )dNo
❑ 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 9No
❑ 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
❑ Yd No
XX
❑ NA
[I 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
El 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 �fNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2 � V ©D�
f
12128104

09Y17/1999 11:22
TO:
FROM:
=== COVER FADE
FAX: [phone]
_ — RECEIVED
JUN o 8 2007
BRENDA W I L I HE SMITH
FAX: [phone]
TEL: [phone]
COMMENT:

09/17/1999 11:22 3102934383 BRENDA WILKINS SMITH PAGE 86
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION:
DATE of FIE]
FLOW METER SERIAL NUMBER: 0''f'-Q6.__--
EQUIPMENT
NUMBER: PALCI 4
MEASURED RING SIZE: [ ' 2 k incises
Is ring size within 0.01" of original manufactured size.' yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: psi
At Traveler: psi(if applicable;
At Sprinkler/Gan_ psi
EXPECTED FLOW RATE( from manufacture chart)__.Zar GPM
MEASURE FLOW RATE(from flow meter): - .2.1 2 GPM
Flow rate variance greater than 10% yes no
EXPECTED WETTED DIAMETER( from wetted acres determination.):
ft.
MEASURED WETTED DIAMETER: 247, _ ftr
Wetted diameter variance greater than 15% yes no _
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETER
VARIANCE, CONTACT AN HMGATION SPECIALIST FOR ASSISTANCE.
Comments:
Calibrator:

99/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 95
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION:
DATE of FIELD CALIBRATION:
(mm/dd/yy)
FLOW METER SERIAL NUMBER:
EQUIPMENT
NUMBER:
MEASURED RING SIZE: ;-- inches
Is ring size within 0.01" of original manufactured size? yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: f' psi
At Traveler: psi(if applicable
At Sprinkler/Gun: ,�y psi
EXPECTED FLOW RATE( from manufacture chart) GPM
MEASURE FLOW RATE(from flow meter): 121 ,z _ GPM
now rate variance greater than 10% yes no
EXPECTED WETTED DIAMETER( from wetted acres determination):
jo ft.
MEASURED WETTED DIAMETER: .2- L q ft.
Wetted diameter variance greater than 15% yes no y-
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEI
''VARIANCE, CONTACT AN IRRIGATION SPECIALISE` FOR ASSISTANCE
Comments:
Calibrator:

09/17/1999 11:22 91029343B3 BFZENDA WILKINS SMITH PAGE 04
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION: �i
DATE of FIELD CALIBRATION:
(m
FLOW METER SERIAL NUMBER: 6 4- -01 - o,T
EQUIPMENT
NUMBER:
MEASURED RING SIZE: 1. j _ _ inches
Is ring size within 0.01" of original manufactured size? yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: psi
At Traveler: psi(if applicable;
At Sprinkler/Gun: psi
EXPECTED FLOW RATE( from manufacture chart), � GPM
MEASURE FLOW RATE(from flow meter): j1y _ _ GPM
Flow rate variance greater than 10% yes no w
EXPECTED WETTED DIAMETER( from wetted acres determination):
.364 ft.
MEASURED WETTED DIAMETER; lit.
Wetted diameter variance greater than 15% 'yes no r
IF YES IS ANSWERED TO Ex'x`IIER FLOW RATE OR WETTED DIAMETEI
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
Calibrator:

09/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 03
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCA r ION:
DATE of FIELD CALIBRATION:
(MM/
FLOW METER SERIAL NUMBER: -,_ _ �� 01 - 10 f 9
EQUIPMENT
NUMBER: 1 t{-
MEASURED RING SIZE: /eJ inches
Is ring size within 0.0111 of original manufactured size? �yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: — Z3,,V 1 psi
At Traveler: psi(af applicable'
At Sprinkler/Gun: .S psi
EXPECTED FLOW RATE( from manufacture chart) GPM
MEASURE FLOW RATE(from flow meter): _ f _ GPM
Flow rate variance greater than 10% yes no
EXPECTED WETTED DIAMETER( from wetted acres determinatioa):
t'7 ft.
MEASURED WETTED DIAMETER: ft.
Wetted diameter variance greater than 15% yes no ✓
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEI
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE_
Comments:
Calibrator: eL bk— C
(signs

09/17/1999 11:22 9102934383 BRENBA WILKINS SMITH PAGE 02
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATI ►iv:
DATE of FV J
FLOW METER SERIAL NUMBER: _ 0 !� - D I(
EQUIPMENT
NUMBER: eG 1 �
MEASURED RING SIZE: f `?' inches
Is ring size within 0.01" of original manufactured size? yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: zj-p psi
At Traveler: psiiif applicable
At Sprinkler/Gun: ��� � psi
EXPEC Y Ell FLOW RATE( from manufacture chart) � 1f' GPM
MEASURE FLOW RATE(from flow meter): b — GPM
Flow rate variance greater than 10% yes I no U.--
EXPECTED WETTED DIAMETER( from wetted acres determination):
31,9 ft.
MEASURED WETTED DIAMETER:
Wetted diameter variance greater than 15% yes no
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAME`ITEF
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
Calibrator.,
(signs urt

09/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 91
Ghp1+4. (,Oki
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION: G It
DATE of FIELD CALIBRATION:
(mm/dd/yy)
FLOW METER SERIAL NUMBER: O q-- D � —
EQUIPMENT
NUMBER:
MEASURED RING SIZE: I.1P _ inches
Is ring size within 0.01" of original manufactured size? L---,Pyes no.
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: 4,19 psi
At 'Traveler: psi(if applicable;
At Sprinkler/Gun: ,mod _ psi
EXPECTED FLOW RATE( from manufacture chart) or GPM
MEASURE FLOW RATE(from flow meter): GPM
Flow rate variance greater than 10% yes no �
EXPECTED WETTED DIAMETER( from wetted acres determination):
,3 Q Q ft.
MEASURED WETTED DIAMETER: �, � ,3 ft.
Wetted diameter variance greater than 15% yes no f
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEIR
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE.
Comments:
Calibrator:
(sigma

1
_ � Division of Water Quality
Facility Number / M
Q Division of Soil and Water Conservation
3 O Other Agency
Type of Visit AfCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit xRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ,=AQ Departure Time: SOD County: LJi✓
Farm Name: _ dL Owner Email:
Owner Name: l ? Z ZtF6 `I _ .4 Phone:
Mailing Address:
Physical Address:
Facility Contact: QQ Title:
Onsite Representative: Z ;g Eft s.�iq✓�S
Certified Operator:
Back-up Operator:
Location of Farm:
Region: 4/rl/`r o
Phone No: Q
Integrator: w — �CJ/P 0,1)
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = ' = Longitude: = ° = 1 0 tt
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish T
❑ Wean to Feeder j
Feeder to Finish j(dQ 1700
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge? .
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ;�' No ❑ NA ❑ NE
12128104 Continued

ti'
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6--1 ( SD Z A—T
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes VNo
❑ Yes ❑ No
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 [:1NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [__1NA ElNE
(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 "o El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El 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) SCu� V, Cr, �SCu
13. Soil type(s) '64
i
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?
XYes ❑ 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 X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes A 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):
/o/2_ zoo.
6-e R�Ss�`D��� (/I//���0 �O/✓�i�OL GSO A0/ 4y0/_ArU
Reviewer/inspector Name
Reviewer/inspector Signature: Date:
Page 2 of 3 1
Continued

Facility Number: 3,f —5D Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes X,No
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes P(No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
El NA
[3 NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ik� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes I Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment {PLAT} certification?
❑ Yes XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes tz No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
El
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
[INA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P!(No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
71, F�Gl2 � u�/�Dtv/:/J T�,� � ,8y'O I
G')z
Page 3 of 3 12128104

r
0 Division of Water Quality
Facility Number Q 0 Division of Soil and Water Conservation
0°Other Agency�'`�
Type of Visit 40Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: VuP�/'� Region:
Farm Name: r✓ R�_/n 1 Owner Email:
Owner Name: _ { Jy Z�F_LL `OA Phone: io
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ Szz'eF� �ig ✓ems
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
�o
Latitude:
2 O- �917 e
Phone No:
Integrator• �,JQoqGt% ,5
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
3 0
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: = ° =' =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes � No El NA ❑ NE
12128104 Continued

Facility Number: — ® Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes PNo
❑ Yes ❑ No
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 El NA [I 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 JX
J No ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El YesNo ❑ NA [I 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes /No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wi767-"�A
vidence of Wind Drift ❑ Applictiti�on�Outtside of Area /1
12. Crop type(s) / .GIJGlL� .450,�W,4-�L1`K/I Gam% �U �f rlf�i � ��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes /�No El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes)!No El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes �No ❑ NA ❑ NE
trh 69z1&� A—`PvpaQ/!s-r-/ 7 0
8L /7-5- 1. / [ .vG2�e , 14c, ' /�1�/, / -�„0(
�' �� �K "//i/ _ � ✓V TV�-T / 1 '+ter � �� �/! ✓G!'� �N i7� 7 K W�r 11
Reviewer/Inspector Name S� v r; ' 4t r, f Phone'
�.... : -
Reviewer/Inspector Signature: AMMI Date:
12128/0 Continued

Facility Number: 2 1— D Date of Inspectionh/Q5 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
El NE
and report the mortality rates that were higher than normal?
YINo
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
X
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
El NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
12128104

^: � '- _s."L � x O, AV:fi A�eiiC. -v �-,c. '"�^" � .�. 4 � - i �' � r� �.,-s:�x �.a• � s �' .;..c. r
" n ,.^:. �- "S' - ._..�� •�aS�' __ _ — _-� 'mow' 3.- .. _ _, ..: _. .....: .�. _ r _ ^
Type of Visit 6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 96 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1
Date of Visit:
APermitted JgCer}fh��ied [] Conditionally Certified © Registered
Farm Name: W................................. ...... ..._........
�_._ ...._ ......__..
Owner Name:.. 5 ;' zz.C— Lj . ........ JG! rri .... ...... .......
MailingAddress: .. . ......... .... ................................ ....�_... �.... - - -�. _._...�
Z 19 Time: tbb
Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: ----- -__ _.
County:!''.. ..... ..__.......� ......
Phone No:
Facility Contact: .............................................................................. Title: .. Phone No:
Z� : _.... ....._ ...... .�...........
Onsite Representative: D� Int tor: , 40 t0 I3 ........
Certified Operator: ....................... . .......................... .. . ................ . ................... . .................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° is Longitude • d «
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(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)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ....... J...... ............ ... _ . .. ---- ............ .
Freeboard (inches): IT 17
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes ;2(No
XYes ❑ No
Structure 6
12112103 Continued

Facility Number: I —,To
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes /No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;dNo
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? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes WjNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;KNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload 6
Frozen Ground/ ❑ Copper and/or Zinc
12. Crop type � _Ff scup. ((,QAzt;.) !]cayAyD& 6anu) 5m*u- cauzi amsEen
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Zr No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes WNo
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 J;rNo
16. Is there a lack of adequate waste application equipment? ❑ Yes /No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes
To
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )6 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;3140
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes )eNo
Air Quality representative immediately.
tComments (refer tct gnesbon`#) Expia n any YFSeanswers and/or any recomrnendatioas o%any ot)ier conmeuts
AUs�e drawings of facility to better explain situatsons {use addrteonai pages as necessary? ,1 ❑ Fteld Copy ❑ Final Notes _ �:
a
pwN62. CAuEfl - S-0 -AIZAA . "fW UAL
emu, S'CrSD P o a by 1123/Oq
fZECOJZDS (PdIL Coop, r
,,� alR.lf; OvwK is To CV-0 COVLr*j ps ,
owN u C. Sty >D� sva� E� �R���'6�1.
Reviewer/l,mpector Name j>
ReviewerAnspector Signature:
Date:
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documents
21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
/No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fidNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
X0
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
OINO
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
W(No
2$_ Does facility require a follow-up visit by same agency?
❑ Yes
IN
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
/Yes
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V40
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddxtxonal Comments:and/brDrasvr�igs � � �.
.. 'Y4,-,..r..'..�Cs4w-._. �-t..<�Y=LA'4.. f:.-z<{a..4<., .`�.«^�.-9: a7viM �.re....e.m m..,-:-..3YSs� t�r`'u' y� � `•S^; :Y _ z
.-:- x+' m �
L
12112103

Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number fate of Visit: L t DZ Time.rO 3 S
Not Operational 0 Below Threshold
©Permitted O Certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: Count} Duin
Owner Name: ' Old+ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative:' Z��I 1 ��iv i I Integrator: 13fow ✓I l 5 4P Garro�'1c,,
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 �u Longitude 00 �• 0�
'Design Current Design Current w=. Design Current
N
-Swine . _ Ca acih'. Po ulation Poultn = Ca��i city Population.Cattle, .� _ Ca achy ` Po tilntton`.
❑ Wean to Feeder ❑ La er -iry ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver ! = n-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other It t�
❑ Farrow to Finish Total Design Capacity.
m r
w
-- ❑
_ Gilts -_
❑ soars Total SSLi'V -
Numbe i►f Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area i `
Holding.Ponds! Solid Traps ❑ No Liquid Waste Management System ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gaUmin?
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- Z 3
Freeboard (inches): S
05103101
❑ YeSZ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes/1No
❑ Yes ❑ No
❑ Yes ZNo
Structure 6
Continued

Facility Number: Date of Inspection ! O -24
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes _ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [--]Yes 0—No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes f No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes J2"&o
Waste Application
I0_ Are there any buffers that need maintenance/improvement? ❑ Yes _�TNo
11. Is there evidence of over application? ❑ Excessive Ponding ZPAN ❑ Hydraulic Overload 12ryes ❑ No
12. Crop type Cor✓1 wheA Sa ba'+PsF7e3GVP 'Pa54V'V FesGV@ C. eolr
13. Do the receiving crops differ with those LsignateJ in the Certified Animal Waste Management Plan (CAWW)? JZ Yes [INo
14. a) Does the facility lack adequate acreage for land application? >k g ¢ �""ti `��>! Co'1 } ra ! l9ra Le ❑ Yes F,Ko
b) Does the facility need a wettable acre determination? SrvLq j r Gf �,'+1 O v¢-se4rd ❑ Yes ,0NO
c) This facility is pended for a wettable acre determination? ❑ Yes ONo
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ffNo
Required Records & Documents �
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Z 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 .ENo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) _,Eyes ,❑{ 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 ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes INo
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (referto�quesfion #): 'Ezplain.ariy YES:aosweirs anchor-yany rerommetrdatmnsor snv other comments: -
Use drawings'of:fad0ty to bettcr.explainisituattobs (use addtdoI pages as ueeessary) =
- ❑ Field Conv ❑ Final Notes
4s overo,Pr(i -�;ov. opF1Qtf ✓R,'1441@ /v'-ErdG,cx, CjLJ t4 leafy
Z Peu-d s Pe{ A4clle 01,1 4je ZG41 `200-1— Small 5eca;►,% oVers¢Bep oh
e a c 1, 44P -P v 11 s 3 � SA '� 01*-to( 6 4.
F v I I S 3, 4, SAS, a -id 1A awe de 4 e d In ale wa��e PrQ�
.re.- be^vtvetoy . A l4j_9e �o•{,'oj-, of pv11 s 3 and' c►eId negrCy a1J
10VIt T Ski Drier' 6A '0ee es10'b1; slued 9rar js ce-o0 ,*ved)
�.
77
Reviewer/Inspector Name ; _ ,� '" S j.]►-5.
Reviewer/Inspector Signature: Date: Z 1 OZ
05103101 Continued

l
Facility Number: 31 7220 Date of inspection Li 4
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 anv dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters, etc.)
31 _ Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes -Z�No
❑ Yes -J:iNo
❑ Yes ZNo
❑ Yes �No
❑ Yes ONo
❑ Yes ❑ No
Additional Comments and/or Drawings:
13. and 41ie✓' nonbermude, VIT-> 4)0,Ae -w crop 'h +ke
4�';eio( reeds -la b� -the Gra,o 4A, } is der�5n2 � ;n 41-te
IS, �1�ase Gon.�►,,t,,re 2�'�a��t �a et-�-a %I;rL, �,en.K.✓dq ih ►'����f J
q rtae_s I!lr p11H s 1" Z) -b 1 'L- . 0 ve ✓'a ll , � e +^
PV11 s 1 17 1-L i s Vey &67d _ �rlso� neevl -�
1 z I % o ��jo✓'vve
�escYe 4,yet,'10s
0-1 end o'r
I g . lueed -to tav 41,,e t S; 4o
ee,1e,vl,A4e k
R lso� J)1e Z,aje 2- n 5110""Sr 23 S a �
t7EG i nn „� 6a,.��,.,�•d� PAN allawa�cP1 1pl�as+-S'�Oc.✓S �%S -
-4tq," pge4a ateve - ? t-LIGi I► �y , SDL�6P.Qr�,s 1
G}►'tOP back b�f.-,✓,�y/ r:eld c5vell QPlarar/ weJ%/rPfW.
/" e- LDaV;s Appeq e'S TO 6e mq /�:�q r „✓lp�ov��S 014 4Ae
1!'G,,r.n. • fje sq.Ys-�1�,,� swr.�,'rt.� ln✓4.1e►��rs �� dress✓��
JP
ce*VI-Pal s k,.e Ilecelq)17 6ee,t ;•., . -1� e, ',,,fs 42/e Alpf�ec,G
T
O5103101

Facility Number Date of Visit: 10 O I Time: 1 35
0 Not Operational 0 Below Threshold
Permitted [3 Certified D Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName: .........ISSD J........................................................................................ County: ... �-7.�..= ........................
OwnerName: .............z-.�r1....�......'.................................................................... Phone No: ................................................. .......... ............... ......
Facility,Contact:.............................................................................. Title:•----...................................--------................ Phone No:...................................................
MailingAddress: ..................................................................................................................... .................................................. ................................ .. .I....... ... ........... ....
Onsite Representative: � j D (S ....... integrator:... �3'ro 1—f s e Ga r A f � � C,
��......................................................................................................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 �6 Longitude • 4
Design = Current Design Current Design Current
-aipicity Population Poultry :` " Ca aci - Po ulation ° Cattle C
a aci ' Po ulatioa
❑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 TOW SSLw .
Nambec _of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
.: _ - .. ... .... Y
:Holding P66ds / Solid Traps` ❑ No Liquid Waste Management System y
Discharees & 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: Z ..........................�....3
.......................................................................................
Freeboard (inches):
5100
❑ Yes j2 No
❑ Yes ONO
❑ Yes ZNo
in ) C1
❑ Yes j2rNo
❑ Yes ❑'No
❑ Yes _ONO
❑ Yes ONO
Structure 6
Continued on back

Facility Number: 31 — 50 Date of Inspection 1D b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
)ING
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes �J No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ 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 JZNo
11. Is there evidence of over application? ❑ Excessive Ponding OPAN ❑ Hydraulic Overload
OYes ❑ No
12. Crop13c rvvt.v d h{vo i �-LLe S,v,� I 1 r eve C 1v "' e
type 4 Ca• G G � s ,�{.a Emu CrCdrn W k�� air
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
jvyes XNo N '
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 PrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes irNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 2ves ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes VNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ®'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E�No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNO
•YiQlatioris:e - d0rJciendb' •v're note daring t�is:visit, - Yo0 Kdl-treeeiye o fui�tb r
cori es deuce aXwutti this visit:
Use,- of facility i o:bettei explain sih a ons (ugi.iii itional Pages ps necessary)
1
il, -rhGre w.'r -<Ome Ovew-CL ��GCZ�GGit of PA+-3 oh 4ke -zoo) Garet � r,rcf,, a
A;s GiS-t Par41 4� e resv/� .f os- +� au.lda4eG� waffle gncllys' 1
4o ot_e -1- q►�+ %ott n } a!' HIV a J
P rove -Fescue .s-�u�d -b er,�,,.;a�e Gad'-I��`o� ice, s ��,e
i5. nree� �o ;m�
a
r-erts o•r lair a _45c.v a .C1e101, A Jse, 1;x ho ie
i` Be sure -la v e wcs- qn4! yy s; s Azt4e_'A w :ah-n 6D da.y s 6-ts gP�17 cis"�v`
even f5 fo 6A)Cuixt4e 41,e PniJ � PPried,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: (o q. a r 5/00

Facility Number: 3) - SO Bate of Inspection I fl p
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 OoNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 110 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 -0 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 JA No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks Iack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
tto omments and/or Drawings.-
6.-OL,Jer- 44L r��Q Ci GiooC� job Q�! i,n,Prov;nc, �jq,,,� 4F be►'v►� od-%
i, 4ke 6,c� J
5100

Facility Number Date of Inspection ffatl,
Time of Inspection � 24 hr. (bh:mm)
Permitted 0 Certified [3 Conditionally Certified (3 Registered Not Operational Date Last Operated:
..........................
FarmName + .. County:.........!-..ti...........................................................
Owner Name -
Facility Contact: .............. ....Title:
............................................................
Phone No:
................................................ Phone No:...................................................
Mailing Address:.............. .....................
....................................................................................................................................................................... ..........................
Onsite Representative:. ............................................................................... Integrator: .................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
:.................. ...... .... ............ ................ ......_ .............. .... .............. ........ T
Latitude 0 6 " Longitude ' & "
Y Ca aci Po elationurre
Design Cui=rent
Swine C.iieacity ` Population Poultr Design y Current Cattle
Ca ac�ty=Po ulabon
❑ 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 TOW SSLW
Number of Lagoons - ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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? ElYes El 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? (Il' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway KYes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �,j
Freeboard (inches): . ` t�....................................
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

•. Facility Number: `3� — G I 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 application? ❑ Excessive Ponding ❑ PAN
12, Crop type
[]-No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
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?
�±1Q yigla(ioris; ..... err... rare ngted du irig �his:visit: Moir will reeeiye rio further
:: correspondence: abi , f tKLNisIt: ..:.. '
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
Comments (refer -to question #): Explain any'YES:answers'and/or any,.recommendatio' ns or. any other comments
Use drawings of facility to'better;explaiit situations '(itse additional pages as,necessary):
,_ .. . _ _ .
Arm
+-�-
��� ���p �-,.ee��.►-� Y�.ca�s� �ee� � �:t � ji �- r��r��. ---
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �—�

} ; jDrv115110n of Water Qual;ty
O.Division of Soil and Water Cohservation
0-Other Agency
F
peof Visit Ai Compliance Inspection O Operation Review O Lagoon Evaluation
ason for Visit #9 Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number SO (late of visit: 1) 0 CD �l ilne:- 3Z 7 Printed on: 10/26/2000
3 !
Q Not O erational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: 19r _ .. ..... County: LS/�!.. 1..........................................................
.......................................... ....................................... ..........
OwnerName:........ ].�......I.L.z e.......�..a ✓.r................................................................. Phone No:......................................................................................
Facility Contact: ................................................................
Mailing Address: ...
Onsite Representative: ^ e
Certified Operator: .................................
Location of Farm:
.. Title: .............................
Phone No:
........................................................................ ..........................
Integrator:...!�D W ►'js..Ot �.c l.tl'�t4 .....................
.. Operator Certification Number
I&
jEr5wine ❑ Poultry []'Cattle ❑ Horse Latitude ' 4 4� Longitude • 4 46
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish S(,0 ID Non -Layer 1 1 1[3 Non -Dairy
l 1
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 3 ubsurface Drains Present ,agoon Area KSpray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [:]Yes E No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes B No
c. If discharge is observed. what is the estimated flow in gal/ruin? 17/G
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes 14 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JO No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 99 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Su-u/cture I Structure 2 Structure 3 Structure 4
Identitier:..............1.................................. ..................... 3....
�j
Freeboard (inches): 29, 2 q 3
5100
❑ Yes §iM
Structure 5 Structure 6
Continued on back

FadliO Number: 3{ — SD Date of Inspection / p Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )gNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste.structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes j No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload /� ❑ Yes � No
12. Crop type Merr""vptG Cohl ni C�+'r�Z���r�G�� fnr"ai�,ll'�SG11e �,lJy1�rD� 4rotZ.e,_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RtNo
b) Does the facility need a wettable acre determination? ❑ Yes JR No
c) This facility is pended for a wettable acre determination? ❑ Yes J9No
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?
t8. 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?
150 •yiolatiQns:or defieie'ndes *e're noted• diWhiii this:visit; • Y:ou will r. eeeiye fto: further
;cor'res�oridence: . at thisit. • ........ .. • .... • ...... • ....... . bouis :v
AYes ❑ No
❑ Yes J0 No
IFX-Yes ❑ No
❑ Yes O'No
)9Yes ❑ No
❑ Yes 9No
❑ Yes ONo
❑ Yes -XNo
❑ Yes grNo
❑ Yes J'No
❑ Yes V No
Comments (refer to question #):; Explain -any -YES answers and/oe ah recommendations i►r "aay other comments :_
Use drawings of facil to better.explain situations. (use, additionaLpages as - - - _ ty essary)
IrI. Need C, -4
$',C'q-1 e 6/' GoJev-ar Genera j Per on
1R So c. I\10./crnder^ -.aco at�PI;ta���-, ev"4, �av-e beeN
,tec,red i+t-_d 4o bery-IMA orrid cou►1_fed - ac,,�nd sw�tl irt;
6esu r t 46 vse wok_t4e 41h'n1 yt4 r Actle-d �- �o dot"ys 6-' Afl ca ia�,
a�► Ae �2(Z-72 arr,s,
15. =►�Pr'ove I o w grcaj ivi fi0saue geld 4M01 &m - sGuG;A,
sbw.e ploLces. word o f prove back berMv4c, �','eId- 1'lmn4 overseeA NIN
All of lGrgE berm.Ud^ -F; eW soak, .
Reviewer/Inspector Name .� �t,s f 7. )-)q . A; -
Reviewer/Inspector Signature: Date: 11IT6106 S/pp

FaQlity Number: 3 -.5,0
Date of Inspection j 3+? p I'rin€ed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or helow
°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
19 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
FrNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional omments and/or ramings:
5100
5100

Facility Number
Permitted E Certified p Conditionally Certified p Registered
Farm Name: WME&r.m.1..
Owner Name: Hizzell.
Facility Contact:
DaYis
Date of Inspection
Time of Inspection © 24 hr. (hh:mm)
in Not Operateona Date Last Operated:
......... County: Duplin WIRO
........ Phone No: 9.0-293-4383 ..........................................................
•-•••--•••.......................Title:................................................. I............. Phone No: ......
Mailing Address:1180.Lanefield.Rd............................................................................... Warsax..NC .......................................................... 28398 ..............
Onsite Representative: dimm y..V.xnsua........................................................................... Integrator: Brum:u.:s.iaf.CaroJixia.jac..................................
Certified Operator:8izuR.J ............................... Ilavis ................................................. Operator Certification Number: 18035.............................
Location of Farm:
Latitude & ©" Longitude ®• ®6 ®�
swine
latlon � •-
13 can to'Feeder
® Feeder to Finish
p arrow to can
p Farrow to Feeder
p Farrow to Finish
p Gilts
p Boars
Number of:Lagoons
Holding Ponds /oh Sd:Trap
esgn urrent - - es�gn urrent
ltry, Capacity Populations Cattle = CapaciEy Population
layer p airy
Ion-Layer11 113 on- airy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ® o Yes No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) I7 Yes p 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) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l.................................2................. 3.................
................. ........................................................................................................................
Freeboard(inches): 9.. ....23................ . ................ .............. .............. ..................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, l7 Yes p No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31-50 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p Yes 13 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? p Yes p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes p No
Waste Application
10. Are there any buffers that need maintenance/improvement? p Yes p No
11. Is there evidence of over application? p Excessive Ponding p PAN p Yes p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? 13 Yes 13 No
14. a) Does the facility lack adequate acreage for land application? p Yes p No
b) Does the facility need a wettable acre determination? p Yes 13 No
c) This facility is pended for a wettable acre determination? 13 Yes p No
15. Does the receiving crop need improvement? p Yes p No
16. Is there a lack of adequate waste application equipment? p Yes p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? p Yes p 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.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
El No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
13 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
p No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? p Yes p No
Reviewer/Inspector Name
Reviewer/Inspector Signatu

1 Diviision of Soil and, _ater Conservatir►n = Oper"ation Review
M
t:t Q Division of Soil and Water Conservation;- Compliance I speet,oii
w Division of Water Qualr _ z
�' t9 Compliance'lnspect'on M
=_ D Other Agency 'Operafiori Review
Filoutine O Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Datc of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted U(Certified Conditionally Certified E3 Registered [3 Not O erational Date Last Operated:
Farm Name : ..........r .S ._..... .�..^.................................................
...... ��....-..... County:....w&
......_....... .- .._............_............................_
Owner Name:... ...................................... Phone No:......._..........:....
FacilityContact:..............................................................................Title:...._................ .................. Phone No:
Flailing Address: ................................................
Onsite Representative :.....�r.�..ZCLr......;-�.... V.L&... .. Integrator: r......
�..
Certified Operator:
Location of Farm:
Operator Certification Number:
............................................. .................................................. ........................... ............ ..................... ..................................... ...............................
Latitude • �' �'° Longitude • �' ��
Design Current W c , ;- ,:.;..-Design Current Design
Swine ._ Poul#rY° '
CattCa acity Population " CapacitCa Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
­7-7G 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ` ❑ Non -Dairy
❑ Other
Total DesignCapacity
- . Total SSLW
Current
Po ulation ,,
Number._of Lagoons c� �" [3 Subsurface Drains Present IL] Lagoon Area I❑ Spray Field Area
-Holding Ponds'/ Solid Traps ❑ No Liquid Waste Management System _
0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Cl Yes j2fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was die conveyance man-made? ❑ Yes XI No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes XNo
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 60 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes V40
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
cc H
Freeboard (inches): ...............L- .........
........... 1.8............. ........ ., t....... .......... ................................... ....... ............. ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes 0"No
seepage, etc.) l
3/23/99 Continued on back

Facility Number: -2t - rS'b Date of Inspection
& 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 %pplication
10. Are there any buffers that need maintenance/improvement?
I I. 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?
i
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
- ; �o �yiolatiFcjris:o:r• deficiencies �v�ere noted ditri!tig phis;visit: - Y;ou wiil•reeeiye Rio furthgr • ; • ;
c6rresp6Tidence. A' ' f this visit. .
&Yes ❑ No
❑ Yes j0<0
❑ Yes UfNo
❑ Yes _20&o
❑ Yes ZNo
❑ Yes eNo
❑ Yes 0No
❑ Yes ZNo
❑ Yes ZrNo
�fes ❑ No
❑ Yes XNo
❑ Yes ZNo
❑ Yes XNo
P'Tes ❑ No
❑ Yes 2�No
❑ Yes XNo
❑ Yes )ErNo
❑ Yes ;-,No'
❑ Yes ,Z No
❑ Yes ONo
w
Comments -(refer to question #):.:Explain_any YIN answers and/or any:recommendateons'or any_^)ther comments.
_. -
Use,drawings of.facility to=bettei�explain_situatibns (use addition-A.oages as_necesssary) t
4) Mu%V 3"t M^r4'MJ',-I5a0 art"'1 A nnir.I�MJ� 4`j y jnlChl�S�F P��l4R� �
S'ifa4�� ?�1 i�P'P AS 54�1 }�.r ?ads?f31 _ Cr�n`J[� i l4Goa
7) LA6uan4 I nrs aa= is ^L-s
S1F y ElW A i a rJ A,40 'T-0 /ur` N r`�►t ,tiZr� C.]�a p7 T-05 cl,
?be-1-1 IM-V '7t}-e; 0T i i*S 4111L ` RZD '_16 Pf" 14 o.i£� t L-7 r-f-A� cc-g�L a fa-
ra—AO i t 53c44 W •a / f 8' 1 -�p` , ! xop a c£r. ella S Z. gi0i .�i 7 t f�_/1i0 Ir 9-v-VO f-� ri-C •i OAr
I B� saM€. C.v_Ac.aGC_ ge-av- P "PFS 9c"JIEAWT4:4 ,�LiAs TA1J�
I" AZ 3 :tom c_ . r u a., t,:. n CA]gtG'2a 1. -W -i_pS T6 r w, ¢i�2 oJE- Ga A lt-S CZ Vet" GE, r •
Reviewer/Inspector Name f..1 cs _ p J'nY 'r : �11 S'Lk_S
Reviewer/Inspector Signature. �-. r _ _ } f , _-t­ Date: -z.:7j cm
3/23/99

4
Facibty Nuiyber: 3( — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 2No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q 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 X] 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 P10
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2 &o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [-]Yes 9--0
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection U
Facility Number $D
Time of Inspection t 24 hr. (hh:mm)
Registered Certified [3 Applied for Permit I%Permitted E3 Not Operational Date Last Operated:
FarmName: .................... Mb .... i ................................................................................ ­ County: ...... buttir ..................................... .......................
OwnerName: ................ ........... ....Drwts.................................................1. Phone No: .... �giQi../*�3.-..�i. g........................................
FacilityContact: ...........................1..........................1...........�................... Title:................................................................ Phone No:...................................................
MailingAddress:...........lkw.....L..O."Lt tAd.....1W............................................................�tA.fS�.4),......ii�...................................... .. Q.g........
Onsite Representative: .................. .........�AVI.......................................... Integrator: ......... BMA,! A..........................................................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude Q• =, =" Longitude =• =' ="
`Current;,'
Destgn Current � Desigr Current r
�Destgn
s"' Swme Capactty-`FPopalation
Poultry g,
Capacity, 'Population• '��Catfle ' Capacity Population`%
--; ❑ Wean to Feeder
. ,
-. ❑ Layer
,
❑ Dairy
�-
Feeder to Finish
' ❑ Non -Layer
- ❑ Non -Dairy
Farrow toWean
h= ❑Farrow to Feeder
-
10 Other
d
❑Farrow to FinishTotal
Design, Capacity v
❑Gilts
�: , 3r
a Total SSLW ,`
❑ Boars$
Number of Lagoons / Roldutg Ponds 0 Subsurface Drains Present ❑Lagoon Area Spray Field Area S
IN
t
❑ No Liquid Waste Management System ,
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 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [] No
c. If discharge is observed, what is the estimated Flow in gallmin? ,Nh
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ,[A No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes CA No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes I9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

acilityNurmber; S, —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
P No
Structures (Lagoons.Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
El No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 - Structure 6
Identifier: 1 :..................................................................
.. .
................................... .....................
..............
Freeboard (ft). ...........7...........................1 ............... ............ 3 3
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
El Yes
[� No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
` 2 No
Waste ADDlication
14. Is there physical evidence of over application? ❑ Yes [4 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................... .C. ..----...........tLsc 1t .......... S1E .. (!....1 1Cf ..............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ;M No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. , Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No.vialations-or deficiencies.we're-ntited,during'this:visit.- Yodw'iH iceceive•no•furiher : -
:�:�correspQndettceatioulrthis:visit:-::�::::-; -:;-...�:.•:�:�:�:�::..�.�:�:�:���:�::�:�:�:���:�
❑ Yes 0 No
Yes ❑ No
❑ Yes P9 No
❑ Yes PNo
❑ Yes J3 No
10 Yes [I No
❑ Yes IPNo
❑ Yes ® No
❑ Yes ![� No
iZ. ErosTcv, aytc, or, Tnnxh- diva (Nai( ap I eor. #3 !�koojd 6e NOtt] cv itstvad
I., yom c). V-, Wo-kiS o , � Doors Az i *3 sh UJ� br-motdJ-
16. Cor.-Vi n j e- 04A,�, -6 , u3c,, rescue i r, CvejO r 3 s a le- Itt%n-�c� .
7-2. V�dow woS_% i, Swr - }�``' Q eor• c �"9�s iar- # z Shost� he in
Irv- re care . LJtt U_ [ oo, kwis S o�cl b c f kwJe �,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

x: ❑ n Review
DSWC Animal Feedlot Operatiog
® DWQ Animal Feedlot Operation Site Inspection
10 Routine O Complaint 0 Follow-up of DNA-'(? inspection 0
Facility Number
Registered 0 Certified E3 Applied for Permit ff Permitted
FarmName: .......,r....... .1.............................................
Owner Name: .......... g..i.....t..f...............3.of.A.�.........................
Facility Contact: .............................................................................. Title:..
Mailing Address: ..( .........4r,�.e.. ..it� d...... .c4- .
Onsite Representative:..... ?..I .� - ....... P..91V t. S........................
CertifiedOperator:...........................................................................................
Location of Farm:
Follow-up (if DS%VC review 0 Other
Date of inspection to t a
Time of Inspection � 24 hr. (hh:mm)
113 Not Operational � Date Last Operated:........... ................
County.... .................................. ...V.)/J...�.Q
.............. Phone No:... ..�.a.).... :q....-...' 3..( . .................
..................................................... Phone No:....`�.1.�.�.z`7..-�.ZO
a.A.n3.......�.............................. Z. .. `. .
.............. Integrator: ...... t Yta. vl...!^-f .................................................
..... Operator Certification Number ,....... ti P.36.�.....
................................
.......................................................................................................................................................................................................................................................... 3
Latitude 1 .6 Longitude a ' "
L
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population .
❑ Layer I I JE3 Dairy
❑ Non -Layer I0 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW 71
Number of Lagoons / Holding Ponds ® Subsurface Drains Present ❑ Lagoon Area Iffsprav Field Area
❑ No Liquid Waste management System
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes ® No
b. If discharg=e is observed, did it reach Surface Water? (If yes, notity DWQ) ❑ Yes 91 No
c. If discharge is observed, what is the estimated flock• in kmllmin?
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 ElNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M No
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 (9 No
7/25/97 Continued on hack

Facility Number_?
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,tIolding,Pouds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IQ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........r...Z:s......................3--.......---..................'.Z............ I ........ .............
.......... ......................................................................
Freeboard(ft):.................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes 0 No
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-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ,�.[.t?..It....................................... .............. .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animat Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0,- No.violatio'ns or deficiencies were noted-d.urirtg this.visit..You.will receive -no flirt er'- -
correspondence about this.visit:•; • : -. -
Yes ❑ No
Yes ❑ No
❑ Yes IR No
❑ Yes allo
❑ Yes f'No
❑ Yes allo
® Yes ❑ No
❑ Yes ® No
9 Yes ❑ No
❑ Yes ® No
KYes ❑ No
❑ Yes ®,No
9 Yes ❑ No
❑ Yes R No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments
Use iirawin 's of facilit to better ex lain s�tuahcsns. use additional a es as necessa o
I t .1 120 i d r „� rri p It C •4.�r.1�-� m-. vJ L L 1.�� i In
b o mot- w r e.a s 4, a t N {-tn:44 L� C 0 -� 4u u t L t s s-d u t-j- L;� t�t-+� �u � GL
w 1ti tiv-c� v. k�t_a.i S o / i .. d
J 4-n-
3w hw l V-XA.du,..A
Z.L• �z-4.�A C .� r r-�,.. � Sd s 1 So--•-�+ plA. - r
q.. A d a_ e d 1•- - W vs C b S
a% z 4 a s 4-
14 vs 1 14 �. S e.w wvp ry D-o�✓ a.v. w -a { �.L i S T o I, � o�•d
it 3 t 1 1 r
7/25197
x
Reviewer/Inspector Name ,S.F
Reviewer/Inspector Signature: y ,_ Date: I p f r / q -)

•
•
Site Requires Immediate Attention: V
Facility No.
DfVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPER-ATION§ SITE VISITATION RECORD
DATE: , 1995
Time:` &4
Farm Name/Owner: _" 6r'Llt-
Mailing Address: VCl
County: LJ
Integrator. Ci Phone:
On Site Representative: _ �flJ�'�t �Phone:
Physical Address/Location: lla ,�Ll !�
;94 3 f V_,?A 3
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on. Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: % Longitude:' i'' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 4 hour storm event
(approximately 1 Foot + 7 inche Ye or No Actual Freeboard Ft. C7 Inches
Was any seepage observed from the lagoon(s)? Yes 6
Was any erosion observed? Yes q0
Is adequate land available for ray? Yes or No Is the cover crop adequat es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. es r No
100 Feet from Wells?t"Yes * No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of
LAestate by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cZZ-,
? Yes/°� No
Additional Comments: /Y1 S BOO_
i
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.