310178_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: UCom ' ce Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 'Z Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: u �N I' r ^ • �' S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: C
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Design Current
Capacity Pop.
--7104 4&y&
Wet Poultry
I 11-ayer
]Non -Layer
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r, P,oult ,
Layers
Design
Ca aci
11
Current
P,oIn
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boazs
Pullets
Beef Brood Cow
Other
Other
Turkeys
Tor ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
O Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑NA
gN
❑ NE
❑ Yeso
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - %Sr Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
26
2Q
EKO L❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes E17N=o ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZrNNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ 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
U NN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 [XN/o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 640 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: '3 Date of Inspection: Z / 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA _ _NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes ❑ NoEf 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 ffNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes VT�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other`commefits.
Use drawings of facility to better explain situations (use additional paves as necessarv).
(A., d
L-*5
Reviewer/Inspector Name:
resS
Rc(�6k
wt i%�-
Phone: 7(0 7/ '6 7)oy
Date: Z_Z %l/%
21412015
Reviewer/Inspector Signature:
Page 3 of 3

(Type of Visit: Q�Coo liance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit Routine
Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: 00 Departure Time: DO County: E 4A'-1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 1, f,/- 3t4 r( e4, �,rroS
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: Z�' 7/ r
Certification Number:
Longitude:
Swine
can to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
(-6gli cj=
current
Pop.
Cattle
Dai Cow
Design Current
Capacity Pop.
Wean to Feeder
tP,
I
INon-Layer
IDai
Calf
Feeder to Finish
Farrow to Wean
1)ry P,oultr.
I Layers
Design
Ca �aci +
I
Current
P,o ,
Dai Heifer
D Cow
-
Farrow to Feeder
Farrow to Finish
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Other
01 Other I I
Turkeys
Turkey Poults
Other
111111
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ErNo.
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: 51 - Date of Inspection:
Waste Collection & Treatment �--���
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 41'_10
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ Z 2.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ICJ 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
A -: 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
ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes 0N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes PNN ❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes O Noo
❑ Yes I K
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yeseo
❑ NA ❑ NE
❑ WUP El 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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes no ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No ❑ NA ❑ ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ Date of Inspection: I
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 provide documentation of an actively certified operator in charge?
❑ Yes
a7No ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA ❑ NE
Other Issues
�f
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
I /I No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
f
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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
C 34o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA 1 3 " E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E'No
❑ NA ❑ NE
Comments,(refer to question #):,Explain any YES answers and/or any additional recommendations or any other comments.
rreo'a ,:�:,ff ri}v,fn'h �} ! PY.,r9 A•Ct�9hf,AC r��CP 9ltfitttlA9t .9QPC ACn PPPCCANt
-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: o 71 / J�
Date: t t4
21412015

17
Type of Visit: QCompli ace Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit :.�,_,,r u'tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
it
Date of Visit: I IV /// 5 Arrival Time: ® Departure Time: I O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: // rr Title: Phone:
OnsiteRepresentative: r`�f5�cl/�4� f��t7S Integrator:
Certified Operator: Certification Number: 2 ir 7fy
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
'710Y 6590
D , P,oultr.
Layers
Design
Ca aci.
I
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Other
Other
Turkeys
Turke Points
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 D WR)
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 DW R)
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 Er 'o ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Page I of 3 21412015 Continued

fteili Number: - Date of Inspection:
r
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: IV\P
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
Blto
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen
'to threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
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 ETNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [ErNo
dyes ONo
❑ Yes dNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑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
amfall [:]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 NJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

i
Facility 14 umber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0-Iq-o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
❑ Yes Q.N6 ❑ NA ❑ NE
❑ Yes [ - o
❑ Yes ]�No
[:]Yes No
❑ Yes EjNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ Nc ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Date: 1, f -1 1 5�
Page 3 of 3 214/2015

Type of Visit: B"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: MDI�:] Arrival Time: Departure Time: County: &OL Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: �S( "]Iy
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Desigo Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Di. P,oultr.
Layers
Design
Ga aci
$o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113cef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream IrnDaetS
1. Is any discharge observed from any part of the operation?
❑ Yes ;21'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
VfNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
TfrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
TT
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2�'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes O-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LI-1_ L)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �16— �( I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes AffNo
❑ 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 4No
❑ 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 ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VfNo
❑ 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 n/' No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P�rNo ❑ 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, Z etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil -
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V6No
❑ 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
,,,__0,,,,((((No
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
0"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
VNO
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number:
Date of Inspection: -.'1-1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
)Z No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
&No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
f--' No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�"No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
V�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
[ZNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
J/
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,ZNo
I /I No
7V�
❑ 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 addtional:recommendations or any:other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ,t-Vk" Q01V13 Phone: 2L52 —36L
Reviewer/Inspector Signature: . �,.. Date: ' OY
Page 3 of 3 21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: (J/(u// M Region: W:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine C+apacity Pop.
Wean to Finish
W`et`Poultry
Layer
Design
Capacity
_Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D .+ P,oulh.
Layers
Design
Ga aci
Current
P,o ,
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
101 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
VTNo
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
Page I of 21412011 Continued

Facili Number: 3 - Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
)Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[—]No
❑ NA
❑ NE
Structure I Structure2 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
VNo
❑ NA
❑ NE
waste management or closure plan?
T
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
V] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
7i
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Zr No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 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 XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
t0
17. Does the facility lack adequate acreage for land application?
❑ Yes I .l^No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'P3'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes KNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes if No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I/ I 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 VTNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �Io
❑ NA ❑ NE
the appropriate box(es) below.
r
❑ 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 (U No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ff No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ;;],No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes 0 No
❑ 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?
(refer to question 1/):
gs of facility to better
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YEN answers and/or any addi
situations (use additional paces as
❑ Yes P No ❑ NA ❑ NE
❑ Yes erNo ❑ NA ❑ NE
❑ Yes [;]-No ❑ NA ❑ NE
ons or any other comments.
Phone:
ly
Date:
21412011

I
of Visit: f
in for Visit:
Inspection U Operation
Referral
Other U Denied Access
Date of Visit: / Arrival Time: /y® Departure Time: County: UN/ Region:
Farm Name: ALA/,/ N. PI-JIL/ S at I / .4RSNRLL LLt S �Atl"`
1�H l Q Owner Email:
' 1 Cl16-9410- p
Owner Name: I�(,A%t% )'V _ 201C LIPS Phone: q10- /rq(o-3.SS /W)
Mailing Address: RC)3 W FQ_�)S V J AW/ / C—
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
Certified Operator:
P0I u_I
p S
integrator:
Certific�ah! n umber: ' d6 �')
1A.
1 4j LU
PS
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Wean [o FinishI
Design Curreht
Capacity Pop.
Wet Poultry
11-ayer
Desigp
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
f
Non -La er
I
ai Calf
Feeder [o Finish
Farrow [o Wean
Farrow to Feeder
Farrow to Finish
I) , P,oul.
La ers
Design
Ca aci_
C•urxent
P,o ,
Dairy Heifer
Dry Cow
on-Dauy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
Other
Discharges and 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 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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes
1] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Nu faber: -3 1 - a& Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )t 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:_ M�
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
(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 1�'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes I No
Jll
❑ 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 JA_No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 ❑ Evidencee of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C(L-N T <39
13. Soil Type(s):
5
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes EANo ❑ NA ❑ NE
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes 0
No
Q WUP QChecklists 0 Design E] Maps ❑ Lease Agreements ❑Other: ....//
21. Does record keeping need improvement? If yes, check th❑ ��
e appropriate box below. Yes A N
El Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
o ❑NA ❑NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Nutpber: -3 Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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?
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)
❑NA ❑NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes b6 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �LNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
ONo
❑ NA
❑ NE
No
❑ NA
❑ NE
j No
❑ NA
❑ NE
P&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other. comments
Use drawinj4s of facilltv to better explai ituations (use additional pages as necessary). '
(��►y/ii 3 .� 1. �
1.�
agALvJS )S
/N Q�oa-os
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
`.-oc>,- F �cu �Aa T
Phone:
Date:
21412011

Type of Visit 01 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (&Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:
MDeparture Time: County: 1Al Region:
m FarName: Y r`• 1-111IItLl�sat1' ILXISHAL;�)t1..91 VGXZ(Yl Owner Email:
Owner Name: ')LJW lY•?HILLIPS Phone:(S`S�
1LJ
Mailing Address: � AF-IriZ�S ��I��� >Q(ZSALLI,Iyc OIC69R
Physical Address:
Facitity Contact: Title:
Onsite Representative: ff)A(LsmgLk_ P •)-i) L-L ©S
Certified Operator: M MS414 L.L_ ' l • `�,H l C—U I vr,
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
OperatorCertfZ on Number:
Back-up Certification Number:
Latitude: ° Longitude: °
r
Design upient
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
Wean to Feeder 1"ZP1
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to FinishEl
Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets
❑ Turkeys
El Beef Feeder
❑Beef Brood Co
El Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
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 L]9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes KNo
❑ Yes
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

r�
Facility NumDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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: MP AP
Spillway?: pQ
Designed Freeboard (in):
Observed Freeboard (in):_ b�
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes '4No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes D�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes bb 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 P.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
bNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �&N CA t e -r 71(�
13. Soil type(s) 9,:�u7Ta S (,,c 590eO N OQOGd 1V6gLFO(.r_ 1
J6tyljFAIA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P�,No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
A No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA ❑ NE
Comments (refer to question #): Explain any.YES answers and/o`r any recommgndahons r any other�comments. m�
Use drawings o((acility to better explain situations (use addrhona4pages astnecessary);"_i` ,:
Reviewer/Inspector Name I C)' /wL S `:1 Phone: 11I^0
/"
Reviewer/InspectorSignature: _ Date: yy/�/'6
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0jqo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi gn El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No El NA ❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers //❑ymrual Certification
0 Rainfall ❑ Stocking El Crop Yield ❑ 120 Minute Inspections El Monthly and V Rain Inspections 0 Weather Code
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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
❑ Yes , No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes hNo ❑ NA ❑ NE
❑ Yes ❑ No bNA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`a No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE

I Type of Visit Q511compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit -Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: )) Arrival Time: �/y� Departure Time: County: T Region:
Farm Name: i'�LAN - 1 it I LL I P - °A I I A2-$1ifiLL Y�idICL i$ �Fl (W \
(� Owner Email:
Owner Name:_ /CLAN N � 'i11lLLI 91U 99(0-6435CH
/ 1 2 (��� (� ' . \ Phone: 910-'�ib p3or�5pSCw
Mailing Address: 96 J �Mb5 1�1t-1 tJ�E 76 WAC-SAUI,/VC Qa J /
Physical Address:
Facility Contact: Title:
Onsite Representative:
�/� l0540U -
Certified Operator: t " '(�1 /1 9Q6y AI'(' I ?N) LL 1 S
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Opeerat IrlCertification Number: WPM
Back-up Certification Number:
Latitude: =o =' =" Longitude: =o =, ="
Destgn Current Design '• Current "Destgn Current
Swore Capactty Pop Wet Poultry Capactty •Populahon <Cattle Capactopula[ion
_. A--
❑
Wean to Finish
❑ La er
❑ Dairy Cow
as
Wean to Feeder
)CS
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
�+ � rt;�""" �;r ,�
Dry�P�oul[ry ^o- TM"' ;.;„.�
❑ Dairy Heifer
A,
.
❑Farrow
to Wean
❑ D Cow
N
❑
Farrow to Feeder
on- airy
❑ La ers
-.f
❑ Beef Stocker
-•
El
Farrow to Finish
w
❑Gills
❑Non -La ers
❑ Pullets
� ❑Beef Feeder
❑
Boars
El Turkeys
❑
❑ Beef Brood Co
Other
y s
TurkeyPointsx§
❑ Other
❑Other
Numbof�4trttd'ures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes El No
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

,Facility Number: 3 — �� Date of Inspection 1 JJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: M
Spillway?: pp pp Z1
Designed Freeboard (in): 1 l• 5 1.
Observed Freeboard (in): -5
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.) 41
,_,(
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;p(1 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 ❑ V� \/ No NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 1No ❑ 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 [70 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 1No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
Drift ❑ Application Outside of Area _ , � (�
12. crop type(s) (but , -r6'2S C'�C �S i A C�G�Go / �i3e_Fwc ��Jlt-!� T S Y.�
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
o ❑ NA
❑ NE
Comments (refer to question #)c Explain any YES answers and/or`any recoriimendations or,any otl%er comments
Use: ot,facility to ;better explain situations. (use additionalpages,as necessary):;.- - w r
9�l�flb 3.5 I•�"
(OGa)lo g.3 a3
Reviewer/Inspector Name ' Phone: - 3
Reviewer/Inspector Signature: Date: txD/ 0I
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tttlT��,,Nj(((' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes q(1 No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design 0 Maps ❑ Other )/,.�\,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ill No ��' ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ )4aste Transfers' ❑ A fm ial Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections [11 Monthly and 1" Rain Inspections [3 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'15�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1;kNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
jANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
. /
I�G No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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?
ElYes
4 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
;dNo
❑ 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*0
❑ NA
❑ NE
Additional Comments and/or Drawings:
3ep:jio�v Qu"& �)O)tot
v�powre C'iaop uy)Lz) FolZ-C,>K_-AC)
Page 3 of 3 12128104

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: i N Region:
Farm Name: AjgA1 /f • �)tjl) L -I ps +
ft7ALSHl9LLYjtclEmail:
Owner Name: At_AnPhone:
MailingAddress: (ZwP_Si
IgOLA3 Nl� 3O9SES 3 9S
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =, =„ Longitude: Qo =,
Discharees & Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *No ❑ NA Cl NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ph No ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: ) —14 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: M P 'A l>
Spillway?:
p
Designed Freeboard (in): 19 -45 1 .
Observed Freeboard (in): _ ° l� 101
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 9No ❑ 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
rANo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
[-INE
(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
Iyl No
1'
❑ 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 El Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)\
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) COW i (4D it ep-r <� ,J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Cic
0L-1 C
❑ 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?
SRw C'qx,c51_ED C_41 Ec . Fc)L ol,c G
WW6N '04 c40 001"e5 Qwi Ix 6001_
❑ Yes
r
ewer/Inspec[or Name Phone:
wre:
Date:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 12128/04 C'ontinuea

Facility Number: 3 ) — jq Date of Inspection
Reauired 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 approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑/nnual Certification
E]Rainfall [D Stocking Q Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �% No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JXNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1% No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
%No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V(.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
a�IN o
❑ 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
I�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P-No
❑ NA
❑ NE
Additional. Comments and/or Drawings:' -
Page 3 of 3 12128104
Page 3 of 3 12128104

0 Division of Water Quality V
Facility Number 3 Ui 8 0 Division of Soil and Water Conservation
— -. 0 Other Agency
Type of Visit ®,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit §� Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: P �%IOg Arrival Time: C 'O Departure Time: County: h�tT N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: Mt4e,5H,4t�(_ ?#/GLIpS
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: [� o
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
X[No
❑ NA
❑ NE
❑ Yes
(.No
❑ NA
❑ NE
12128104 Continued

V
Facility Number. Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: fi P AA-P
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[7No
❑ 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 W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5�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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Eq 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName I A,4AAfj31q Ai,,V UL44Nb Phone: J/0-4%9-439_4
Reviewer/Inspector Signature: Date:
Pape 2 of 1 12/281ad Cantinuod

h
Facility Number: l ))A Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
P No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3.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
[KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CqNo ❑ 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
E[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
qNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
q 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
RIo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 11118104

- 0 Division of Water Quality
Facility Number n
Division of Soil and Water Conservation
_ — - - -- -- Other Agency
IType of Visit 95 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: '3 nty:'S
Farm Name: A. /0/ .5 —� Owner Email:
Owner Name: / /��� /�, N=<c�pt Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 94,ce
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
0 ❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
ii
//%J Phone No:
Integrator: (i4Iwee( S
Operator Certification Number:
Back-up Certification Number:
Region: 60i/��
Latitude: = o = ' = « Longitude: = o = , =
Design Current Design Current . Desi
Capacity Population Wet Poultry Capacity Population Cattle Capa
Dry Poultry
❑ Dairy Cow
:J
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ 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?
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures: FTT
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 gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[--]No
❑ Yes
W'No
❑ NA
❑ NE
❑ Yes
z No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — �j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: AI° /7) 1,"-
Spillway?: 1-4 NO
Designed Freeboard (in): A?,
Observed Freeboard (in): 2 J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
%oNo []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
/V1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CyNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 His ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) d oRd" 6/1-/44-r So ,oc rJ
13. Soil type(s) '6,y-r1—ee5 T/2f1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
El NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
nnn�111
El Yes y� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,/pf No
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes A No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as. necessary):
Reviewer/Inspector Name
O,BQ Phone: O --za 2
Reviewer/Inspector Signature:
- Date:
Page 2 of 3 12128104 Continued

Y . a.
Facility Number: Pj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,,,J---[,,,No ❑ NA ❑ NE
M 20. Does the facility fail to have all components of the CAWP readily available? If yes, check El Yes /ICI No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )/ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )2fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No A NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�TNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'�INo
Pr
❑ NA
El 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
,,,___,,,{{{
ICJ 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
ElNA
❑ 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:
/I)a7e : o� Gi Gootr F,o el��nao.
/ Y
Page 3 of 3 12128104

r
00 Division of Water Quality
4 Facility Number _ _ I. _ 8 0 Division of Soil and Water Conservation
0 Other Agency V- 11 I
Type of Visit 95 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 95Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access_
Date of Visit: 60 O Arriv 1 Time: !00 Departure Time* ounty: az Region:'^�I,/(
Farm Name: ZCC n/ G ; ��Z���Owner Email:
Owner Name: AGAA/ Yf/2cczP5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 44 c�� Z L/
A i1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=" Longitude: =°='
Design Current Design - Current
ine Capacity Population Wet Poultry Capacity Population Cattle
Dry Poultry
Pullets
per in Turkey Poults
Other 1r ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes hXNo
LJNo El NA El NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: 400 17
Spillway?: A/O_ AD
Designed Freeboard (in): �q. 5 / r
Observed Freeboard (in):? 33
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 El No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No El NA El NE
El Yes XNo ❑ 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 ,I/J(1No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes `I(J 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 ElNA ElNE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes EfNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r���//tNo El NA [I NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes y� No ElNA ❑ NE
11
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes (P� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes l No ❑ NA [INE
18. Is there a lack of properly operating waste application equipment? ❑Yes ZNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/ LG 92lJ G�iz t Gt/�5 l✓OFO r+ Zf>O$ lzL o n,P/cz }i✓cE S.oEc��o
Yoe 7.aos, 50=�a� 7doT �sJcrc Four T�rS yisA.P S6t., /� /�.4rE
2V-t Z�) 6'11zGG I t-40 75- 4�511 zoo s,
Reviewer/Inspector Name 1 I Phone: i/0-7% —'7uo4 I
Reviewer/inspector Signature: /— Date: iL �o�i�b
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
x/p�(/ pa"'41m6&/
❑ Yes gNo
❑ NA
❑ NE
[:]Yes ❑ No
8 NA
❑ NE
❑ Yes ;ZNo
❑ NA
❑ NE
❑ Yes J'No
❑ NA
❑ NE
❑ Yes oNO
❑ NA
❑ NE
❑ Yes ❑ No ONA ❑ NE
❑ Yes
Iq No
[INA
El NE
❑ Yes
)zNo
❑ NA
ElNE
ElYes
XNo
❑ NA
❑ NE
❑ Yes
?No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes (ZNo ❑ NA ❑ NE
Page 3 of 3 12128104

(Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit OrRoutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: I q
Farm Name:
Owner Name: _
Mailing Address:
Physical Address
Departure Time:
Facility Contact: . / Title:
Onsite Representative: � /Y'Z/�G�s
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current.
Swine Capacity Population
Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Region:
Phone:
.. Phone No!
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: D u 0, LALongitude: L—] o L__A' 0
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,;Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R�No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Condnued

Facility Number, — Date of Inspection k5/
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?
StrAicture 1 Structure 2 Structure 3 Structure 4
Identifier: —i4� /7) IAO
Spillway?: No NO
Designed Freeboard (in): /�
Observed Freeboard (in): 2 47 Z
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 VNo
❑ Yes ❑ No
Structure 5
❑NA ❑NE
El NA ❑NE
Structure 6
❑ Yes Z No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JO 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? �5
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce table Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Croptype(s) �-512 S
13.
Q_
Soil type(s) 4 .'neO
14.
Do the receiving crops differ from those designated in the CAWMP?
l;.J Yes
J0No
❑ 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,
[I Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Pj No
❑ NA
❑ NE
'3)\C'oRy�//-1/Fo x1��� iu�F�o�s�to � �o/�� �`20•�
ZD
�(ZGT
Reviewer/Inspector Name _ �F ' ;#.,,�„ p_. Phone: ,,3F5—,5
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: '� — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No El NA El NE
the appropriate box. ElWUP ❑ Checklists El 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
J0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? -
❑ Yes
L No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
'0
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
rY
t,o No
/�
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
No
❑ NA
El 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
gNo
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
El 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
,T
No
f
❑ NA
❑ NE
Additional Comments and/or Drawings: _
, :•,
s
OR
a2o� ` �O �,✓
s
/�'L; ��//`/1�tL! /-"1�i+�- G5 Gt/f� /y1,9��✓'i5Lzi✓E/J
12128104

Type of Visit Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit dRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: D y�
O Not Operational O Below Threshold
Permitted Certified 0 Condittlonaily Certified 0 Registered Date Last Operated or Above Threshold
1Q n NI
Farm Name: _...__Tll.�il !_-_I tT+! 5���.......1�!RNA...PIc%CTf County: ... .._._
Owner Name:
Mading Address:
Phone No:
Facility Contact: .._....... ..................................... Title: ... ..... ..... ...... .—..-----------._.... Phone No:
Onsite Representative:.._._.L11itJ.a-�:17jY....�4{.U.,.t._._._._._.___.. Integrator:
R LL �' S.. ......._....----...___._..
Certified Operator: .................... . . . ..........................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =I- Longitude =• =' =11
Design Current Design
'Cnrrent� Desrgn Cprrent
K
-Ca act ,;Po uhition Poultry __.. _Ca
-an _ P,o Mahon ';Cattle =-= -Ca aci , : Po nlahon ,,
ean to Feeder
ZOO ❑Layers
❑ Dairy
Feeder to Finish
❑Non -Layer
❑ Non -Dairy
Farrow to Wean
Other
-
Farrow to Feeder
c -
-
z
_ Total Design Capacity :.
JIN
Farrow to Finish
Gilts
fx
_o ^.
r Total SSLW ''
Boars
-- , w-
4.
Number of Lagoons
2
=
ti
Discharges & Stream Impacts /
1. Is any discharge observed from any part of the operation? ❑ Yes trrd,V`o
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 B '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 ONo
S�j j cntur 1 /�'tr�uc(ttu�r Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._...!11AL._............ !rn!t�✓... .__...... .............. ....... _._.............................. ........_..............._._..... ....................... ........ _
Freeboard (inches): y?i
12112103 Continued

Facility Number ` ' — : 8 Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes7No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ YesT�10
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[ <O
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type Sa✓ ih� 6CVL*J W146A
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o /
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
L— oo /
b) Does the facility need a wettable acre determination?
❑ Yes
Yes
�o
c) This facility is pended for a wettable acre determination?
❑
❑'No
15.
Does the receiving crop need improvement?
❑ Yes
:�01_
16.
Is there a lack of adequate waste application equipment?
❑ Yes
o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
Io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ONo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[�No
Air Quality representative immediately.
:comments (i�er to question #) Ezphun any;YFS`answe�s and/or any recommendations;oreny other comments _
_ r�
Use drawn of to gs facdtty; - better explain stbuahops (pse addttional,pages as necessary)�t ❑Field Copy ❑ Fina! Notes tC
Reviewer/Inspector Name ' �_' '� �� ��-,.� '�
___�� „g �< _ s� :,2��. -->♦;K �.. _=�
Reviewer/Inspector Signature: 60. Date: 6
12112103 1 V Confirmed

Facility Number: — 17K Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes L—XINo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes o
23. Does record keeping need improvement? If yes, check the appropriate box below. ElYes �hlo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes BNo�
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [3'Aio
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Now
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [a No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall []Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

j
IType of Visit Y Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Z Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted (p-,rtifi-1ed �/C/�/f ditionally CertiPfied/yp/ 0 Registeredd
Farm Name: /��CIL". hp/ // UzgJ tY ///i�}lS/�/.)'Y 1/
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: d7je1-6i�G�.J
Certified Operator:
Location of Farm:
Time:
Phone No:
t
Integrator. 4e&L S
Operator Certification Number:
36 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F1' 0` = u Longitude Oo =` = u
Farrow to Feeder
ttiotam¢1Y.onasUlsouaiFraps)®I I 1LJ No Liquid Waste Management System®'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;JNo
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 r❑ No
yJ
2. Is there evidence of past discharge from any part of the operation? ❑ Yes rrr���No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes t�l No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure 1 S cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Akv
Freeboard (inches): Z
05103101
Continued

Facility Number: —
Date of Inspection Zli O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence Aover application ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload
12. Crop type CoRed. l�ff/.1Y"/. �dVAeA-r✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reunited Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Tl4 ,1�/1/No
❑ Yes No
❑ Yes 1 No
ElYes No
El ❑ Yes I Q(No
❑ Yes 0No
❑ Yes VNo
❑ Yes KNo
o
ElYes
❑ Yes 0,,..,(No
El Yes No
❑ Yes V(No
❑ Yes U No
❑ Yes )ZfNo
❑ Yes ONo
❑ Yes W(No
❑ Yes No
❑ Yes 91No
❑ Yes �[J,No
El Yes (��] No
❑ Yes )ZINo
❑ Yes �dNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r to question ti) Explain anv YES answers^and/or an iecommend'ations or=an othercbmments .. at"
Oilv. s.,�r;. m : .a .r .,_ ..
. fr. iat ' y ._..... y e drawttigsof facil9ty to better ezpam srtuahoos
,additronal pag�,as�necessa?ry). Field Copy ❑Final Notes�.v4;p"
µ(use
/8 GfFG�n/ 65�i(% Dig A/2 6fi1f}-LL Ff}/ln'1 GdC� ��.
(/��\ Lt%iT7��L�C/1F5 �E7Fl�/Y►ait�/j �Zo.v Oi>1 PGFl�/7�,
7v��/�,yFL
-NFfb ,O
Reviewer/Inspector Name I
Reviewer/Inspector Signature: Date:
O5103101 1 - 1 Continued

Facility Number: — Date of ❑vspection I Z/LU/071 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
���///
IJNo
liquid level of lagoon or storage pond with no agitation?
/
27.
Are there any dead animals not disposed of properly within 24 hours? -
❑ Yes
�"o
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?
El 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
A. No
A.
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
5100

Facility Number Dale of Visit- Time:
...,,,......,,,/// 0 Not Operational Q Below Thresho
p( Permitted E3 Certified �[3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: ..
/Fa`rmName:..1..1.`:'.::..1���"T`.`...._)..l'V�\.......................................... County:..._ tva �L .....................................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ...................................................................................................................
Onsite Representative:..k \G. [ h�................................................ Integrator: ....�� r................................ ..............................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =_ =11 Longitude =• =1 =I -
Swine '
Current
PnnulaGon Paull
Wean t
r7 I Q
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Cattle
❑ Other
Total Design Capacity -C
Total SSLW C
Number of -Lagoons 7 Subsurface Drains Present ��❑ Lagoon Area J❑ 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 yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struc/tture I Structure.
truct re.2 Structure 3 Structure 4 Structure 5
Identifier: ................l:T... l`O\.................................................................................
Fre eboard (inches):
5/00
❑ Yes )4No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes gNo
❑ Yes ONO
Structure 6
Continued on back

,1
Facility Number: 3 —,r%g
Date of Inspection Printed on: 10/26/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�(No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
h
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
t No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
[]Yes
ONo
11.
Is there evidence of over ap1plication? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
❑ Yes
�No
d
f
12.
Crop type �✓� 4
QA SG b�Cc'j_
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
D�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
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XYes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
lor Yes
NQfZZ
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
• kNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ff No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes NJ No
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 �' o
BVti dyiolatitii...... cie ..were noted .... 9 this;viS. t. You ....... a ..further; ; ;
::comes orience: about his visit :. .... ::::::::::: :
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments ;-
Use drawings of facility to better expUn situations.. (use additional pages as necessary): I �`" " � �
`) RP co w v,, ca�� he�a c b�� sl � S 4+ s ' T�� G� n 4 1 I J
Uk,
See_ cov���s a�
loco"U'> V Pt-
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( � '�_' ��- Date: LI-- t-`j-0 ( 5100

1
I Fac1lity Number: — Date of Inspection Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[]Yes
XNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�fNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4NO
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
eo 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
0
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
KNo
Additional Comments and/orD rawtngs:.- _ ...
�.°\> S�� CGS- +p� �h►� 5„ �3e S es . I �JOW s-e
v-
5100

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC ieview 0 Other
Facility Number i Date of Inspection
Time of Inspection : 3D 24 hr. (hh:mm)
Permitted Certified 17 Conditionally Certified [3 Registered Not O erational Date Last Operated: .............
Farm Name: ...... ............. ...�..... ...P.C.._:t....l.!/f..... County:.............�...�j�,f�.L�/L--................4f%,.:............
OwnerName: . ... ............ ...... ...........Y...�L��.. ....�.........................
Phone No:.......................................................................................
FacilityContact: ....% .... ................ !....... . _ l e: K....................................... Phone No:...................................................
MailingAddress: ................................................................................................................................. ................ ..........................
Onsite Representative• ............`.�..'.�Alf �Cl..`l..`.'..:5............................. Integrator:................/..%!.............................................
............... .
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
..........................................................................................................................................................................................................................................................................
Latitude =• =' =11 Longitude =• =' =°
.Design,,. ,Current'
Swine 'Cauacity ^ Population
can to Feeder
❑ eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current` Design' Current, .
Poultry Capacity Po ulation Cattle- Capacity -Po-ulation -
❑ Layer I ❑Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
,Holding Ponds /Solid Traps . ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? v
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 �IVo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,y�
N1 �..� ................�r•
Freeboard (inches): ....__.....�..
y ' T
.................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.) /
3/23/99 Continued on back

Facility+ umDate of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
*,No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
90
�
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
(dNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
11.
Is there evidence over application? ❑ Excessive Pending ❑ PAN
❑ Yes
��K///No
)p No
/\
12.
Crop type G/{/�S -7;
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JXJNo
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
19f,No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
KYes
❑ 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.) -
9( Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
''KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNO
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;(No
.
. i. . . . . . Qtls,ol'• . e . . e_[ICiCS N'< CC IIQiC(•t (JISH;lIIg {�IIS, VIS1t. ,Y,OI. . . . l'e. . . . i. . iU!'i.
:-comes
ondence:about:thisvisif'•:•:•:•:•:•:•:.:.:::::::::::::::::::::::::: :
Comments (refer to -question #)iExplain any YES answers and/gcany 'recorhmendafiods 6r atiyother comments - L
Use drawings of fa.cility-to better. explain situations (use additional pages-as;necessary).*_
>� r3 l'e re
/facts /r., Se. r,7 r s
/ //e nG �i .. _ n..!/ / '-� i wii/ ✓MAA,(" n A ti ,A1/V,J'✓n 11Y14 _—
Reviewer/Inspector Name
Reviewer/Inspector Signatures----- Date:

- acilit� Nu 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
,,.,/
tb 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
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
t� O
PO
roads,
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
)flo
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
YNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
1N0
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ONO
'Addrkronal dents and/or Drawings: ,
3/23/99

+ - r 0 Division of Soil. and Water Consergation -Operation Review
0 Division of Soil and Water Conservation Compliance Inspectimn = +
' [vision of Water: Quality _Comphance Inspection
therAgency-.OperatiowM "ewe..`._
Routine O Com taint
O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
(
Date of Inspection
Time of Inspection : 00 24 hr. (hh:mm)
E3 Permitted 0 Certified
Q C{onditiol naliv Certified 0 Reg—istered
No[ O ¢rational Date Last Operated: ..........................
Farm Name: ........?.. v....._a........1".f.lAX
of
County:......... ��\�L9r�f�.......753G
....................................
Owner Name: ............I: CI--.._�_�!iA�:�.h.Pl.�.............I:.YLi.J.1.t:�$
�.�1.........*T.(Y.Lr.S..T.�.S.......1�(tYt'a..-......
..............................
. Phone No: .... .1•.�!�oJw':.9.�i.�...4��..�5...............................t....
Facility Contact: .......................................'..1.................................
Title:................................................................
Vitt - 3a5sr Ali- PL&-6
Phone No: .4::Y 0-7-.iQ...'..f 1IL.....t!? iJ, M W6
MailingAddress: ..... 1.0-&..._W.at
..... J.QJ.,:K.......
Rrl�3t..... W...........................
...... wousw-1..... EI.......................................... ..X.93..91
OnsiteRepresentative: ...........................................................................................................
t
Integrator: ...... C.P..Y.y0..1t.5........................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
Latitude =a=1 =11 Longitude =• =' =11
Design Current. " =:- 'Design Current '_ Design Current
Swine _ Capacity Population Poultry Capacity Population Cattle Capacity Population_
Wean to Feeder f ❑ Layer ❑ Dairy
❑ Feeder to Finish Q Non -Layer I -Dairy
❑ Farrow to Wean - -
' ❑ Farrow to Feeder ., ❑Other _
❑ Farrow to Finish Total Design' Capacity
[j Gilts -
❑Boars Total SSLW
`Number of Lagoons - F --- z-----] JE1 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area -
Holding Ponds / Solid Traps F JE1 No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PNo
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 [UNo
c. If discharge is observed, what is the estimated flow in gaUmin? PlAr
Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [P No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [)f No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1� No
Structure I Structure 2 Structure 3 Structure 4 - Structure 5 Structure 6
Identifier: M A
Freeboard(inches): ..........4.`I................................. 9..!............ ................... ................. ................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 — % Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? El�-t Yes Y 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 52 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes R No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Aaulication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
OM No
11.
Is there evidence of over ap lication? ❑ Excessive Pending ❑ PAN
El Yes
[9 No
12.
Crop type p�y� wL
a
13.
Do the receiving crops di fer with dr1se designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
$3 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
(B No
b) Does the facility need a wettable acre determination?
❑ Yes
P No
c) This facility is pended for a wettable acre determination?
❑ Yes
ER No
15.
Does the receiving crop need improvement?
❑ Yes
[RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ja No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General 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
[R No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
.® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
W No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
allo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
OpNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JO No
V ' W,V] �aiioxis,ot. aeticle,ntiCS -*' ria R6te(�. fi&ih 4bis,vlslt.. Yob Wli�.tebd*0 il6 tutu[@C : , : , I
correspondeht e.about: this visit. -.
Comments (refer to question #): Explain any YES answers mid/or any recommendations or-any`other comments.
Use drawings of facility to:better explain situations. (use additional pages as:nee essary)a'-
k A �P I aF Yvj- Qo,Gcr+ (,'caiTo.� lagoon deli s sko,;IV Ue- i,, Airp— V'tcordr. `
& BnAN for (-ofv. labeh,) or- 41A_ IR{l-Z 6rS-
Av, vPhQ wo.sk o vtmtl�s<< s4o13 6 it. accv-k.
P„1\
51�
Reviewer/Inspector Name }
Reviewer/Inspector Signature -� A..
Date:
3/23/99

IFE01ity Number: Date of Inspection-L
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
W 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
kii No
roads, building structure, and/or public property)
T
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[p No
30.
Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
N9 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 CM No
3/23/99

Division of Soil and Water Conservation E3 Other Agency d-
IlDivision of Water Quality
1p,.Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 31 Date of Inspection
I Time of Inspection EiEn 24 hr. (hh:mm)
E3 Registered 79 Certified 0 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
Farm Name: ....... Mwi..... 4:....
A0nhhi� .... ...... �41f6a.... Alil o$.... Jr County: ......... �L0r.r.............................................................
Owner Name: ...... �W ....d ..L AdSyw.I�.........t..11�aS......................................... .Phone No:......L�.I.Q� 1-` k...R.Os.......
.....................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ...........:.1qqn...... ... 5.....lilyj[....... M.r...................... ............. wOYSfatJ.�... N�........................................ ?.s.`I.g...........
OnsiteRe Representative: ......�h.va.o�S..................................................... p...�.�..`.��......t................................................... Inlegrator:............��r
Certified Operator:..................._��A,t?.....�.-.........tkllifxs.............................. Operator Certification Number:..._1 j.� .....................
Location of Farm:
Latitude ®•©'FqE7j,, Longitude ®• 01 ' ©"
Design Current
DesignCurrent
Design ,Current „
: swine -
Capacity Population . Poultry
Capacity Population Cattle _
Capacity Population .-
Wean to Feeder
o4 ¢ ❑ Layer 1
10 Dairy
❑ Feeder to Finish
I0 Non -Layer I
JLJ Non -Dairy
❑ Farrow to Wean--
'• ❑ Farrow to Feeder
.° ❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
",Total SSLW
- 2.t3 120
Number of Lagoons l Holding Ponds,
Subsurface Drains Present
❑ Lagoon Area
JEO Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
I3 No
2. Is any discharge observed from any part of the operation?
❑ Yes
tp No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
�l No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated Flow in gallmin?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ)
❑ Yes
1p No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Yes
El Yes
tEP,
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
lA No
7/25/97

- Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... N1'............. .... ........... Im................ .................................... ................................... .......................
Freeboard(ft):....................................................�.((..._ %i .................................................................................................................
Y
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 ......... cprv, .......... ............ ....................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
p No.violations or deficiencies. wen noted during this -visit. You. -Will receive no further .
correspondence about this:visit:
❑ Yes No
❑ Yes No
Structure 6
❑ Yes ® No
❑ Yes lH No
® Yes ❑ No
❑ Yes N No
❑ Yes 1M No
❑ Yes MNo
❑ Yes ® No
❑ Yes 8 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes [A No
❑ Yes 91 No
❑ Yes P No
W) l�tl��be s�0 (16 0e Jd � o� eVVQ �,uz lO.LQ1ILJ . ad -
o � IajanS ' NAP lwjnor Siwu(0 (� ,ovt
t)�%Y PLC, 1,o.11 o`f Mp (AjXv+ Sl'\; �- v�awed,
ZfZ.''�\v� ctv�i�ital�cti SkoA loe.A ii- tv M(01 s, f(V\-, 1corrtLt� P(k`11V I-r-o�c IslmA`, bet
-l(N�U-t) o� `WW1-1 S�l �',� `1ritUYoS. F'c���1+l,r0.�a�� �c•.l'c S``\\tt� h)vU-o`1 SlnoJt(1 �l�- Q7aifnr.�'W, (-Y
S i i'�el(�) I F s6A �- 177 �4. it. WO.
J \ 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: f / X )- Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
Q Division of Water Quality
ZDateInspection bo • 0 1ity Number Inspection 24 hr. (hh:min)
0 Registered ELCertified ❑ Applied for Permit E3 Permitted 10 Not Operational I Date Last Operated: ..........................
4Av IL'�a1 I &
Farm Name; A..C.1,ex..... A.1.... ........................... Countv:2^a � ......j �
II \\ l—
M )-• F;Ii i 6 PhuneN'o:...9uto....)..Z`.�.....W
..........................Owner Name: ......... %l.ar�.....i........ ...... .'h11i4S.............................................
Facility Contact:. ..... .. Tif�e``............................................................... Phone No:.....................................
�-d ",Phone
Zs �§..�.
g0��...�....6Jw�-d-i ��vi e. _ C�
Mailing Address:..`. �a.S......ucrd6........r...i..4,..P�J }-ov4.c.e.s.v.. !�.g.t....!v-C%.............. .ZB3 ...�
Ons{te Representative:.Ai.tl,Y�......r..... ._.... t..S............................................... Integrator:...CA r.YA..��..5.......................Cf....��.jj.........//..��.............
Certified Operator:............................................................................................................ Operator Certification Number:......1..`._4.. .0............
Location of Farm:
..Q.n....�.r,..L.1�...S.i.�......p........�.. ...l..e�..�l. p.1...�...Q��..lp..,.. ..X'E..X'x.Y.a:.._a:........... .......1_-._��..._?�^...........ta4..r...�:LeE............. �
......sS_tad_..1...._............................................................................................................_`.........................
Latitude =• =` =" Longitude =• =' ="
Design�—� Current
"'", :' ''Design-� .� urrent Design Current
Swute y
Capacity Populatgon
PoultryCapacity"'Popolatton T, 'Cattle Capacity Population r.
e Wean to Feeder
_.SZ'
❑ Layer
�_,
❑Dairy=_
V - ❑ Feeder to Finish
:'
❑ Non -Layer
I
❑ Non -Dairy
`': ❑ Farrow to Wean,'
c
+,
❑ Farrow to Feeder
❑ Other I I
° Total Design Capacity,= 7��YZ
❑ Farrow to Finish
'`❑Gilts
Total SSLW
10'Boars
z •,
-�,:� 3 o
Number of L oons / Holdin !Ponds'Subsurface
a$ g
©
Drains Present ❑Lagoon Area HSpray Feld Areal"
m
❑ 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 eat/min?
it. 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
W No
❑ Yes
®No
❑ Yes
I@ No
❑ Yes
19 No
I-
❑ Yes
KNo
❑ Yes
gNo
❑ Yes
S No
❑ Yes
19 No
❑ Yes
1g No
❑ Yes
VNo
Continued on back

Facility Number: 31 — 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Laeoons.Holdini! Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
®No
• Structure 1 Structure _ Structure 3 Structure 4
Structure 5 Structure
6
Identifier: & ..1......................1..............................................................................................
. .....................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
[RNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
B No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
allo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
&jNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .Sar{.h R ..... - .....G o c:.a ............ ;. 1.h..._±............................................................................................................................................
16. Do the receiving drops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes IMNo
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 reviewlmspection 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?
No.violations or deficiencies: were noted during this:visit..Y.ou.wil} receive no further..
• : correspondence ab:oitt fhis:visit:::: ' : ' :::' :::::::::::: ' :::::::: :
❑ Yes KNo
C9Yes [I No
❑ Yes BNo
❑ Yes ® No
❑Yes PgNo
I@ Yes ❑ No
❑ Yes 14No
❑ Yes 10 No
t2-Re.rs�bt4O2L­a-i"ot wo-lI 42• AUo, o
wa.0 4 1 Pq)00,
18, I/�} E + 4L G N G Y�!-t�i'-+ v t �v v� •I.3.LV' 1 S-Q-Cn Lt v� �'�t-'f. O-Nr'S S 0 I A4- C-" p
L2:4Aa.CAtu.P— 6 C..ea.4�o;I ta.v`a.-Gyi�t w:H- mot! c.evx4-t. A-tio, rut �1tU* J7.�
i,n tv w u.s p CC.-.n_ la.e.�-o •r-� > D 1p �,..) t w'a t L he.,re. C o ti.v-. iY.. �..o- s .�. r
pv,.,...r d yeE tt s �;c4lJ+.
Reviewer/Inspector Name
7/25/97
Reviewer/Inspector Signature:
Dale:

U
Site Requires Immediate Attention: k*,�
Facility No. 31 -1 CIO
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE vISITATION RECORD
• DATE. f/ 2 R 1995
Time:
Farm
IwTMK
County:
Integrator. C (S — Phone: (2/0)
On Site Representative: Phone:
Physical Address/Location: S/L 1 s� �� I �00 — Z �. ccQ �-
Type of Operation: Swine Poultry _ Cattle
Design Capacity: '� S' S d Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latimde:S ' 00 Longitude: jj�_' Of ' -LL_" 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) Ye or No Actual Freeboard:`"4_17t. Inches
. Was any seepage observed from the lagoon(s)? Yes or(o Was any erosion observed? Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o I6 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: ri 0 d� .
.n
• �' t%Azo
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
Site Requires Immediate Attention: Yl Q
Facility No. 3 1 — 1�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. i5ld '6 1995
Time: I -) `f
Farm Name/Owner: a0_4_X � � ; 1 if S o-rr, f 3 (�i L",_,M -0•�
Mailing Address: LP-43- E�A
County:
Integrator. tcAt^ol
On Site Representative:
Physical Address/Location:
Phone:(_d9Ce-0�171_ Chl�
Phone:
Type of Operation: Swine Poultry _ Cattle
Design Capacity: S S Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° S9 ' Y• Longitude: `b° I:b 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) Gs or No Actual FreeboardV 3 Fc Inches
Was any seepage observed from the lagoon(s)? Yes or t o Was any erosion observed? Yes or 'o
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with cover crop)? Yes or No
• Q(��
Inspector Name
�6 AIM_
Signa e
cc: Facility Assessment Unit Use Attachments if Needed.