310122_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qual

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: U ��i`yul NAI
Certified Operator: i�r1
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 161 (P 0-
Certification Number:
Longitude:
Design Current
Swine C►►apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I lNon-Layu
I
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
20
Design Current
D P,ouIt , C►a aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ 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 1 of 3 21412015 Continued

Ljvacili Number: 01 - Date 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: 1 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L`I 3D
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 W No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 5& No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes k 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 1% No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �,?No
❑ NA
❑ NE
maintenance or improvement?
��``
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes t� 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): _W h(w6w' k6o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
)S� Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Q(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 P No
❑ NA
❑ NE
❑ Waste Application . ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 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
21412015 Continued

Facility' Number: - Date of Inspection:
,24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes VNo
❑ 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
4 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?
24. 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 X 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 gNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �0jNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #)-. Explain any YES answers and/or any,additional recommendations or any other comments. -
Use drawins of facili to.better explain situations° use additional pages as necessa
g t?'... P ( p g ry). ..
5 % l UY�- L�,YI�` nS �l �r�n leuve 1 rn Yw� v u
�
4
14 3. K �j MxO A
1 s , WW (V+w1 1 �; '4etds
Reviewer/Inspector Name: ft, 4 W
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Z�
21412015

(Type of Visit: Uinpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: u2sC-1 Departure Time: County: YlV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �p�{)dl�'E(z
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: j 9
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Feeder to Finish
d
b
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
DrP P,oultr} Ca aci P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
OtherIE
Turke s
Turke Poults
Other
01
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 42n No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Oo
❑ Yeso
❑ Yes WNo
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: "1 1 - 12 Date of Inspection: l IGIto
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
I a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
}}1
Identifier: � ! r -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or env' onmental 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
ENo
❑ 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
2fNo
❑ NA
ONE
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 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application'equipment?
❑ Yes 2Nto
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �(No
0 NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ff;No/D
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

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[A No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. 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
ZI-No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Y
Er No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA ❑ NE
Commenfs(refer to question #): Explain any YES answers and/or any additional recommendations orany other comments.
Use drawings af facility--�to'better explain situations (use additional pages as necessary).'
.._
17) 051� 0 �j
5�) wrLL-- ��oC4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
+-'Alsaav-J 3 (J6GL2s .i�PAC oaj�j_(; W6f-f(,
B� DecE���- tv' -To "VIEW
Phone(il
Date: U (Yi
21412

(Type of Visit: (Z Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: � Departure Time: �,Q County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: V a N ATh q-t'j Y 'tta.� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
E]
Design C*urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I iNon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr, $oul Ga aci_ P,o .
ILayers
Dg Cow
Non -Dal
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
0
Qther
Other T
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
'
dVNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of Ins ection: ! J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ 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: &OW �� LA60)_3
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 EJ'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 env nm oental 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
Pf(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
ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
[DNA
❑ 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?
es
E6 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
Y No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[!fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
t$
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
El Yes
EZ
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
j(No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 V'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facili Number: jDate of Inspection: l [
40,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
2�, 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Wo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [�No
❑ Yes O/No
❑ Yes C1111110
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
I__I No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
� o
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
Comments (refer to question #): Explain any:YES.answers and/or any additional recommendations;gr-any other comments.
Use drawings of facilitylo better explain situahbtii(use additional pages -as necessary).
7�osr 1�DDGSS Ww�, Cn� aN
6E 0IG NZ /-T 4-111fset-, cd 4_T6 1\1.
Reviewer/Inspector Name: �'_ T6� tj cAaaj e a,,.,
Reviewer/Inspector Signature:
Page 3 of 3
Phonecgid U
Date: r(6 1
2/ I2015

(Type of Visit: a 7Routine
fiance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Q Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Q Arrival Time: ® Departure Time: County:{ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
[ Title: Phone:
Onsite Representative: �aNAS N�
Certified Operator:
Integrator: "
Certification Number: l (/
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Desigu Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
1) . P,oult , Ca aci, P■o ,
Layers
DairyHeifer
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults 1-1
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[DNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FaMity Number: jDate of Ins ection:
Waste Collection & Treatment
4. N 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 2j 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? Yeses �No[_] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm:20vo
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ea No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes El
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesZN
❑ 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 ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes []' o
❑ NA
❑ NE
Required Records & Documents .
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ 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 E3o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tranr sfers ❑ 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 II 1`"' ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 10 120
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes El"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [G]No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
CJ'No ❑ NA ❑ NE
��❑NA ❑NE
No[:] NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments;:= .:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 10
Date: 36
412l1 4

Type of Visit: Q Co pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint 0 Fallow -up O Referral O Emergency 0 Other O.Denied Access
Date of Visit: 04,
Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J011
61 Integrator:
Phone:
Certified Operator: Certification Number: 1Uq�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
r
Design Current
eltryCapacity n to Finish
Design Current
La er
Design
D ' Cow
Current
n to Feeder
Non -La er
Da Calf
er to Finish
Design Current
Pout C►_a aci_ P,o ,
ens
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
-La ers
Beef Feeder
Boars
ets
TN
Beef Brood Cow
Other
esOther e Poults
r
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)?
❑ Yes JZJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes VN0o
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility.Number: IF jDate of Ins ection: tl
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 Structuree 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA L LA &o12-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23 Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EdNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes d o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [DNA ❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�;o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
011rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fai o have all components of the CAWMP readily available? If yes, check
❑ Yes
E/yes
No
❑ No
❑ NA
❑ NA
❑ NE
❑ NE
the appropriate b
WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility.Number: - Date of Inspection: t r
' F
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 L� 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2fNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C34o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
(refer to question #f): Explain any YES answers and/or any additional rc
gs of facility to better exDlain situations fuse additional Daees as necessa
2.d:> w uP 0660s Ss6vo,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
fo
❑ NA
❑ NE
❑ Yes
O NNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
D4o
❑ NA
❑ NE
❑ Yes
1ji_
❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
idations or any other comments.
,7?4-
Date: I )
21412011

11.
Type of Visit: QJ C pliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
1416
Reason for Visit: 0 Routine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: 1 Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: `} n ►�jA-�-lOj�fL� (L Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cai#le Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
lt . Ca aci_ P,o
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Othcr I
IOther
Turke s
Turke Poults
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?
[:]Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 9
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes Fg/No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

[FacRity Number: IDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: I"CealZ {3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "�a �-,t,;o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2"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
C' "'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L.No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �3" 0 ❑ 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 [a-Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes �o ❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
[:]Yes 5zo ❑ NA ❑ NE
❑ Yes
[—]Yes rNo
❑Other:
❑NA ❑NE
❑NA ❑NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E21�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes �7o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Ds ection:
I jig
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. Isythe 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
C2<0
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E:`-
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
❑ Yes 1. jXo ❑ NA ❑ NE
❑ Yes ®No
❑ Yes [3/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes WNI
o ❑ NA
❑ Yes
❑ NA
❑ Yes❑ NA
❑ NE
❑ NE
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any tither comments I
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: (-1 jcl 1 b "7 J
Date: /I

IT
(Type of Visit: Q CC pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: I t Arrival Time: , Zp Departure Time: Z .b County: DU,0=12 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
i
Onsite Representative: J ti ► lt4 A 0 MZZLL/cjR_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: !u, 72-
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
C*attle 11
Dai Cow
Design
Capacity
C*urrent
Pop.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish i i r ODD
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,ouit . C•_a aci P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turku s
Turku Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
I! I °
❑ 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 21412011 Continued

Facility Number: - 7-1, Date of inspection: It johl,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-A&o,/ I C,A &mj L 6vW3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[ryes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E!(No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E(No
❑ NA
❑ NE
maintenance or improvement.
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, 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?es No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes [JAo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [AIo ❑ 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 '
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail o have all components of the CAWMP readily available? If yes, check
the appropriate bo .
❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes E No
❑ Yes ❑ No
oe
❑ y
s No
es [d1io
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
21. Does record keeping need improvement?,If yes, check the appropriate box below. ❑ Yes []No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Wl�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FErNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: I I 11b
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
21 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
❑ Nan -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
o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
7permit?
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
NA ❑ NE
(i.e., discharge, freeboard problems, over -application)
Wo
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
❑ Yes
N ❑
E NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or:.any other comments x
Use drawings of facilityto better explain situations use additional pages as necessar
y).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
kxE f 16PY W 71(!cam
"I/P,
LJdhlh/ 1Pk&C. Phone:(DO ff
Date: 11/it
2/4 011

Division
DivWi of=Sod and'ualtty az :
FaC>1lttywNumber ` � ZZ � :� Water Co6servati41
x
type of Visit
Co liance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
2eason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: h `1 o Arrival Time: ; 3 o Departure Time: I� County:
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
yUfL%w Region:
Facility Contact: Title: Phone No:
Onsite Representative: �.JruMfi #W M-Mk—Cfk- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = 4 = fl Longitude: = ° f
Design
.Current . DesignCurrent,.,..Design " Current,
�SwineCapacity Populattoo Wet Poultry 'Capaciiy Po'pufahorY, ' Cattle '= apacity`p pu al Lion
❑ Layer
El Dairy Cow
El Wean to Feeder
❑ Non -Layer
? El Dairy Calf
Feeder to Finish
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes LZ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L.Zo
El NA
❑ NE
El Yes
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: — j Date of Inspection 1
Waste Collection & 'Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: ( c..f6d 1 t ,4 (raoj-J / L.A6_a6d 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environ
tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
V 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
LJ No ❑ NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No ❑ NA ❑ NE
maintenance/improvement?
]I. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
�,�
Id No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E-3 No El NA
❑ NE
15. Does the receiving crop and/or land application site. need improvement?
El Yes
[2 o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ff"No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No ❑ NA
❑ NE
jcomments (refer to pquestionP#) Explain any YES answers andl©r any recommendatrons or any other comments = "
xUse drawtngsof facility, to°F6erier explain"situations (use`addihona[ pages as necessary) ;* w
1) LA60oA/ 43 66 I kV)41S -0-T E Co✓Eti v",ID . ,tQmf 0606r) Pc,EASE 60te
AJ4p r t
� tra ►cat - �!d• far, Trst _,4IcR.EAf f or q �,✓ �C ,ZS TO 6 mach.
A/E605 IlPPAtL:'V r.
LReviewer/Inspector Name Phone: 0
Reviewer/Inspector Signature: Date: /% a
'nov �0 f)f ? 12128104 Continued

Facility Number: — Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes [] `No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box elow.
Yes
❑ No
❑ NA
❑ NE
ElWaste Application El Wely Freeboard El Waste Analysis L Soil Analysis [I Waste Transfers
❑ Annual Certification
❑ Rainfall El Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2"N' o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
4o
❑ 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
E. I o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El
04.
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,_,__��
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
Yes
No
[INA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
L?'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q(Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: i d i 5 p Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Q ON � MaO-� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = i 0 Longitude: = o =' =
Design Current
Swine Capacity Population
Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ an to Finish
❑ an to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
airy Cow
❑Non -La er
❑Dairy Calf
Dry poultry
El Layers
❑ Non -Layers
El Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other
Dumber of Structures:
❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El El NA
El NE
❑Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3
12128104 Continued rAA

Facility Number: 3 Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA C>,t:bA+C!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/7 lit/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
D/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
0/'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ NA El NE
maintenance/improvement?
VNo
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. El 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
U/ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
[2No
❑ NA
❑ NE
Is-,.) F'-1'a'Pf AW a)w'
x %:
Reviewer/Inspector Name h.<n Phone:
Reviewer/Inspector Signature Date:

Facility Number: — Z Date of Inspection 0 /�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WiJP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 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
'[✓,.J No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E 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
B'<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[I NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,D-go
Li No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IKNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EfNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,�,�
I� 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
'lX'o�1[I
ElNA
[INE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;110
NA
❑ NE
Additional Comments andlor Dray
12128104

Q-Z
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation "11Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: tl til. ug Arrival Time: 3y 5 Departure Time: County: J UFLXJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Design Current
Swine C•_apacity Plopulati_on
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow io Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
i
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = { Longitude: = ° = ,
Design Current
Wet Paultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Curren#
C*attle C•apacit_y P,opula_#ian
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State?. (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Eg/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
X
El NA
[I NE
El Yes:No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection t► o
Waste Collection & Treatment //
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? EYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L-WGMA-) I LA&-cw� Z LACr2012 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 �Zo
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yeso Cl NA El NE
maintenance/improvement? ll
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VINO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,_�__,,
LyNo
//////No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
[� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments {refer. to question #): Explain any. YES answers•an&or any°recommendations orm .any other coments i
,.
"Use drawings,of facility to better explain situations. (use additional p""ages as necessary). 3
Lo � ff CQ-t'�r "1 -[�►G� 1t x.el1 , �,V�
677 LJL 0� ed►µ e )i k ht1, iss c , Nod 1^'► � � b e, i s s r� � � W, a S S, 1�1,x
p
4*Kfir U _
Reviewer/Inspector Name �, t ,4 Ga; i Phone•C 9/ SG —2 3`cS�
Reviewer/Inspector Signature: C%�b Date: (t 6h VC1
VI... 11NCB[

Ficility Number: — Date of Inspection I1 b
dR d & RD t
_eLjuire ecor s ocumen s
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other �, /
21. Does record keeping need improvement? If es, check the appropriate box below. ❑ Yes ❑ No ❑ NA al E
P g P Y
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA L'J NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ;W/E
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA CIE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NAT
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA / NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:I Yes
❑ No
El NA
�,
LINE
/b
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ No
El NA
NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA�/NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
EjfrE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ 9
12128104

Type of Visit C pliance 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: I• s Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: O A✓ 1M SZ COIL Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = f = `1 Longitude: 0 ° "
Design Current
Swine Capacity Population
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er I
Non -Layer I
❑ Dairy Cow
❑ Dairy Calf
Wean to Feeder
10
Fil Feeder to Finish
Zovez
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
El Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Non -La Non -Layers
❑ Beef Feeder
❑ Gilts
❑ Pullets
❑ urke s Beef Brood Co
❑ T
❑ Tiurkey Poults
❑ Other Number of Structures:
❑ Boars
Other
❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA 0 NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
El NE
El Yes
Cl Yes
VN9(❑ NA
❑ NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — ZZ Date of Inspection t4 4 •
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: t_Across_'M_ ! Lid CsQ�r✓ I-+Qi S� 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E 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
�,�iv
Op o ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
�o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ZNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] yes
B N ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ONo ❑ NA
❑ NE
maintenance/improvement?
;Z
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DNoNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
QlKo—
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
;u) -L"t_ ( NGE 7 3 rr gAVE
Pvmf, lJG— 37A rL1 AUD "fit-,P
Reviewer/inspector Name-2187
yiU��j{_,t,l, Phone: C1(�..
ReviewerlInspector Signature: Date: 70/1 4

Facility Number: —y4 Date of Inspection 1° t. c
Reduired Records & Documents
l9, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, Yes ❑ No ❑-NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes ETNo ❑ NA ❑ NE
El Yes 01o El NA ❑NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FJ'N�o ❑ 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
El o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑-N'o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E3,o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
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 and/or Drawings:
❑ Yes
E1 o
❑ NA
❑ NE
❑ Yes
E3 o
❑ NA
❑ NE
[:]Yes El-Ko ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [INA ElNE
ElYes Lid'No ❑ NA ❑ NE
Page 3 of 3 12128104

Diivision of Water Quality
Facility,Num6er Q Division of Soil and Water Conservation
O Other Agency
3
�
Type of Visit 2,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint /Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a G Departure Time: County: ( Region:a,
Farm Name: s�Ci i`�i�Ls(.� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f:�6p,
Certified Operator:
Back-up Operator:
Location of Farm:
Design
Swine Capacit
ElWean to Finish
ElWean to Feeder
eeder to Finish t�
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
Phone:
Phone No:
Integrator:
Operator Certification umber:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = o = ,
Current' Design Current
Population. Wet Poultry Capacity Population
r
Ell La y er
❑ Non -Layer
Lf Boars -- -_ -�
Other.
❑ Other V -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Pouets
ElOther
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity, Population
El Dairy Cow
❑ Dairy Calf
El Dairy Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
ElBeef Brood Coid
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 I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: — �, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments {refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
tylS P ce vfet.J
K4 hei-e, dvtiY-\3, ks� I ns cam,
Ha ri
Reviewer/Inspector Name Phone: ' 2,1 y
Reviewer/Inspector Signature: Date: Q�
Page 2 of 121N104 Continued

Facility Number: — ) 2.. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2r'N"o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ;] No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking JzCrop Yield ❑ 120 Minute Inspections Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2'No ❑ 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?
❑ Yes
;�'No
❑ NA
❑ NE
,ZYes
❑ No
❑ NA
❑ NE
❑ Yes
f2 No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
b oAr-
Cr
Q2
3)
te I°5 4a
�a1a6
a >
a fgC0 J-Q-CD -Cal'yn5
> �� i �1 C' �� 11
1 ra, r -Fay Il
aboGyx l nseecko r•
1�1 C)
a Na C 03 a('aA,t► .S - ` a Go'
�. L. a 5`0 o ^. \
L0.1/t,, o - Ac�-h Cd4U 5 +51 &zTi
Sbrri tip- o•
ti
"Ydr'_0
Page 3 of 3 12128104

Type of Visit Ge ompllance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit,,C +routine 0 Complaint O Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit „ Arrival Time: -' GNU Departure Time: I� County: Regiod_ -Lv`9
Farm Name: L — 3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r�w ( L�� _ Integrator: Mt, - ofjA
Certified Operator: Operator Certification umber:
Back-up Operator: Bach -up Certification Number:
Location of Farm: Latitude: = c 0 A = u Longitude: = ° = ` = .,
Design Current
Design
Current
Design
Current
Swine C+apacity Population
Wet Poultry Capacity
Population
Cattle C►apacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daiiry
❑ Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
ElBeef Feeder
El Beef Brood Cow
❑ Boars ❑ Pullets
❑ Turke s
Other
ElOther
❑ Turkey Poults
ElOther
Number oEll] f Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes O—No ❑ NA ❑ NE
El Yes El No
[I NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 13 No
❑ NA
❑ NE
❑ Yes _E;�No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection 3 O
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: 1 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z Z 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 '[TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2TNo ❑ NA ❑ NE
❑ Yes -0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O'filo ❑ NA ❑ NE
maintenancelimprovement? �,/
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L/J 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 [] 4pplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 'ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )�kNo
❑ 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):
Pre��e c eaj-- mayittf a�an.�
-Jfa {�te��S �� Lr\ � 5kgc.
- r'l_ I
___ _
Reviewer/Inspector Name
Reviewer/Ins 1� I � t.V
P I Phone: 016
Reviewer/Inspector Signature: Date: Z 06
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
1
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q'No ❑ NA ❑ NE
the appropriate box.
❑ WiJP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )ErNo ❑ 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 ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J:[No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [7No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ 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 ,0 No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes O No ❑ NA ❑ NE
Additional: Comments and/or Drawings:
' No iecovv+ Pump in ecor(js orn 51G^l9
had � s eAO6K � t
4; r
r �d lV_&Se SUo6 Cetc-ins wl, cryt 5►
records
Piats e ogczi i �1.5
T��1��YL KCcJV llo/
Nc Da" K
9--1 e. a r Gh rya l �D
' � � • re. n�� �s� �o� ab1�. -�a �D � � 1 r. 5� ec��n
Page 3 of 3 - P I eecsip- 5 e� r 1212&04
Coy-_P,2� 1h

Type of Visit JfCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: a Trine: ,
10 Not Operational C Below Threshold
Permitted PCertiiied ©Conditionally Certified Registered Dat Opera r Above old: .
Farm Name: i _ County: �.
Owner Name: _ _ ..... Phone No:
_flailing Address:..
Facility Contact: --Title: Phone No:
Onsite Representative: a�, ! Integrator: _
Certified Operator: _ Operator Certification N r:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle © Horse Latitude ' 4 Du Longitude • 44
Discharees - StreamImpacts
1. Is any discharge observed from any part of the operation? ❑ YeVj[!!�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E040
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes• Z •M
Structure 1 Stru� 2 Structure 3 Structure 4
Identifier:
Freeboard (inches):
12112103
Structure 5 Structure 6
Continued

Facility Number: j Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes1To
seepage, etc.)
6., Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ZNo
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 •fffio
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes SRO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes )2mo
elevation markings?
Waste AnDlication
10. Are there any buffers that need maintenancetiimprovement? ❑ Yes ETTio
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes '01�0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ zen Ground Q Copper d/or Zinc
12. Crop type6d) 6 LQ
13. Do the receiving crops differ with those designated in the Certified aste Management Plan (CAWMP)? El Yes o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 0 No
❑ Yes PNO
❑ Yes ff No
❑ Yes .8'No
❑ Yes JErNo
❑ Yes ErNo
❑ Yes rU'Ro
❑ Yes ,20Ao
❑ Yes ;3'No
;C A(re#er ta'�ga�on j nay YES aerswecs a�lur anger ar, A-- - �Gtf3Er
�� � �ifsaiity>betttr,� �•m�tions. (use a c p 1"-rnal No
-� Con (I U s s _ C-a �� G
13 a(-Q C'L n r Q� con ,$ $- o� .
CGn4,,, d i h `fit G 14
oocl shame /�c_o►-c.Y�
a,-,->° /?ect dC or-- o r=&O',00-
Reviewerthmpector Name
Reviewedjnspector Signature: Date: O
121IM3 Con"Ued

Facility Number: 3 — Date of Inspection
Reauired Records & Documents
ZI . Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes PNo
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 _Q'No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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 014o
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �014o
27. Did Reviewer/inspe= fail to discuss review/inspection with on -site representative? ❑ Yes r0 No
28. Does facility require a follow-up visit by same agency? ❑ Yes ONo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Olo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ,,rYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes E]'No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [2"No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Q No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. J] Yes ONO
❑ Stocking Form OCrop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted dining this visit. You will receive no further correspondence about this visit.
'�Vev)4 RGLj
3s, Please ��co�cl c�'o� yl e-��s �n PtovLdb-off
.12/I7,/03

Type of Visit 9F Compliance Inspection O Operation Review Q Lagoon Evaluation
�C r'�i°/3
Reason for Visit 0 Routine 10Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: WF=NtO
Time:Facilih- Numbererational 0 Below Threshold
Permitted 0 Certified ©Condttionaily Certified Lj Registered Date Last Operated or Above Threshold: _
Farm Name: 'r +V County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Iq Title: Phone No:
' Onsite Representative: hwze-J "UQQ /? Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Nnmbec of goons,' ❑Subsurface Drains Present ❑ La oon Area
=Holdrag Pondsy! Soltd_Traps ^ -0i ❑ No Li uid Waste Management Svstem
❑ S rav Fie[d Area
Discharges & Stream Impacts
1. Is any discharge observed frorn any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
Z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
12rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
ONo
Structure 1 Structure 2 nS cture 3 Structure 4 Structure 6
Identifier: �� 9
Structure 6
L-
Freeboard (inches):
05/03/01
Continued

Facility Number: 3 / —1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? -(ie/ trees, severe erosion, ❑ Yes [INo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
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 ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload 01"yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [:]No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ZNo
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j2rNo
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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_ q -..1 p y _.- w_ Y ' _.
Comments (refer;ta uestiosi Ex lam an YES answers andlar an recommeadahotis.ar aav outer comments.
Use drawtags of faciltty-to better explain sttvattons. [ase addtt,onai pages;as necessary) ❑ Field Conv❑ Final Notes
• � S�ECTZo•J r>�D�C ���,70 [�,�'Cr¢Z1s/�}r �F f�� � T�.2f_ s ��',tJ�
��C`f
„vD tJF�rfO td a�,/�, Y9nlOzd��. r7z-Dr✓� ��Pi>'-r42��- 7 �
H.,
Reviewer/InspectorName = -GoPAram'
Reviewer/lnspector Signature- Date:
05103101 f f Continued

Facility lumber: Z Date of inspection
dor issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
additional Comments and/or Draµ'inrs:
AtZ
�"ON,Q �� 1 „1 �Dcv ��./�' S �L o•�IC � �P��Jig � ��o �� /r`E,�
AW
y(J-��11m .�l��G✓� Lou��R �..-�oG-�f�,�i� �Q,e�W�+� �t�0 ���
NO �Ufz,2�Gau/ ®rj� �QftmS �SF/�v��,p.
����rl/zit,� �����G'fI-L- �.�5�.��ip�,/cE ��ur �zs ,D•es�„l�1
,Q2D
rR
05103101

Type of Visit O Compliance Inspection O Operation Review Jj Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit-
[3 Permitted 0 Certified [3 Conditionally Certifi D Registered
Farm Name:
Owner Name:
Mailing Address:
Facility Contact: 4 Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operated Above Threshold -
County:
Phone No:
'Phone No: , Q
Integrator:
Operator Certification Number:
swine ❑ Poultry
❑ Cattle
❑ Horse Latitude o•
�'
�� Longitude
Design
Current
Design'
Current Design.- Current
Swine
Caoacity.
Population.. Poultry ;
Capacity
Population Cattle Capacity Po --illation "
❑ Wean to Feeder
❑ Laver
❑ Dairy
�; Feeder to Finish
f 17 Q/
I JE1 Non -Layer I
I Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
_.;
_
❑ Boars
M
Total SSLW
Number of Lagoo s �'�, �LJ Subsurface Drains Present U Lagoon Area U Spray Field Area
�'`---��fa e
Holding Ponds LSolid Ti aps E� ❑ No Liquid Waste Management System
_ _.
��.
Al
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes PINo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes 01
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q�No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Xycs ❑ No
St re 1 Stnic�2 Stnycture 3 Structure 4 Structure 5 Structure 6
Identifier: / 0-
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection �J
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste^ Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Cl Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. 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
ONO
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
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments#efer to question #) . Explain any YES answers and/or any reeommendations.or any:'other� i eri
y
. .. r'
Isdrwingsof facrlrty to better explain. situatia (trseaddthonal;pages ass necessary) ❑Field Cony ❑ Final Notes
Reviewer/Inspector Name 0%� '
Reviewerlinspector Signature: Date: Q
05103101 Continued

Type of Visit J6 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up O Emergency Notification e Other ❑ Denied Access
Date of Visit: nNot
ime:
Facility Numhererational 0 Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified [3Registered Date Last Operate r Above Threshold:
Farm Name: iC A, rARM6'3 County:
Owner Name: �� kL�� Phone No:
Mailing Address:
Facility Contact: ` C Title: Phone No:
Onsite Representative: y I F (/1'_` ��-y5/ Integrator: u
Certified Operator: Operator Certification Number:
i
Location of Farm:
f
56 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �� �« Longitude
Wean to Feeder
JLJ Layer
I
IU
Dain
Feeder to Finish
I10
I0 Non -Layer
I
I❑
Non -
Farrow to Wean
_
❑ Other
Total Design C>apaCl
Farrow to Feeder
Farrow to Finish
Gilts
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon $Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
StruSture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: q�` 2>
Freeboard (inches): 24'
05103101
Yes ❑ No
❑ Yes VrNo
xYes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
❑ No
❑ Yes ❑ No
Structure 6
Continued

• - .
Facility Number::31 — 2 Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/irprovement?
❑ 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
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN gHydraulic Overload
XYes
❑ No
12- Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (WkIMP)?
❑ Yes
❑ No
14- a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records S Documents
17. FaiI to have Certificate of Coverage g General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notit, regional DIXQ of emergency situations as required by General Permit?
(ie. discharge, freeboard problems. over application)
❑ Yes
[:1 No
23. Did Reviewen(Inspector fail to discuss reviewrinspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
[IYes
/1Li
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AVW?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
YCaiaments (iefer is qu ou #j. Ezplai> any YES ans'�we� s �ndlor aay reedii me daft nsv i iV ments, K
x - r..
Gse drawl gs of fac�ty to better explain s�iivations: (nse additu7tsal pages:iis necessary) i ❑Field Copy FinalNotes'' , �r _ -
:"-F�"y=°r=.'a�.e£`r;-'-�,:5:=2::-.s_•i'..car`,2'.a'W'r.4=,.:..:r__ai�:.sr.-:'Cns;., �"t..:::Y.,..,,,. ..F:-'�
Nonc ; y rp nJ�P�C� u5��i� �i4aa�v� I�Z 3l- � Z o
-- S ��15 �Gt7r vz✓C OFF FzAFC D J 7;V7- ;:;,o w0©Ds� /S�NQ
z f
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: —7774q date of Inspection 1*4
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below
liquid level of lagoon or storage pond with no agitation?
27. ,are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt_
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s)_ inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
and/or
❑ Yes ❑ No
❑ Yes ❑ No
El Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
��� �DutJ KG2�s�cJ7A-f1� S?a �PC� FLDc,e.7 A-7
n cry fl rvt�r: 'L ODDS 6 5reP
�-
FLO
puu.� D
6 risv7
(�A7 �
A A � r
�'DLWD >: b
Amur r
o tom TO O �z
�R0r2�
4-0�oR.� i��aN 1 GV
.77 Iry
05103101

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluationw�p�,! I
Reason for Visit O Routine O Complaint O Follow up 0 Emergency Notificatioryc#fe Other ❑ Denied Access
Facility Number Date of visit:
Permitted 0 Certified © Conditionally Certified [3 Registered
Farm Name: bFAArn
,Q
Owner Name: '_5 .ig,2Z,.� {—� LE V
Mailing Address:
Facility Contact: Title:
Onsite Representative: S+l 6 0 6 rji�5
Certified Operator:
Location of Farm:
Time-
10 —I
Not Operational OBelowThreshold
Date Last Operate or Above Threshold:
County LIPc.2--N
Phone No:
Phone No:
Integrator: Po QR'P A
Operator Certification Number:
1A swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude 0 1 u
Wean to Feeder
LJ`Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
11 ❑ Gilts
Subsurface Drains Present
No Liouid
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Str}r� re 3 Structure 4 Structure 5
Identifier: 01 /ff jf�x
Freeboard (inches): �2_6
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
Structure
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [:]No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers kith required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
13. Crop type
33. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAAArMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a avertable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Regyired Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WliP, checklists. design, maps. etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DI Q of emergency situations as required by General Permit?
(iel discharge. freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
�?No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Cotiiments'{refer to goe t va }: 'Eiplatn:ae'ry YFS snstive s andly y mammeudatt as ar siary r menu W � F -; `'
Use n drawings of fhcilityeto better ezplam situatios. (use additional pages as necessarv) -. r .T
. , : fi �ti R Field Copy ❑ Final Notes
D%E � �N��Nu� �iJtJ�ST�G.t�7rl�n1 � �.SCN�RG..E DB��QvE,O O,�
3 fi��a3.
APPEARS �or� Tk��
�f� F�AR-rM6t•1 DAMS,
Reviewer/Inspector Name - -
Reviewer/Inspector Signature: Date: G
O5103101 Continued

Facility lumber: 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 ❑ No
liquid level of lagoon or storage pond with no a_itation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes ❑ No
roads, building structure. and/or public Property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were anv major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? Cl Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanentftemporary cover? ❑ Yes ❑ No
LL):rzz- /JE le P -ro Pain P Du.-r Po KID I~.p ("-s AK E p A-r
feeco' COC C �Ack rprry Lp-ooO, IKFIc ?
ml rJ --r eu rn p E C K L n) LRG oO 0 ,
RE C-- .5 �� � ��� E S VIM
rill` ��5 Pu�p�o� ���P6' R��46 1��� �x
►a- ���� d� 12� G-Pm. II
-r o n�� r� A-r 7� � � /AA-
�Y a
VU�
�S
PUmoo-r-ez-Ar A Rauri D I ( ' ooArr• ,
A
gI0OfQ Z +1��. 7 m .
s
LC ��7ff �� �ivSE�4�i°�D
�� �'�' SDd 1.��R�rrR7�jJ �,�'nl�-
Oa
cumE►
60U S L+Eli dGAD T;Jro A
� 5 zrtF`r-� /r E �A�� i�ir'A2 �x.✓rs.�
�QP�y 10 �a'4X w�c- CREEK
2,500 WA-s Ca�r��►F_o �N WCADISD l
s7 NAP 6rzed AasvrS E,o 64 TtAy'
o
u L a
i lour Iry Av�i-ryn�G �v�tR r���os,
05103101

Type of Visit 95 Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (� Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number state of Visit: Time: `j"! �'`�_'
Y Not O erational Below Threshold
P Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: County: U PL�f1
Owner Name: S Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: /�/i�GS_ �n%L Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Gilts
❑ Boars
Totaf SSLW
© ❑ Subsurface Drair
�r. ^ _. ❑ No Liquid Waste
Discharges & Stream Impacts
1, is any discharge observed from any part of the operation?
❑ Yes PTNo
Discharge originated at: ❑ Lap-oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 'VNo
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 ONO
Scture 1 Syucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3
05103101 Continued

Facility Number: 2 Date of Inspection % D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? /- A ❑ Excessive Poriding ❑ PAN ❑ Hydra5tic Overload,
12. Crop type tJ LrKA 2F_ Df ffZ/J k'CSFf�
13. Do the receiving crops differ with those &signated in the Certired Animal Waste Management Plan (CA'
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WL"P, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the. facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [ZNo
❑ Yes /No
XYes ❑ No
❑ Yes �NO
❑ Yes VNO
❑ Yes VrNo
P
Yes VNo
❑ Yes ZrNo
❑ Yes ////❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes XNO
❑ Yes /NO
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes o
❑ Yes /NPNo
❑ Yes X No
ElYes No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:..
Coin rieats.(refer tu;gueshar: #) ;Explai r anr.preomate�datiaus_or anv'other-cornmentL
Use drawings of facility. to better explain sitiiati©ns (ase additional pages as necessary) Field Conv ❑Final Notes
-. -
e. _ _
.J
n
JSD fi E A,2 ci eEi9`5 Xv4io 00 G ' (C�o "V #.� '7 mo lid 6'9ek S, 7,O '
ii?D 524� �iJ �AC S�D� 4t9,-- L/k,'000 2. 4e, 9, irl F7✓L� � lS�j✓�
�,✓ �� /'BPS r Sir ac 1�a
Reviewer/Inspector Name _ -
Reviewer/Inspector Signature: Date: 9 O
05103101 Continued

Facility Number: —;5 1 — Z 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additional Comments andlor,Drawings,•
❑ Yes ❑ No
❑ Yes X No
❑ Yes P'No
❑ Yes VNO
❑ Yes No
❑ Yes No
❑ Yes ❑ No
6v0,ek P^/ ,CgE���oi4� FZ�Gos (6t�r%kF 4S
QCG'on'i/Y1��J� A�1��`i7�J�
/1
R)AW ACIJ6110 o�,P �
r
f S<9.� S -,�
7;F
S �a
05103101

Type of Visit grCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit §YRoutine O Complaint O Fonow up O Emergency Notification Q Other ❑ Denied Access
Facility Number) ! 2 Z Date or Visit: 1D Z 3 a! Time: 1 ! 3b
Q Not Operational Q Below Threshold
13 Permitted [:1 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ....
Farm Name: �4 .....'. .. ..... County: „D vP /,'-I
......... .....................................................................................................................................
OwnerName:........0 �c f..Vri�r.�............................................................. Phone No:...................................................................................:.
Facility Contact:............................................................................... Title:................................... Phone No:
.............................
MailingAddress:...................................................................................
Onsite Representative:. C,?``t �(C 5 &- i A k l e Integrator: r1 v✓ ...
................................................................... _.... ..;r*...
Certified Operator: ................................................... ............................................................. Operator Certification Number: ...................... .... ..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 66 Longitude • 1 64
Desagq, Current Design Current Design '. •Current
-; Capacity Population , Poultry Ca aci Po ulatioa cattle Ca C1 Po ulatroa
Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish JEI Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
El Gilts „.
❑ Boars Total. SSLW
''°Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
.. Holding )'Duds / Solid Traps ; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )yNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes J21No
c. If discharge is observed, what is the estimated flow in gal/min? 'h ) q
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes gNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'id No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identificr:............................................................................................................................................................
...............j...........................ttz......... 3 Q
Freeboard (inches): 3q 76 38
5/00 Continued on Lack

Facility Number: 3? —12.Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 13er—%)dG, 6r,,i-, r-zeacd , Coeii) WtvAi
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
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?
r% SS
❑ Yes ,� No
❑ Yes XNo
jayes ❑ No
❑ Yes PrNo
❑ Yes 010
❑ Yes ,dNo
❑ Yes ❑140
(CAWMP)? ❑ Yes 1PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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?
(ieJ 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?
! Yigl�t>�iQgs:e�- "Odencie -vrwre pQ€e �1H`ing �his:v�s�t: YoU wiii-tec�iye I t #'utftr .
correspondeirce allo f this visit.
�omutents (referto question #)::'Expiate any YES answers and/or arty_erecommendatioa4 or. a
edraws'ol' facility to`better e>zulain sitbstians. (use JsaditionalasQesas iaeress>ii v}, .
�Yes No
/Q❑ ❑ Yes ',,ffNo
❑ Yes j2fNo
❑ Yes ONo
,[Yes ❑ No
❑ Yes IffNa
❑ Yes ONo
❑ Yes p`No
❑ Yes ONo
❑ Yes ONo
''Yes ❑ No
-4_
'7, Guess cv.rer vleFC]s �o be �s-}qb[;s��; o� bask t-.�a[j r�' [ayoon � �-l2e�v•�im�ci �
using sow o[ci k,,, f Sp r'44 P U4 4e> 10,^ a ✓. Gte of b ^.ve A;,- /LO :
)S. Tke geld oe t,.1h,'cL. Lies fjyd,'-tvl-�- zy e7eeds 4-a have be;r .-)da s rt� rrl
SQ"''" 20o Z �-L e work A, es4-ab[; s(, k good s-�'ut.�ni aFbe�-wiv q-
kxedj -jo be sot vevl w/ s►ti►q.1( Jruy, 01-14„ri dQe-j ma+ etQ.pAr
00 Sange? -Field( e; Need vov%+ s ma I( o r-c n R-r rear► a►s 14 is' ev i deny
► e+ 50;n5 4o��-
Reviewer/Ins for Name - S
Reviewer/Inspector Signature: A�� y-b-zab, Date: iD Z 3 O SJoo

.Faeility Number: .3 j - ! ZZ Dale of Inspection 0 5- p
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below XYes [:]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 A No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �^o
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 10 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 ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional : omments an or rawings.
Jry. T� � e �� fie/ resv)fs 4- 4ke
L,e re 1 i 3 sa ��
f'or 4LL;s ���,N.. T'k s ;s ;.nso c.►2&II. T1iere mre cix4ecln
-flel ets in -t,e wAs4e Ia,., j eAc eIPV YxP-4 s i4e owv\ Sq le
Se 4 L A cxvi be "a of e �c �r � l q 7i � ► � � d ,
Al<P 1 -fete 1,vePR ble acres d"' J`% rkew s' " 1 SZ. orr-n-r/oL-,, re,4 e
1'r 41,e ) . og" nUZZ_le i s weal wh-ik Me .Br;,,k)c7 s S ;s 4Ar one
6e�ny used• HoxveverAr--rKg-2rs S"" A -'low r4+e or 1(sJ rr-1 .
rv)r. �r;nkJey vieeaGS 4d fe%law 4he we�able ae-feS Aes►,h +A- %e
�'GG6rds s►��1d be keP� RLGerdin�l�� -�1�;5 W�[1 ehsvrerroDer`
lee ed e✓(; q,�.e-lc� s a v1o1 we-H ed ac,res . 4241.
ZS. ►'h e - -Sr;'N k.1ei is vto-�er�}i �011 evJ;►z we ed qc re s e(ts 5,A ` 0.'
f>eldg, 4e 4Lieee yells o"t awe sJ'4e
of bhp F:PId w�N,cl, o
- fVhS , Need to wua ke qd v.s4-,v,,evt4s so 4 ka4 yo ti l av, ea—Arl lv-14
4l•,e we+lable etG,res 4es;3 �"�• Wr:nk1e d,`d nel •Qow
�'��►-► T "rtcai
Gt �Pl.# Clipppli Gq¢iort ✓ 1NQ 20Oo" 2-001 Sa-411 C'-)
G,rOf s
�d fir, [3r�nkleI ,'7o4 kb Gp 1 .wort -f►1a►-, S�a 165. Ih ei4k bv,"dot e"14l
r,d4 � C' wmore 4L-.cth -�,e✓'ert.ainder lo�Me,w./•
ltia C*-e i n g4eci oo T�,ge-4 21 a't rle lA .1 of 12.3 Acres i h
WCL-Oeowk;ct� c,gj{s -for CorYI )w►\ecti l or .salbecinc. M' -. Br;►1kJt J
:r,n, y S 4"-V a clop Gan'-- be pl w4cal i+•-, 4�:s -T17 s ior;e-lv( 171�s
(vav, of 09 cud �rv{ 614y rind ,S esse,"i4,gII� ,� to 4,* g -�'oof Glop 61e
aGress Y.,,cO of Aeld eQ4.t Me. Tr f'okle' . me -s�"Js ` h..s �i*W -elA
/'/ bor P q,-,d same was
;..,as vsed � �� �--1 f ,�, )q1 if 'qs � n-oL✓ ,o;
,^�,►'to�'e�, -{ror� i� as rG cEK•F7P'l;vd?
71arri ;+�Glvd�S 44L f;2lof ']IxeIM. de-F:C;+.
V1;1iZcl�:an
Tb:s teefo( need s to be rerA-,-oved-6',o^i -AC f1,0 anal -A e wa54e ptaYl
St o+ltd $-�,11 wL-,; l �ek;& 1 A fife-f ,C"� Tor
tiD e. Ove+ad) 44e - C-nroaof s4an,d ar cco•-r4ol &-re-vvdo -b
+tea Q f e i not a usF� �r h as K f d 6 ✓1e,41
w
r
5/00

- - - -_Q0iV6i6 of -Water Quality -
- O Division of Soli and Water Conservation"
' 0 Other Agen -
cy
IType of Visit '0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 12 2. t)ate or visit:
*Permitted ❑ Certified © Conditionally Ce,rttiified 0 Registered
Farm Name: � -&15 i�� r e-.S -4 j 3
............................................................................................ ...............................
Owner Name: G� 5 r r - �le
.......................................................4..................................................
f Z 97
S Time: �Printed on: 10/26/2000
O Not © erational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: �...1.''...................................................
Phone No:........ ...............
FacilityContact: ................................................ .............................. Title:................................................................ Phone No:...................................................
MailingAddress; .................... .......................................... ......... ........................................... ..................................................................................... ..........................
Onsite Representative: ... cg r,,,,,,,,,,,,,,,,,,�� �2 grator:...... y ...................
�� ... Inte
Certified Operator:. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 .4 Longitude �' �6 44
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
eeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts;
1. Is any discharge observed from any part of the operation? ❑ Yes ;KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convcyancc man-made? ❑ Yes �ffNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes XNo
c. II' discharge is observed, what is the estimated flow in gal/min'? i) A
d, Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JR No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes J ] No
Structure I Structure, 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFier: ............... 1.................... ..........z3 ..............................................................................................-.........................................................
Freeboard (inches): 4 1..5 4 q 7,61
5100 Continued on back

Facility Number: 3 — /Z Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes V 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 X 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? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? J] Excessive Panding ❑PAN ❑ Hydrjaujlic�O+ Overload
Yes ElNo
12. Crop type - R'��'y"�(!a� 'l�s�� &fir, tkl t, t.7PAzC) �i►�aL 1 (f,xift-•L _
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?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
'No •yiolafioiis;oi- clef denues were hated dtWing this:visit; • Yoir wiil•reMW fio futther • ; .
correspondence: abauti this visit:
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
WYes ❑ No
[:]Yes 0 No
'9Yes ❑ No
❑ Yes ONo
X Yes ❑ No
❑ Yes ONO
❑ Yes ONo
❑ Yes _P(No
❑ Yes )'No
❑ Yes 0 No
❑ Yes XNo
Comments (refer: "to question #): Explain any YES answers and/or any recommendations any other, comments
Use drawings of facility;to better explain situations. (use additional pages as necessary): --
4a 9rcks5 Ve9e4,-,4ian on 6ocl &-PA?j or oi . .
is, So wee avt;✓L,A t.,JgSge. P0nd1-1d ir, 5� a y,�i ld Need �o
owl en4o sera,
1-3 `rpl'. Be;#I 1eV sa.i.s `ale �i, `j 0, t I I 6�'1 7 ac-.es . -T oi►^e
rrc,%+i ?�ar1-cs, OL4 of 163 ul<Gres Lvl i"C_n
�raLe y ��a��r-� �'q�e, tie �vre -�1�n4 2,✓gr- e �1�>� q�o� �'►g1d ee c4;f'
,ca
jeee a -
IReviewer/Inspector Name
Reviewer/Inspector Signature: Date: / 2,/S/00 5100

Facility Number: - /Z Date of Inspection EO&IPrinted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below J9Yes []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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, []Yes ,g 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 XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ;'Yes ❑ No
Additional Uornments and/orDrawings:
.Sa ; l 4eS � / < �!'rr�+-� 3 / O L% iG C O Yv!►� C r✓t La �C �Loi h t� h s��tG lQ,
A.
^I .E';e1e s. rou,c..- na s - a gpP1 y i, S �o$A s f c,cee
On qlt rlettd5 ;k7 tc,.-Fe. 7n.-.vei.- /'et-/t� Fe.b.-..ej
P✓ q
��� �� +rltW oKnO( �O-�
�e,/'1'►Gv ! 5r �e-�' S�n'c�
4kf. low Q� 6�1�; taSpQ� 3 W,fhe!'e eecen4 WOI"k
has beeki o(c rte -
I ?, Pieed Ce,-4. ,10,--.-fie or ceveray A 1a Genceat
°i- IVeaea( 4o ob+,d., f--..s4 f'rc-eboaevi records -`Q•Lvaf�] I�19
zovo b° 7reebodf�r
�u vs Aid 4e �.,�; �►����� �,eekl
•f'6e�ids, i4e ur �a-use Aky�s-le n11n1. s,s
64 d,q � j D� ot,0'4 � 1,e C�'C40e.''1Ce Si/ v'-lme+-✓
}QI 1 ► -�.�^"' ��� �Or �';��d 3 w,' �. wa34e A►'1et�,vs� s�.
use 19AA) 41InLA)aJuc ���� �,,�t.r�AVV
Dh ���� �'3 (,✓'6.F'ere�ce ��N'1/i1_Gi` 4��Of�j f'�f �iGi� �,,�.
ke' sell
/Vo4e ; /Ins �l�,n-�d lti4vr, . :I;r
w +�,�I Ger� i r7 ue t L9 noL"Cr +-xq y t'vevn�l�- -15, i h v'e sl' : jizrk 4,Lv, nn
-es
�AkM"'y�,9
10e4e: & -owe,, vs PA4 3 0 yn"'.
1��ve A �lz►'
k4se a 100ran�1'v
q qd � sv O-e -�
5100

t Division of Soil and'>Wat6r Cons&vahon - Operation Review=
El Division of Soil and.nserY Water:Coaaon'-Compliance Inspection r
Division of Water Quiifibiimpliance Inspection
Other Agency, Opeiation'R.eview ?� �=
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review Other
Facility Number 1 Z Date of Inspection r2 q
Time of Inspection ® 24 hr. (hh:mm)
® Permitted © Certified E3 Conditionally Certified © Registered © Not Operational Date Last Operated:
Farm Name: .... 64,S r,,e-p"►s 1' 3 County: PVQI;�.......................
...................................................................................................................
Owner Name: Phone No:
!'! .!. •.............. r t..^....... t.e. .._.......................
I.........
FacilityContact:.............................................................................. Title:..............................................---............... Phone No: ...................................................
MailingAddress: ....... . .................................... ............. ........................................... ...... ..................................................................................... ..........................
Onsite Representative C h �f e S to �- F yt �C) e y Integrator: r Fe,r,, ; 1 `1 1 64 �!'l S
............................................. ? "l.t�... f
Certified Operator: .............................................. . Operator Certification Number:.............
Location of Farm:
3;?.! ... i.t.. iwf& ... o.t^ .... er.16...NG....N. t...1.I.,....1n.45...e..5.....h[s-t.rAh.... e.K.. tf.7.......................................................................... [-,
........................................................................................................................................................................................................................................................................
Latitude �' �° Longitude • �' �`=
' 'Design Current - ', Design Cirt"rent: „ - Design Current
.._
,Capaciy=Populaon Capacity Population Capacity Population e
❑ Wean to Feeder
® Feeder to Finish
11, D J
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer
❑ Dairy
-
�^
❑ Non -Layer-';
❑ Non -Dairy
u.
❑ Other
_........
Total • DeMgri:`Capacity ..
= _,Total'SSLW
�Number:of'Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holilh g'Ponds / Solid.Traps ❑ No Liquid Waste Management System
Dischar_Zes & 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'? ❑ Yes ❑ No
h. 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. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? N Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............................................................................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
...................................
❑ Yes ❑ No
Continued on back

;, Facility Number: 3 1 — 1 2- 2-1 Datc 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 A yllication
10. Are there any buffers that need maintenance/improvement?
1 l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
1Z R 4$
❑ Yes
❑ No
❑ 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?
0: Nd-vigl'afi&is :oi: deficiencies •were noted• during this; visit: • Y:oi} Wii! •r, eeeiye d further
noires• orideirce: abaut this visit.: .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
�gmments (refer tb,question #)..:Explain any_YES answers -and/or any.recommendadons or -any other comments
Llse drawings of facility twbetter.explain situations (use additional-pakes as necessary)
2. Mr. $"I'%kley cetlleoL X7W6 o 4he ni� h4 o-f 1216? 99 *o rcf6ri -�ti.a� tjis. ie �
P" �t';n1, t.v. ske �dtot 50-Acrt in+a ek Zrc eAve 4-41 rrtecllgrt; eaI &1-d-FVP?C4;dVt .
rcee;YCA 41,xc re e--4 &P Yt'I-.9rirtkre7is Gall 411;5- tkO^11r1
-ICt,,ek Mr. Erinkl� 0.4 41e �4t�.dt Pesq;ef -i-kJ %e 1���f s ki-fca�
t✓1rn -•fie vt �' �t�� e�afc •tnd Wc44. L rMe 4e, Jqc4 saov%e �1t'nj *a ee�t4.
�het1 l)e rz-�vrrle�,s-1"e in 4t,e d�4c}�. c said f�t�t +�.' c�t�,h
oh 4kc reel +k,0 pvfls 4LI,e- 50n ;kj was sl:�p;�g. Tkvs -��,� juA L,,%s
Reviewer/Inspector Name � � ..�'-�o°yl et.v•t � � g-r . � �. •3.�0(j: � ��.,.F
Reviewer/Inspector Signature. Date.
3/23/99

Faoility Number: 3I —I Z 2
Odor Issues
Date of Inspection l i-7
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
'Additional -omments an . or-rawui �..
►'�O� 6Gir.� f011Cd rL aS �� OVGIk� Olytd /'vYlOt�t' fPSi�tT�, !1'�r. �r:K��e�
Said -FLt� -F11:s GoAlot have eG�cvrreq *Col" 4bcbtf cin 40t.tr. 01S+z
re
was o17ved ivt 411a di4-cl,. 'Y1terc a
ser6-tG�; gh 'et L'►d !,tv Hates
rotLj4ty} 4ke Z4;46c so }i12 WA4e vlaa[ beets
4e ol,,--ok and A;ot nod reaG� Su�FgcF t.���ers.
Lts4c
MvG1,% d1 -}�,c 444+ iS s4111 54,1nd;n 1n 4-1,c
a55 :ble back avt¢o +kC s��a ,c,'t1�. Pe sa41,a- ke
Me ge;Y,,�Cie7 51-\azJd h,ve reel 4':xed
Aottict seed -ne n !eAer descr; �,^j wka-� huP�eh�d
CtVid 41-,e 4e, Garr-ect 4. 5ePIA 46: S 1 4 eV 4a
h eW A l l f%&-+h 1 S
/V CDC N (z
DWO
1 z-7 Ce,.c!„ng1 Dr 6)(1,
}
3/23/99

From: lau To: Wilmington RO-WO pate: time; 8:21a6 AM t'age 1 oT T
L : Vi C to H 'C a -- 11/ (A
NC Division of Emergency Management
Emergency Report Form
Taken by: Mark Brown Date Reported: 12/0a199 iTime Reported; 10'59 PM
Date Occurred: 12108ISO 7ime�Occurred: 05:30 PM
Reported by: Charles Brinkley jAgency: E and B Farms hone: 910-285-9322
County: Duplin lCity. RURAL EM Area: E 4
EVENT TYPE
eather Event: Chemical Event:
x Event Name:
Chem. Class:
N/A
Chem. Mode:
NIA
FNF Event:
Non-FNF Event:
FNF Type:
FNF Cuss:
Fire Event:
Complaint
OTHER EVENT: Animal Waste
SAR Event:
I.
Event Description: While pumping from a hog lagoon the pump reel broke, approx 4000 gallons of waste was
spilled on farm property. Waste was contained in a ditch by Brinkley. No surface waters were affected.
- _ ---.-- ......... -
Deaths: lInjuriesc _..__ ivac: _.. ^._._....-. -Radius:
- =- -
Responsible Party: Charles Brinkley Plhone: 910 285-3723
Point Of Contact: Charles Brinkley . POC Phone:_ -
Event Location: Near Registers Crossroads
Latitude (decimal degrees) (NC inland range is 33.840 - 36.588 degrees. Values outside these parameters may
be used.)
Longitude (decimal degrees) (NC inland range is 75.460 - 1i4.322 degrees. Values outside these parameters may
be used.)
USFS Block -Square -Point System: Block= Square= Point=
JRRT Request: No I
NOTIFICATIONS
Y=On Scene A Advised
COUNTY AGENCIES _
LEMC: SO: PDt : LFD: CHealth • Sewer: PWRK:
Other Local Agencies:
STATE AGENCIES
AIC: SHPISWP: Env. Mgt: A :Water: 1DRP: CAP: JDOT: DMV:
Other State or Federal �E Agencies://t�
Notes: /'. �•', h je 1/ m ee? e/ s F. c-.1 � � -5, 1 r -7ta
1 of % e. J y _1-_ -.r of v-7 e e-� Li W r v 'I 121-'Y,99 9:07 AM

Division of Soil and'Water-Conservation 'Operation Review z k,=.� �•
E Division oFSoil and; VlWater Conservation ,Compliance inspection �t
DRvision of Water Quality °Compliance Inspection ' 3
the A enc O eratioii.Review = _~
S y P. r
IOLRoutine 0 Com laint 0 Follow-ue of DW2 ins ection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
Permitted © Certified [[ Conditionally Certified © Registered JE3 Not Operational I Date Last Operated:
Farm Name: .....&.-�t3................................................................................... County......... .. ll....................... .........................
.
Owner Name: ....................................................... ........ Phone No:.................. .
FacilityContact: ..................................... ................................ Title:......................... ..... Phone No: ...................................................
Mailing Address:
........... ..........
Onsite Representative: ......... Integrator:.................................................... ....s............................................... �,a.
Certified Operator:......................................................................... ............. Operator Certification Number:..............................
Locatiyp of F rm:
K. apd
G... ........ .... r�l .....!....... . f 1�� ... .......... Q ...................!.......... ..... ........................
...... r.. ,
k.4A� ...15.R...1vA.1.. �( �u�....... .........................................•-.._.........._..........................................-...._._...----...._....................................._.......
Latitude 0 6 .4 Longitude 0 4
,'' Design Current y -Design = :._Current ,. ... = Design Current -
Swine, - Capacity Po ulahon Poultry Capacity. Po `ulation _ .:Cable Capacity Po 'ulahon n
❑ Wean to Feeder ❑Layer " ❑ Dairy
Weeder to Finish 71ENon-Layer [] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design. Capacity
❑ '
Gilts
❑ Boars > .. ... ._. yTotalSSL-W
Number of.Lagoons Y. ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
%'Holdhig°Ponds7 Solid Traps ❑ No Liquid Waste Management System _.
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MNo
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 b
Identifier: Freeboard (inches): p .a �...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes UNo
seepage, etc.)
3/23/99 Continued on back

Facility-Number:3k Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
KNo
(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
KNo
8_ Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
[XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
t<No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
9No
12. Crop type
13. Do the receiving crops d ffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
hrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
N'Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there a lack of adequate waste application equipment?
Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
NyYes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
If.
No
(let WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
EfYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
UrNo
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?
❑ Yes
NfNo
(jet discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
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
❑ No
0: o yiolaiions:o'r• de#ieie;ncies were noted OiWhid this'visit: • Y:oik w111-teb6i ee Ti further ;
cories oric�ence: A' A tM visit. :: : :.::::::: :
Comments -(refer tc question #) Explain any YES answers andlor any recommendations_or any other coiuments
Clse.drawings of facility to :better explain situati©ns (use aditional:pages as necessary) -
_
AL
Vt
n)
Reviewer/Inspector Name ;W z3gS3go:0
Reviewer/Inspector Signature: �� n Date: (9
3/23/99

a6lity"Number: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 ❑ 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 M-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 O 'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [. No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j `No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ®'No
Xdditional Comments an or awtngs=; _
�[ t `
1 {
YIQ
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10 Routine O Comelaint O Follow-up of DWQ inspection Follow-up of DSWC review O Other
Date of Inspection g
Facility Number 3
Time of Inspection I $: Z5' 24 hr. (hh:mm)
D Registered Wertified © Applied for Permit IMPermitted 10 Not Operational j Date Last Operated: ...
Farm Name: ...
................... �--��--%-........ �i�.y-ts`...... #:�..`..�...................................... County: ...... .�itx�i �kr.......................................... .................
Owner Name:.......................%4............ .... !ai!—Ai.......................
...................
Phone No:...`11Q�.'.�
..........................................
Facility Contact:...................................................... . Title:................. ..------ Phone No: f
Mailing Address:..... ..Q.........QX(...............
..n.............`..............................
................ ......... C ...tAA..,, G..........
............................ ZOO........
Onsite Representative:...............�,r.!!`1�:VL'4........ r'-h{L .. Integrator:.-.-lv uz4 . ..........
Certified Operator................................................................................................................ Operator Certification umber..........................................
Location of Farm:
�... e�aS........Si sz:... ........ # ,t ..�!....t....�t.,.... r s.....'.. ........a'j...... R,....I.l. :Z........................................................................... A
.................. -- ................................ .. .----- .............. .... ..
Latitude =' =` 66 Longitude • = ` 0 «
:Design Current
. .
I)esig nCunrent r Design Current .
�,
Swrne „Capacity_ Population
-Poultiy
.
Capacity Population Cattte-.� Capacity Population
Y
.-
❑Wean to Feeder
❑ Layer
-
❑Dairy
Feeder to Finish
❑ Non -Layer I
❑ Non -Dairy
❑ Farrow to Wean
m
❑ Farrow to Feeder
❑Other
sx_„k
❑ Farrow to Finish
Total Denw$t n Ca acit
P y
v
❑ Gilts
Total SSLW
❑ Soars
n
Niniih of Lagoons / Hoidtng Ponds
ID Subsurface Drains Present:][[]Lagoon Area
❑ Spray Feld Area
. No
s ❑
Liquid Waste
Liqu Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes 1] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ip No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [$ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes UNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 19 No
7/25/97

Facility Number: 3 — 22.
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes [2No
Structures (Lap-oonsJlolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...
............................. ................... .............. I .............. .... ................................... ................................... .............................
Freeboard(ft): ............,.3............................ ........................14..................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application,
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............?.Y..MV.IL1.1.............................. -mm.t.L.-Csyb").......... •...........................................................
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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities On]
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?
❑ Yes
JZ] No
® Yes
❑ No
Yes
❑ No
❑ Yes
No
❑ Yes
® No
❑ Yes
KNo
❑ Yes
EA No
Yes
❑ No
❑ Yes
No
UYes
❑ No
❑ Yes
® No
Yes
❑ No
❑ Yes
® No
Yes
❑ No
Q1 Yes
❑ No
0• No.violatioinsi vk defiden' de's4e're'nt ted during this.visit:- You.will i•ecei've n' 61tirther
correspondence dhout this:visi£
4 t-Az- t_+lt}SiOr, pn 11mcr- O + 4 fwft l t oT 1 v� *'A tvKlen is. 00t� fi XL Walls 0T lar"g r
L + 3 . Cv�& SinW�� loe r (l t c� w — C i8 - ry edul tort oah� o �, &11 4c.,1
���pm}-.- c�; 4� Wads 5�©�(� �ae r•t-Vegc��� �:l(�. Wt�,.tlt or. �t,�aAn.S �-t -r- -�z sf,�,y�rt
Ejp r'O 04 , Ero s i o S�Wrr� W 4- t,r tr1� {o,ti .JCJ��ru) .
CDVI rnVf- CA-orA 'iO �x,�rave, . A" [5pn� e � errrwclo� �F r� b � berfndda., Kr-
��� 6-56AA S Yl r�etJ� GLt.o-C-'{p `� S S�Yl+riwr.
12- Mir `3afx , t b r�z1 � %� s (�tjj%. G,Cz,, Ske-dj 6-e-
-U . N d d , h'Nt,� aLV + �c �s vJ44tr i�-s c . V� ►W-1' s host ci be, 7/25/97
Reviewer/Inspector Name,
h;
:".,'
il
Reviewer/Inspector Signature:
Date: 7 iZ to

Faciiity Number: .. — Date of Inspection:
Addi6 ' 1'C6 Jni nts and/or Drawings .X
1 to A ut 4 ll<<
IIA nS S �Utl i ►� T
s A, -.- %Yy--% ��-�'�^ " s ut"In) �1, r-,-S-.r 4- �Jl 1 1acahOY15
'I ,cv1J Ve. uAtt b,t s tro l V;) l
wK" au" e �� `�., �1i W ce � ��la�i� h,i�oiel,
t _ 2- .s`9 be�-mva% sf�oi1t� ��" ret;e� ev4a rd 4-
0 u��o
+ � C O �4 � b� 4 12� ; t,�,;,��o n, NC ,z
24(v . (i rclrat��� c{i�1. 4 ULrvnet,-,i � 34- � �laz fac it �; Zlc� �l o►� sr�c��� �h �
cv es s S � �"t S %, ti acWJ �r 41-4 �I
4/30/97

Routine O Com Taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Z
Time of inspection ;(,Y} 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review 0
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: � ���.., `�(r'C.lh!1.� � . , .._ . __ ....._.... _.. ... _ County:._.... ... . _ . ........ _ . .. �.
Land Owner NamesPhone No:...�il�?�$ �....... _.
Facility Conctact:...�YltdS...(1�.... Title: ._QwlutL!... .....
..... - Phone No;
Mailing Address: ... 2 .. .......�.� ....._ ..-......... �. _. _ ...._ .. -- x ¢... r ..
Onsite Representative: Integrator: N!.1��....._......................_................
........__
Certified Operator:.. �.�5...... ..;, ....11.....�........_... Operator Certification Number:
Location of Farm:
Latitude E3�:]• f C u Longitude ©• 4
Type of Operation and Design Capacity
t = SI1€Current * DeSEgn Current�DeSlgn
DBigCorrea[
4
-.Ca ace Fs Po ulafiana `ga!dtry° :Ca ace ,Po ill ��oo = tt�e ... Ca aci Po` ula8 one
❑ Wean to Feeder f ❑ La er ❑ Daily
Feeder to Finish -7❑Non La er r on-RLir
Da
t
Farrow to Wean
w. Farrow to Feeder Total ..estgn Capac
Farrow to Finish 1 5
� s
❑ Other k
r ... .
Num er of agoons`! Holding Poiwd�s ❑ Subsurface Drains Present
n
fi " ' Lagoon Area ❑ y Fie Area
❑ Spray ld
QtneLml
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes EA No
❑ Yes ED No
[:]Yes 0 No
❑ Yes 1P No
tA
❑ Yes No
❑ Yes 29 No
❑ Yes 09 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30197 maintenance/improvement?
❑ Yes W No
Continued an back

Facility Number:---ai..._
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 to No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes (M No
Structures (Lagoons and/gr Holding onds
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Y.. ....... _..... _ .. _ ..........
10. is seepage observed from any of the structures? ❑ Yes K) No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes R1 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..................................513A11......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For CCrtiiied Fltcilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
V Yes [:]No
❑ Yes [9 No
❑ Yes [5, No
❑ Yes M No
❑ Yes JZ] No
❑ Yes BNo
❑ Yes 50 No
❑ Yes W No
❑ Yes 0 No
❑ Yes 1A No
❑ Yes No
❑ Yes ® No
Comments (refer to question'^#) ,Explain any YES ;:answers` and/or `any reconunendations or any other comments
Use drawings;of facility to better expiain situations {use additional:pages as necessary}
1z- Erosion s on %muv oo' q 4,4vJd be- -RW J vtweJq eaK .._Jvald be— 4
CCSceded' S�XW% Wb-4• - didQVSion M&& r rK Cr- c" i, �rcV&k '�6r' eyb%ron
Reviewerllnspector Name ` :: n ' _ ., fM �.•'° 3
Reviewer/Inspector Signature: �- 6UADate:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. 1 /- / ;2 Z.
DIVISION OF ENVIRONMENTAL MANAGEMENT ,
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
. DATE: I I , 1995�11A 1�__ `?
1�� L T;mP. l )� � _3
Farm Na
Mailing
County:
Integratc
On Site l
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE- DEM Certification Number: ACNEW
Latitude;`'" Longitude:° S? ' Elevation:' Feet
Circle es or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: j-Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or Was any erosion observed? Yes or
Is adequate land available for spray? e r No Is the
cover crop adequate? (K or No
Crop(s) being utilized: `!
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Q or No
100 Feet from Wells? ' s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o"lJ
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o ND If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage. with cover crop)? Yes or No
Additional.Comments: /h1C_.-.1
c.Ae/_ y
Inspector Name V Signature
cc: Facility Assessment Unit
Use Attachments if Needed.