310175_INSPECTIONS_20171231

NUHTH CAROLINA
Department of Environmental Qual

of Visit: C) Co lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
in for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: . Arrival Time: ® Departure Time: n_ County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: } Title:
Onsite Representative: a M! �� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: I ( ] V r3
Certification Number:
Longitude:
Swipe
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Desigu Current
Cattle Capacity Pop.
Dairy Cow
an to Feeder
I
lNon-Layer
I
Dairy Calf
eeder to Finish73600
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Qther
Other
Turkeys
TurkeyPouets
Other
Discharees 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 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ No NA ,❑ NE
❑ Yes VrNA ❑ NE
❑ Yesr�No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number; - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No . ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F2rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
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
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
Ef No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[31 o ❑ 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 facility fail
the to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q o
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes [N
❑ Yes o
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: -t 7 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 4d 0 ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a PDA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No NA NE
Yes ❑ No E3�NA NE
Ej Yes E]Ko NA NE
Yes ETNo ❑ NA ❑ NE
Yes L p ❑ NA ❑ NE
❑ Yes No ❑ NA NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes
34. Does the facility require a follow-up visit by the same agency? Yes
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
l a, -a
ff'No ❑ NA NE
No NA ❑ NE
No ❑ NA ❑ NE
Phone: —( (D 7P6 �3 y
Date:
21417015

(Type of Visit: Q CCopliance Inspection 0 Operation Review 0 Structure Evaluation U Technical Assistance I
Reason for Visit RRo�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: fOl1III I( Arrival Time: Departure Time: County: V L,_-_-,jJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: Jo4p,--'f III 6AO-4F1`
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 9 lq Lis
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
C*attle .Capacity. Pop:.
Wean to Finish
Wean to Feeder
Layer
Non -La er
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Design
Current -
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
I) , P,oultr.
La ers
Ca aci_
P,o
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Turkey
Turke Poults
ffi `
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
[3Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number; - Date of Ins ection: ',l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OlNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure
I, % Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '3 V1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm
I threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
El Ye
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 EYNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes i No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 101bs. ❑ 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 Q 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 [J�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ 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 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes WNo
❑ 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 V Rainfall Inspection ❑ 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 WNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
124. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes z�N/o ❑ NA ❑ NE
i25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ICJ 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 ❑ 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
["No
❑ NA
❑ NE
❑ Yes
E2to
❑ NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
❑ Yes
[/�No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
K❑ NA ❑ NE
V❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use:drawings of facility to'better explain situations (use additional pages as necessary). -
qao - 1300
o 136z
p� w 2 9 Do - 1350
Reviewer/Inspector Name: �6 b� 1J �A�\7 t( ��/ Phone`Q 1 o) b l3 b 6
Reviewer/Inspector Signature: Date: (
Page 3 of 3 21412015

(Type of Visit: 0 Coyfpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Comolaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /5 Arrival Time: L [L = Departure Time: Z d
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: % Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
18 jqb
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oal
Layers
--i
Ga aci_
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
JBeef Brood Cow
Other —TurkeyPoults
Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z140 ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes ❑ No
[:]Yes no
❑ Yes uNn
[—]Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility umber: - Date o[ Ins ection: j J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1940
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
,
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): _jam
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 0No
❑ 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 environment 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 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 1 /i No
❑ NA
❑ NE
maintenance or improvement? TTT
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 F,/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 JD
❑ 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 o
W't'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
�o
❑ 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 Z 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? ❑ YesZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24,Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ElYesrNo ❑ 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 YNo ❑ 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 VNNo
❑ Yes ]dNo
❑ Yes MNc
❑ Yes 2No
❑ Yes Z/No
❑ Yes 4�-� o
❑ Yes INo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
(Comments (refer.to question ft Explain any YES answers and/or any additional recommendations or any other comments. I Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
gi)d)-194_
Reviewer/Inspector Signature:
Page 3 of 3
Date:

f'ype of Visit U f:gdrpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C�1J Routine 0 Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: EMETKI Arrival Time: Departure Time: �) County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J0 AIA-d4AA I r, 5 L Uc Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: l O' q
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle CaPop.
apcity
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
12,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oultr.
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
17IBeefBroodcow
Other
Other
Turkeys
Turk- Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes . NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑Yes /NE] NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: - Date of Ins ecdon:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
��*i�
C "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:
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
dNNo
❑ 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 environment 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 Noo ❑ 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 EXo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
�
❑o
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 No
❑ 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
FO
❑ 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 V Rainfall Inspections / ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faciti Number: 471 - 11 Date of Ins ection:
24;Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes 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 ❑ 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 o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
❑ ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
VNo
31. Do subsurface tile 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 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?
Reviewer/Inspector Name:
dH0
❑ Yes
❑ Yes
❑ Yes
go ❑ NA ❑ NE
U o ❑ NA ❑ NE
P No ❑ NA ❑ NE
Phon I'
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: U Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: tC1J Routine 0 Complaint/'O�Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: V6 ` 1 Departure Time: ® County: � 3 Region:
Farm Name: YY Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: C /hjr✓ w z4_� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
e Capacity Pltryp.
Wean to Finish I
ll
ILayer
Design
II
I
nt I
t
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
I
INon-Layer
I
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oult
Layers
Design
Ca aci.
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other —TurkeyPouets
01 Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Cf No
❑ NA
❑ NE
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
Oo
❑ 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
Zo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

1 /
Facility Number: 1�t ) - Date of InSpeetinn: 16 h 11
Wast&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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IdNu ❑ NP ❑ 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 WNo ❑ 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 environmeut hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �fNo ❑ 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 u 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 ❑ N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V
❑ NA
❑ NE
Repuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ 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 I /' Vr � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection. 43 1
�No
24. Did the facility fail to calibrate waste application equipment as required by the permit?Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rNoo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Wo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? []Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2rNo
❑ 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
n 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
N/o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
—
b
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better exDlain situations (use additional Dages as necessarv).
.. ..
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of
Phone:
JUIfl6_199
Date: � �—3 Aetja
21412 11

(Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: LUAaA Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: OOAIATPA / %j/IT LL-t-(( Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: EM
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean [o Finish
Wet Poultry
La er
Design
Capacity,
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P�oul
Layers
Design
Ga aci +
Current
P,o
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
0
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [:]No
❑ Yes [-]No
[—]Yes
❑ Yes
❑ Yes [�No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facili Number: Date of Inspection: 10jq
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: G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Y
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
WNo
❑ 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 hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ADplication �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U N ❑ 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 YTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F ❑ 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
N ❑ 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 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. A 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 90 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) /
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 "u ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes al �N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature
Page 3 of 3
nopyV Phon�j_�0 3M
Date:
1/4/2 Il

Type of Visit: (D Cot"ptiance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7l. )l I Arrival Time: Departure Time: County: DLIPL—W Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J0NA7NAe/ MS.4—k1j . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: /p(ya
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I JLayer
Design
Capacity
I IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I INon-Layer I IDai
Calf
Feeder to Finish
O
Dai Heifer
Fatrow to Wean
Fatrow to Feeder
Farrow to Finish
Dr, P,oultt.+
La ers
Design
C•a aci_
Current
P,o
D Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef13roodCow
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [:2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes El NLo ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: - Date of Ins ection: 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E�`No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (A60V-A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2�`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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
7o
❑ NA
❑ NE
No
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 [�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? ❑ Yes — []"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I LN ❑ 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 D<O ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Cl No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to ❑ NA ❑ NE
the 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EI�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Q N ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: I I
/�N
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
La 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
D<O ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
<o ❑ 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
CfNo ❑ 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
Io ❑ NA ❑ NE
permit? (i.e, discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Io ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name: ,,f,14d Phone: (9(Q 7 6_ g
Reviewer/Inspector Signature: Date: Q 4 II
Page 3 of 3 21412011

Ab Division of Water,Quatity .. , F �,,,.
ir Facility*Number` `� "O Dtv�sion of Sod and'Water Conservation
0 Other,Agency
Type of Visit OCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit I Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0Mq9_V) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address: _
Physical Address: _
Facility Contact: Title: Phone No:
OnsiteRepresentative: LioAtq-kArJ MZLA-&L' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� U = [� Longitude: 171 U
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
m
❑ Yes nNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes , KNLj ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
12128104 Continued

[Facility,Number: ) —
Date of Inspection
aste 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: CA r�675}./
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j 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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,,_JN/o ❑ NA ❑ NE
❑ Yes VJ 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 �1J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I/ 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 IQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application (/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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 CA WMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
��/N
I� No ❑ 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
Comments (refer to question #): ,Explain any YES answers and/or any recommendations or any other comments.A
Use drawings of facility to better explain situations. (use additional pages as necessary): "::
Reviewer/InspectorName
Phone:
Reviewer/Inspector Signature:
Date: o ! (7
Page 2 of 3 1 12128104 ' Continued

Facitijy Number: 2j) — ��' Date of Inspection
Fieguired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
;No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El
,mil/
E2 NO
❑ NA
El 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
ffNq
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
e
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
No.❑
NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,.,
I IN i
[INA
❑ 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
ffNNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
l,j 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
ONo
❑ 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
Z5No
❑ 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
/NN��
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

S
(Type of Visit O'C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit LJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: (O >G' Departure Time: County: N P(L) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: n o n. n" Longitude: I I° r I I"
Design Current
Desig
Pullapatym•
Design Current
Swine Capacity Population
Wet
CattleCapacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Dairy Calf
® Feeder to Finish
3%oo
57.oa
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Fee der
El Pullets
❑ Boars
El Brood Co
El Turkeys
El
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Wo
[I NA
[I NE
El Yes
No
❑ NA
❑ NE
Page ]of 3 12128104 Continued

Facility Number: 31 — Date of Inspection i
Waste Collection & Treatment
4.�Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,�
El Yes LI 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: CA 4cwr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
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
ElYes LJ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�`N o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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
[ZNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,No ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,❑1,(No
L No ❑ NA
❑ NE
to questtorfiiyExplain any YES answers'
IReviewer/Inspector Name I LD-Nj J r-AR�.1 C—( %,_ g g I Phone:
Reviewer/Inspector Signature: Date: ti
o___ 1 _1 2 11/2RAld cnnBn� and

Facility Number: 3 — 11S Date of Inspection v o
Required
Records & Documents
I T
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
//
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
_
OJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,__,
CJ l
El NA
❑ NE
24.
rm
Did the facility fail to calibrate waste application equipment as required by the peit?
❑ Yes
�(1J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D4o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
�,�
IQ No
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

Type of Visit pliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: og Arrival Time: O$ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
i
Onsite Representative: `)b M14 P4 %✓ — Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
1OLayer 1
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Dairy Calf
Feeder to Finish
b ab L`b
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turke Poults
❑ Other
❑ Other
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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑NA
❑NE
El Yes
❑N
ElYes
❑ NA
❑ NE
❑ Yes❑
7No
NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Neaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure,I Structure 2 Structure 3 Structure 4
Identifier: LA t',2'a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yV
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 O No ❑ NA ❑ NE
❑ Yes [3, o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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 E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��
10. Are there any required buffers, setbacks, or compliance alternatives that need El Ye E N ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
L7 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
� El NA
El NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
7 ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Commentst(refer+to questton #) Ezplam anv YES answers and/or any recommenid-' tj or—i other comments
F^:u .n.re+ hN h uw+.: Tw'?., tf'¢«• .ufs_e. M`"Ps•,.�M".^M+",t9�tiwMYi"S'l�i
drawings of facthty to better explain situations (us'eYaddttronal pages is necessary)Y ti t#4,i
Reviewer/Inspector Name �E . Phone: Qd -Ad% g
Reviewer/Inspector Signature: Date: d
Page 2 of 3 / I2128104 1 Continued

Facility Number: 3 — Date of Inspection i
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 appropirate box. ❑ WUP ❑ Checklists ❑ Desi n g ❑ Maps ❑ Other
❑ Yes 2No El NA ❑ NE
❑ Yes l� No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Io
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain InspectionVNo
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
,
Ld N
❑ 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
�Io
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
9
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6 /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
'lo
❑ 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?
[I Yes
91NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
: No
❑ NA
❑ NE
lAdditiional Comments and/or Drawines:
Page 3 of 3 12128104

4
4 0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- - -- -- - _ 0 Other Agency
Type of Visit [Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 911(outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: M _ 6 Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J "11)ITVDlj Z11&,
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = 1 = " Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
19 Feeder to Finish 1. 0 b s9�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Design. Current.
Capacity Population
Number of Structures: ='
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
El No ❑ NA
❑ NE
❑ Yes
❑ Yes
L ❑ NA
[I NE
El Yes
L'J No ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 1 — Date of Inspection 8 Z
f 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: (�7�160^
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 O No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t7heat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No [I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,....//
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QN° ❑ 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
NN{o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,,D�
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U NNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,
N/9
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,L��,
I�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ZjJ (9,0e Viet P ion.- JW A)& GSELb IV606P. *22/ (2 Jn/ - 68 ?407 mx4t'
6 Vj- pm i, -1 NEB (✓,
Reviewer/Inspector Name CIO-4 eeL L Phone:
rp
G
Reviewer/Inspector Signature: Date: p
12128104 Continued

❑ Yes VNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Facility Number: — � 5' Date of Inspection
Reuuired 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
I
21.
Doesrecordkeeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
2 Waste Application ❑ Weekly Freeboard [I Waste Analysis ❑ Soil Analysis El Waste Transfers
El Annual
Certification
❑ Rainfall El Stocking 13"Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
��N,o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,13No
L (No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E 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
2 o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
rKNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
nNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El yes
,�,/
L7 ivo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
�--,,``
E o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PIKIO�
❑ NA
❑ NE
Comments and/or
12128104

`.O-Division of Water Quality
Facility Number O Division of Soil and Water Conservation 1
O Other Agency l/
Type of Visit —p Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access ' n
Date of Visit: t;;L Arrival Time: Departure Time: County: Region:
Farm Name: rpilee- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
e
Other
IM Other
P ne No:
Integrator:
Operator Certi tcation Number:
Back-up Certification Number: _
Latitude: =o =, = Longitude: =o
Design Current
Wet Poultry Capacity PopulationCattle I
Dry Poultry
=• M
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: -1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
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 ❑ 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 I O 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
❑ 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
f?
Comments (refer to question #): Explain any YES answers. and/or any recommendations 'or any other comments,
Use drawings of facility to better explain situations. {use additional pages as necessary):
Reviewer[Inspector Name I Phone: — -
Reviewer/Inspector Signature: Date: el-2ip
Page 2 of 3 12,18.1041 Continued

Facility Number: — Date of Inspection `� L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
N
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
;NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA-
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
yaoo6
_��Pas2 Sli�mi� D�n o�/�c�2vn
7/3//0 G a2
Page 3 of 3 12128104

L
e ofVisit Q C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
�[ry_nson for Visit V ttoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q O Arrival Time: 1 t_ca Departure Time: County: bt/O LTw/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Gap kkM6�'
Certified Operator: Ge4,IS.E. w S 6
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator: onJ2t U%/
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
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)?
Number of Structures: =,
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
OW
El NA
❑ NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

�))'acility Number: 3 ( — I i�
Date of Inspection Or
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
Identifier: GAGQorJ
Spillway?: rjo
Designed Freeboard (in): M
Observed Freeboard (in): 39
Structure 2 Structure 3 Structure 4
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 L/J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ;No
Nc ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) 8CN_ UoA 03J
13. Soiltype(s) Ave (0QJ3
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
15,E cover 6F CER-MCMCR C (C G0JckA(y6 ,,.rya R-Ewf-Ds,
At.) r6 -P OATC Cr a441s1FAt - a C.a 1t--V 5 A +J tD n( r o t✓ SMS 7N� op
Reviewer/Inspector Name
Reviewer/Inspector Signature: Y-41 . Q.fy Date:

a
,Facility Number:' — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
VYes
0 No
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
IJ No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
dyes
❑ No
❑ NA
❑ NE
❑l Waste Application ElWeekly Freeboard ElWaste Analysis El Soil alysis El Waste Transfers
❑ Annual Certification
U/ Rainfall El 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
L'I
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
_N!o
�yao
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
u1
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
Z
7
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ E
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance.of the permit or CAWMP?
❑ Yes
Ld N�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ur .
❑ 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
ffNo
❑ 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
ffNo
❑ 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
2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128.104

Vl
Date of Visit: 2 Z 6 Time: I a+r
Facility Number / /
10 Not Operational 0 Below Threshold
�$ Permitted M Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 0 ,�n.iSt, �✓M County: ZOLAZ''n
Owner Name:
Mailing Address:
Facility Contact: )� Title:
� K Onsite Representative: e O tnn r ri
Certified Operator:
Location of Farm:
Phone No:
Phone No::
Integrator: II)a0�G v
i
Operator Certification Number:
❑ Swine ❑ Poultry []Cattle ❑ Horse Latitude =* =, 0 ` Longitude 0* =, =
Design Current
Design Current Design Current
Swine @a aci P,o ulation
Poultry Ca aci[v P.o ulation Cattle Ca aci P,o ulation
❑ Wean to Feeder
10 Layer I❑Dai
® Feeder to Finish
49&4
JLJ Non -Layer I❑Non-Dai
❑ Farrow to Wean
r"�g•
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ©
❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps E�
❑ No Liquid Was Mamt ement Sys
Discharges & Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Stmcmre 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): 36
05103101 Continued

Facilitv Number: N —
Date of Inspection 1 LZ D
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
❑ Yes
❑ No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
.
El No
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 anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Aoolication
10.
Are there any buffers that need maintenancehmprovement?
❑ Yes
❑ No
. 11.
Is there evidence of over application?? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop typeiY/M-
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?
El Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment? -
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coveraee & 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)
2 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?
El Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iei discharge, freeboard problems. over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss reviewiinspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
JE3 No violations or deficiencies were noted during this visit You will receive no further correspondence about tfiis visit
Field
Final
/�u/( �/zz�Os�,'/
��/!Rd✓i �O� ( //f.LN� /L� II eeQ� iG Kl/[ �r ,r 36 (rc Q ` 10 iG %j G✓/f�i��
t�/1t �' �i � � �� ♦t�1 he i6 �.lct rl .
Reviewer/Inspector Name
Date:
05103101
Cors>7rsrsed

.IJ
Facility Number: — Date of Inspection / Z
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 fans) 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 at permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

Facility Number
Date or Visit: i Z 6Z Time: 9�3%
7
Not O 'rational OBelow Threshold
EpPermitted ®Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Namc: f I ct 64'le /M County: ZZ4'1i
Owner Name: Phone No:
Mailing Address:
Facility Contact: /, �/JJ Title: //Phone No:
Onsite Representative: 1;-en6 le-Aztg4 Integrator: ( lvidl�5
i
Certified Operator: Operator Certification Number:
.ocation of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude u• "I I � Longitude =• 01 =`
.Design ,''Current ., :Design -=Current" -Design. ::Current
Swine;.. - z., Caacitv':�Podhition Poultry ''=Ca` acitv;=Po'ulationLattle - -
Cs� acifv.:Po dlation- 3
❑ Wean to Feeder ❑ Laver ❑Dairy
r
Feeder to Finish ❑ Non -La er - ❑ Non-Dairy
}:' ❑ Farrow to Wean - - - - - - - -
�`,�' ❑ Farrow to Feeder ❑Other,t
�s x
❑ Farrow to Finish ' Total Dest Ca act
P ty`
❑ Gilts
❑ soars Total
* fiNei�mb. 'ofLaors .�.. - n 4 a ❑ Subsurface Drains Present ❑.Lagoon AreaIlls rat Field Area }
oi 1nkPonds1m%i9J. " ps, ❑ No Li uid Waste Management Systems -
Discharges & Stream Impacts -
1. Is.any discharge observed from any part of the operation? El 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) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑Yes ❑ No
i 2. Is there evidence of past discharge from any pan of the operation? El Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes JRNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 7�
05/03/01 Continued

M;n
Facility Number: '31
Date of Inspection S
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 addressettand/or managed through a waste management or
closure plan?
(If anv of questions 4-6 was answered ves, 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 pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any smctures lack adequate, gauged markets with required maximum and minimum liquid level
elevation markings? '
❑ Yes 5TNo
❑ Yes %9 No
❑ Yes n No
❑ Yes �9 No
❑Yes ®No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ZNo
11.
Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydrauullic Overload
El Yes
[3No
12.
Crup type alr4 C�%'li� :5;W114VV4 !/NP/S e-
13.
_/X/i
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
L}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
Reguired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 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
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
f No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
.RINo
25.
Were any additional problems noted which ramie noncompliance of the Certified AWMP?
❑ Yes
Eg o
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
777
//l��✓
Reviewer/Inspector Name
Reviewer/Inspector Signature:. Date:'a 'Z
05103101 ` Y
Continued

Facility Number: 3( — /% Date of Inspection7�
odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑Yes �TNo
❑ Yes ® No
❑ Yes J�3 No
❑ Yes MN,
❑ Yes ® No
❑ Yes ONo
❑ Yes [9No
05103101

(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit qRoutine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit: Time:
Q Not Operational Q Below Threshold
*Permitted Q Certified ORConditionally Certified 0 Registered Date Last Opera Itedd or Above Threshold: _.......... .... ......
FarmName: _._by.! ���... �.5� I f) �.......................................................................... County:......, (.!.: �1 ............ .......... ..... .... ......... _...
OwnerName: .................................................... ..................................................... . ............ .-.. Phone No: ........................ _...................... _............................... __.
FacilityContact: .............................................................................. Title:................................................................ Phone No: ..................................... _...........
MailingAddress: ..................................................................................................................... .................................................................................. ..........................
Onsite Representative: Integrator: .............................................. Integrator:....
.. ............... ...��.s ................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =` =11 Longitude =' =- =11
Design Current Design . Current " ,... Design Current
Somme ._ ` : oultCCattleCa aril Population aCapacity Po "uletion"
[IWean to Feeder 10 Layer I airy -
Feeder to Finish ❑ Non -Layer I I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE10ther I--
_0 Farrow to Finish Total DCSign Capacity
Gilts
❑ Boars Total SSLW
. Number of Lagoons ,.: ' ❑Subsurface Drains Present ❑Lagoon Area ❑Spray FieldArea
Holdmg Ponds T Sohd Traps: L-------J ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
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 ��k0...rrr'''N'''o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: ...................
Freeboard (inches): 43
5/00
Continued on back

Facility Num9;r_73T_—_(r_7S_j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes V No
(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 ONO
8. Does any part of the waste management system other than waste structures require maimenance/improvement? ❑ Yes 14 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 19(No
11. Is there evidence of over application? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload ❑ Yes P'No
12. Crop type sa 6V('V1; 2eC
13. Do the receiving crops differ with tt ose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
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
allo
Reunited Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
h�No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
W/No
(ie/ discharge, freeboard problems, over application)
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
ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M�No
iVq•Yiblatii¢tis;o�i3eCclencie$were)ii0e(�tlit669this;visit;-YouAils•iei 606iii titgr :
: • :'
C0fTesuorideitce: abi)ik this visit::::::::: :::::::::::::::::::::::::: :
� �% �-c t.,e,. ��s a� n�� fe _sP ��, pAt�- a� � elks ����•—� �l�-wle.-
`
a��� �•e�, ��t�
�
�l� �•.� Ise. � ��(
�� q ki`
haw c� ear tis
hee
�Se
4,N; ec t- l� ��
G�.I . �e
�i �� e�
Reviewer/Inspector Name
t'•� ".h
_ _
_- _ =ra.,
IReviewer/Inspector Signature:
Date:
- 01 smn _

Facility Number: — 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 ,ONo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes {y No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JVNo
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 4 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or y,
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Lh7 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes h No
Additionalommelnts an or rawtngs:
5100

RMS
' ,Division'ofSoilandWa(erConservation Opeiahon'Review
:.�.
-, Division of Soil snd: Water Conserva4on Comphance Inspection r = 5,. . s
�Drvtsron of Water Qaalrty, .Comphance Inspection - -k-.a' "�_"
D Other-Agency`.;-Operation:Revrew
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
,,,,,,,,,rrr Time of Inspection : 3(y 24 hr. (hh:mm)
pd Permitted.R�Certified [3 Conditionally Certified 0 Registered Not O crational Date Last Operated:
L ..
Farm Name: (.....1.'.la!_"(..........._ko .. 'e r`^........................ County: u� C'r
. ...............K�..$j.�.................1......... t3"................................Zr.!.......................................
OwnerName: ...... L.Y..ry .'e .......................... moots..` .......................................... Phone No:................................................................................
Facility Contact: ..............................................................................Title:
Phone No:
MailingAddress: ................. ................................................................................................... ............................................................. r / ..........................
Onsite Representative: .... a.�%:... 15,.{k................................... Integrator. ....................... l..k.!�L...................................................
Certified Operator: ................................................. ; . ................................ ............................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =•' Longitude 0• =' ="
` .
Design '.= _,'Current - - Design -Current .. Design.. : Curreitt
... -- , ._,.,
.. .,C.Swine Capacity,- Population Poultry Capacity..Po Population Cattle, a aerty Populatioo.,:.
.
_
❑ Wean to Feeder " ❑ Layer I❑Dairy _
...
Weeder to Finish 3600 , ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
-
❑ Farrow to Feeder 10 Other -
❑ Farrow to Finish Total Design Capacity,:;,
❑ Gilts
❑ Boars ' Total Sk.w.
Number of Lagoons �. ❑ Subsurface Drains Pment710 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?
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 ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 3� o
Freeboard (inches): ............................
❑ Yes CQNo
❑ Yes ❑ No
❑ Yes []No
i A/bL,
❑ Yes ❑ No
[]Yes ONO
❑ Yes b�No
❑ Yes )(No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes kNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — ,�7+J Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
s-t8-cTo .
❑ Yes ONO
11. Is there evidence of over application? %❑( Ponding ❑ Nitrogen
12. Crop type .......... .. ...........?_!i')..... J.....!......................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Revicwer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ No Xialattons or. deficiencies .were noted daring llns:vlslt:. Y'ou wtll.reseive no further . .
edrresportdeitce.... t.................... ...................... .
❑ Yes JErNo
es E2-9O
❑ Yes �(No
❑ Yes KXNo
❑ Yes �No
❑ Yes KNo
❑ Yes &No
Z.Yes ❑ No
❑ Yes >14fNo
❑ Yes 5No
❑ Yes E:�No
❑ Yes Wo
❑ Yes CjrNo
❑ Yes jrgNo
❑ Yes ®No
❑ Yes Nt�o
❑ Yes Sj�1Vo
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):, �-
*'r /vwl & /ins 4m"' A �'Jr/i9�gy) fi /Lu u•! l�nw� +tixlwf ��/iu/uv� w
41,.ati. r[ cot-eLs . %j�Ls� • �`k u - /� �.a ��r.•f,/� a s ti (ate
1t//F/41 1-Y[✓bv ±--�� "� en��y.n�f Cxi'tM(%/:1
I 0Ssr��;c tnni van w+t— ill tq �kti uv. 3I] w� A 'L �Oa cAit
a d� ll e G�rc tvr crl- G�- 1 Lc z`/�! o ( } L u (� avVt , ,(c i
Reviewer/Inspector Name -C 1Y i y t 1 uu✓✓ - -
Reviewer/Inspector SignatureDate: 5 % 11/6/99
z

Facility NumbSr, -;1 - 1 Date of Inspection
i
Odor Issbes
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?
❑ Yes [WNo
❑ Yes ro
❑ Yes P0
[]Yes $o
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 WINO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j<No

JJD Initial Evaluation 0 Follow-up Evaluation
Facility Number 3 1 / 7 y'
Denied Access
Does Facility Require a
Date of Evaluation
Time of Evalnation L—J �hr(hh.m�rn)�
❑ Permitted 0 Certified ❑ Registered 0 Non -Registered ❑ Inactive Facili
®Date Last Operated:
Farm Name: County:
Owner Name: Phone No: Facility Contact:
-- Tittie:�G! d� Phone No:
Mailing Address: `— __ N ___ _ l___.__— -----—
Onsite Representative:Q{_/i� / Integrator.
Location of Farm: --
.Swine _
Wean to Feeder
Feeder to Finish
Farrow to Meanz
Farrow to Feede-
0._I rarrow to Ftmsh I 1 14
Boars
Poultry
❑ Cattle
Yml arues oc Jtream tmnxcrs .. .
1. Is any discharge observed from any lagoon? ❑Yes ❑ No
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?
2. Is there evidence of past discharge from any lagoon? ❑ Yes ❑ No
Waste Collection & Treatment
3. Estimate Freeboard Level: ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
Reviewer/Ins ector Name t° yam, LL
p vR m•A orR"x_
02
Reviewer/Inspector Signature: Date:
fLEF
1112/00 1

01/18/2000 12:55 919-715-6048 DWO NON DISCHARGE BR PAGE 03/08
SO Sketch Showing All Active and Inactive Lagoons
n.EF
1/12100 2

--• --- •••- �.� rio-uuro 1JWU NUN UlSCHARGE BR
Inactive Lagoon Field Data Sheet
Facility Number: �- l�� Inactive Lagoon Number: L.J
Latitude F] , FT F "
4. Waste Last Added (mm/yy)
5. Estimate of lagoon surface area (acres)
6. Effective height of embankment (feet)
PAGE 04/08
Longitude . EJ' [LGPS ❑ Map FJ
❑ Owner ❑ Estimated
7. Distance to Blue Line or Intermittent Stream (feet)
❑ Determined From Field Measurement ❑ Map
8. Down Gradient Well
❑ < 250 ❑ 250 - 1000 ❑ > 1000
a. Is there a down gradient well located within 250 feet? ❑ Yes ❑ No
b. Is an intervening stream not located between any part of the lagoon and the nearest well? 10 Yes ❑ No
9. Distance to WS waters or HQW (mi.) < 5 ❑ 5 - 10 ❑ > 10
10. Does the representative know of overtopping from outside waters? JE1 Yes No ❑ Unknown
11. Appearance of Lagoon Liquid
a. Sludge Near Surface ❑
b. Lagoon Liquid Dark, Discolored
c. Lagoon Liquid Clear
12. Embankment Condition
a. Poorly Built, Large Trees, Erosion, Burrows, Slumping, Seepage, Tile Drains, etc. Elb. Construction Specification Unknown But Dam Appears in Good Condition
c. Constructed and Maintained to Current NRCS Standards ®�
13. Outside Drainage Area
a Poorly Maintained Diversions or Large Drainage Area not Addressed in Design ❑
b. Has Drainage Area Which is Addressed in Lagoon Design
c. No Drainage Area or Diversions Well Maintained El
14. Liner Status
a. High Potential for Leaking, No Liner, Sxidy Soil, Rock Outcrops Present, etc.
b. No Liner, Soil Appears to Have Low Permeability 11
Elc. Meets NRCS Liner Requirements
15. Application Equipment and/or Sprayfield Not Available ❑ Yes ' No ❑ Unknown
16. Contact could not be made with on -site representative
❑ Yes g No
ILFDS
1/12/00 1

2vu�
Water Quality Active Lagoon Ranking
Draft
Central Office Criteria
1. Was facility constructed before 1993 NRCS Standards or there is no verification of standard? /d0 (1, i 43
2. Plant Available Nitrogen (PAN) Deficit < 500 n per year or F1, F3 or F4 Wettable Acre Determination
Flags
FI Lack of Acreage resulted in over application in last two years
F3 Obvious field limitations ditches, buffers irregular shape
F4 Application acreage in excess of 75 /o of total acreage C L,9f
3. Lagoon Capacity greater than 1,000,000 cubic feet /V r7
4. Was there a discharge from waste system in last five years? NU
Central Office Criteria available after new verified GIS data is uathered from field GPS Units
5. Distance from Lagoon to Water of the State (WOS) > 300'? y e 5 (7 300')
6. Is lagoon in 100 year flood plain? 00
Field Inspector Criteria
7. Modify Question n4 from current inspection_ add choice box: Is high freeboard due to storm water or
management?
i
8. Modify Question n 5 from current inspection form (take immediate out) and define in form instructions:
Current question: Are there immediate threats to the integrity of any of the structures observed? (trees,
erosion)
9. Add question on effective embankment Height > 10'
2/3/00

is
Groundwater Rating
The following questions will be incorporated into the current inspection form or answered at the
central office.
Rating Questions for Groundwater
YE
N
UNKNOW
1
Has the lagoon/sprayfield been m use for 5 years or more?
S
O
N
2
Is there a water supply well within 250' of the potential
Pollution source (lagoon or sprayfield) with no intervening
groundwater discharge?
3
Is the predominant soil drainage classification well drained
to excessively drained?
4
Are rock outcrops present?
5
Are either of the following true?
• The lagoon was constructed before 1993 NRCS**
standards
• There is no _verification of adherence to the 1993
NRCS standards
6
Have groundwater standards been exceeded at this site
based on existing monitoring records?
7
Was groundwater encountered during construction of any
lagoon?
Depth to Groundwater (feet below land surface)
*Generally unknown, but if this data is available is should be recorded.
**Natural Resources Conservation Service
ZA 5v It)
Responses to the questions will be entered into a computerized version of the scoring table on the
following page to deternflne the rating
n
vr�

13 Division of Sofia, nd Water Conservation Operation Review
--2' RDivision of Soil and Water Conservation Compliance Inspection . , ,.m
,. Division of Water Quality ,--Comphance inspection-,f,-
Other Agency, Operation"Renew . _
µ
Facility Number (��� Date of Inspection
Time of Inspection 24 h
Permitted 0 Certified [Conditionnaally Certified [3 Registered Not O erationa-lf� Date Last Operated:
FarmName: ........... C` 43.(:......RC.%S.e.......rA!Y.,rr........................................................... County: .......AJ>�,f[on ..................................... .......................
OwnerName: .......................E,y `ic,............ ....... FOJ.S.................................................. Phone No: ..... '�I"...J.... J(.s......3ia�.7....................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ......... P.4).....
.�X�..... ..T1.............1................G...'...................................................... HI.6.-Avn.i....NC.................................... .....:UW :......
Onsite Representative: ........... cna `9...' .hC4.Q.1I.... ....E.V 1.1G.......FCt2.5L' i........ Integrator: ....... Cfa.Y.Y.ofi,S..........................................................
Certified Operator: ................................................... ...................................................... ...... Operator Certification Number:
Location of Farm:
Latitude =• =` =11 Longitude =• =' =11
"Design Current _ - .: Design -, Current P: _ Design Current
Swine Poulty I tonCattleCapacity Population Capacity Po ulahou
❑ Wean to Feeder) ❑ Layer ❑Dairy
Feeder to Finish 36t?6 Zcoo❑ Non -Layer ;_„ ❑Non -Dairy
`.: ❑ Farrow to Wean-
>_-'. ❑ Farrow to Feeder ❑ Other _
❑ Farrow to Finish Total Design Capacity
s:❑Gilts, -
❑ Boars Total
Number of Lagoons - ' ._ ❑ Subsurface Drains Present ❑ Lagoon Area I0Spray Field Area
Holdiu Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [f No
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 ® No
c. If discharge is observed, what is the estimated flow in gallmin? - - N/A
d. Does discharge bypass a lagoon system? (If yes,'notify DWQ) ❑ Yes 1� No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P 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): ...........j�
_.i.�..................................................................... ............................................................................................................................ .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �'No
seepage, etc.)
3/23/99 Continued on back

t Facili Number: — 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 [RNo
(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? [7PYes ❑ 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 tA No
Waste Anolication
10.
11.
12.
Are there any buffers that need maintenance/improvement?
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
Crop type YYnt)f IA. M.S SN�e[ a rn:r\
❑ Yes
❑ Yes
4 No
[Z No
13.
Do the receiving crops differ with those desi nated i1i the Certified Anima Waste Management Plan (CAWMP)?
❑ Yes
[ 4No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
P Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
[Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 0 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 ESrNo
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 ;9 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ® No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes [2fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes MNo
0 Ko'*'Watidris:ot- deficiencies •were itofea• during this;Asit; Yoil :witl-receiye .lid fuk&r' -'
: cori•es otidertce:abouEthisvisit:•:':':':':-:':... .
y _ _ - _ ., ,, r„
Commments'-(refer `to question #): Eiplain an`y YES answeiis and/or any recommendations or ani, o er comments
-Use drawings of facility to better explain situations. (use additional pages as necessary)::
-.btu-
..C��or13
T CAnR N/e, 4o V��jj2J&e e
`0-f'taS.._.
013 V\c,j b00% shoo be movtU o4 e�, 6,6s dct r 46,.- 1
yv,>
la- rarrr ��s I E,cti 0fkj SS i for WA o?e,� Ir�c��bn,
Is, &'(M , ir` { Td( A s6ull] 4 tr,l. AA,
n
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Fa6lfty Number: — 1< 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 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 1� 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
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
® Routine O Complaint O Follow-up of DWQ inspection O Follow-up'of DSWC review O Other
Facility Number
�""� Date of Inspection
L Ia�p 5g
3
Time of Inspection Mk= 24 hr. (hh:mm)
D Registered 0Certified 13 Applied for Permit VkPermitted 113 Not Operational I Date Last Operated:
FarmName: ............ —�r�i.t... gw.SE.......... .1TrM�ir.................................................... County:........4\\Ln.............................................................
Owner Name : ................................. L st:Y.L13,........... 1�4.4/SC i............................................. Phone No:.... L.�5'2..?...611-165......................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: .... R.P ..... %s5 .............N�si({'. x\......... tj ...................................� .�.......
Onsite Representative: .......... t.1b........�WnnAs14...................................................... Integrator: ......... CaY. 1115.....................................................
CertifiedOperator................................................................................................................ Operator Certification Number ..........................................
Location of Farm:
Latitude =*=, 0« Longitude =• =' =11
Design Current '=Design ' Current Design Current
$wme Capacity�Popalation Poultryapacity�opulation Cattle Capacity Popula4on
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish G 0' ❑ Non Layer 1 ❑ Non -Dairy
❑ Farrow to Wean _
❑ Farrow to Feeder ❑ Other `:: =•
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
w::
Number of Lagoons / Holding Ponds `� -IS ubsurface Drains Present ❑Lagoon Area IDSpray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
/�
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
1P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
0 No
c. If discharge is observed, what is the estimated flow in gaUmin?
� 1,k
d. Does discharge bypass adagoon system? (If yes, notify DWQ)
❑ Yes
PNo
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
No
n 5. Does any paof the waste management system (other than lagoons/holding ponds) require
,,,rr❑Hr///Yes
ip Yes
/
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
f,No
7/25/97

Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
ONO
Structures (Laeoons.Holdine Ponds. Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ANo
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard(ft)............_3....................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
51 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
(21 No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
(V3 No
(If any of questions 9-12 was answered yes, and the situation poses
an bnmediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markets?
❑ Yes
Ep No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WM1P, or runoff entering waters of the State, notify DWQ)
15.
Crop type ................1f YlYltlAe........................... SMA.V..... C.Y.AiA............... ............................... .......................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
(ANo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
'ONO
18.
Does the receiving crop need improvement?
❑ Yes
%No
19.
Is there a lack of available waste application equipment?
❑ Yes
qNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
(XNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? -
❑ Yes
1P No
22.
Does record keeping need improvement?
rpYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
( No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
a-No.violations-oc
deficiencies. were noted duffing this:visit. You:wil} receive no further
eorrespotidepce about this:visit:: ,
SIQ`� rttof-k 56uli) be d I PUll or � WAI volohjt use3 -6 covw
Sit Z t15ct7 n/ 405t,. MP0;U'-k0n
t_ttr i -4,0016 be atW spTj fit(ic as re(_Omml,tt j �y U so'Il kC4
s. here) Se;u 'tln �IkxV SCS S6L)1 6 cb.&w3 UQ
7/25/97

i
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Follow-on of DSWC review
Date of Inspection o zz t 1
Facility Number 31 1
Time of Inspection 0 24 hr. (hh:mm)
E3 Registered ® Certified 13 Applied for Permit O Permitted JE3 Not Operational I Date Last Operated:
t�
'.\ t
Farm Name: _r..r...�..:...... .`.!..�.ir...... ........................................................
..."f.�............................................... Countv:....b.V.aAi..'.5...............................
C..W.L...;.cv
OumerName: .....................r.^..i.e.............F 9.JS..........................................._ Phone No: ._�.q.!_1 .�..... i�.�1_ .. Z_�l_�?. ...............
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ... p..Q...... &...f......5..3................................................................... twt .��? .d_!\}....L�..C../....... .. .zs.'5_P.e.
t
Onsite Representative: ...-��_ !_' ................................................. Integrator: ...... Co:.:Y�'Y.0s..............................................
Certified Operator................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
.....$..%1..I..o..`... .f.....s.g..�..ro ...waa... ....... ..:..5...._ r.;..lt.t......Se_v..t!t.±�e.s.f.........
................................................................................................................................................... .
Latitude =•=, 0°1 Longitude =• 0' ="
Design - Current -- �Desrgn Current `; Desrgu Current
Swme = Capacity Population' Poultry CapacityvPopulation',,:Cattle Capacity, Population
t. ❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish __ ❑ Non -Layer � ❑ Non -Dairy -
❑ Farrow to Wean `` k
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design Capacity
r -
-.❑Gilts
❑ Boars Total SSLVY_:
Number_' of Lagoons i Holding Ponds,, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
r ,
: ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in I-allmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [9 No
[]Yes [&No
❑ Yes ® No
❑--11^^Yes IN No
►�
❑ Yes ® No
❑ Yes WNo
❑ Yes RNO
El Yes QINo
❑Yes 19No
❑ Yes &No
Continued an back

Facility Number: 3 -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La000ns.tioldine Ponds, Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l
Identifier: ......_4. 1...............
Freeboard (ft)....................................
Structure 2 Structure 3 Structure 4
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 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 --- io Ln :r . . . . cw ..........................ter,:
16. Do the receiving crops differ with those designated in the
❑ Yes XNo
❑ Yes
® No
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
® No
❑ Yes
® No
VYes
❑ No
❑ Yes
KNo
❑ Yes
O No
Waste Management Plan (AWMP)? ❑ Yes KNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violationsor defkienc(es. were noted during this.visit. Yoii 4ilt reeeive ito ftirther .
correspondence about this visit.
❑ Yes i9No
X Yes ❑ No
❑ Yes ERNo
❑ Yes lff No
❑Yes 12No
® Yes ❑ No
❑Yes RNo
❑ Yes 5a No
❑ Yes N No
12- " lowre 0- t-" 0 � (°� 0 0 .•• �^j 0. L l (o y r V-1 �- i- W oLJ k 0 V
It • Wo. er iw DraYi �oclet SFa �d li-e t�l r+--Pr-1t' y va IV
s p P. r i R-& W t.o 1: �d J
zz. T-Va i tF our s` •fiAA - JAt_s t,-a tt up w 1. o-VV-
w tad E-c P La.� . 1 r tw.e w. ,� 0 K NI � ate. 0_K b o i�
1�A c.V;'`'`y e fo CA T Z-o-t- C-- in Gv to .0 1"3 k -U-P t P 1 t v, S ei+ CL
�+tn0.� I �ab(.0 t� �1P.�i� a . d wav rwki in Ftc
�J 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: (A_."wp _ _ t- 141-3- 111. p�.,�..-...._. 0 ri.. Date:

•
CJ
Site Requires Immediate Attention:
Facility NoA 1 l 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERAT 0 S SITE VISITATION RECORD
DATE: 0 Z 9 1995
Time:
Farm Nair.
Mailing A
County: _
Integrator.
On Site Representative:
Physical Address/Location:
Type of Operation: Swine �� Poultry _ Cattle
Design Capacity: Od Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Oz'3,3_" Longitude:_°4'1 5�" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Os or No Actual Freeboard: Ft. __ Inches
Was anyseepage observed=from the lagoon(s)? Yes otY Was any erosion observed? Yes o49
No Is t'ne cover crop adequate? Yesor- No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin. or No
100 Feet from Wells? e or 'o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or to
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?
Yes or6)
Is animal waste discharged into waters oAhe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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:
• Inspector Nadine
cc: Facility Assessment Unit
i
R93
Sign _ttt
Use Attachments if Needed.