310189_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

-rz-«
(Type of Visit: )f Corn ' nee Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j,2 1/ -/ 7 Arrival Time: Departure Time: County: Region:
Farm 7 tC Name: " e W q 12 y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Ct(927 e I iG/hgley Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
[Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
QD tl
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oultry
Layers
Design
Ga aci +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCowv
Other
Other
—TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes VNoo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesNA ❑ NE
of the State other than from a discharge?
Page 1 of 21412015 Continued

acili Number: - Date of Ins ection: - 1 / —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I( C9 tr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Aorilication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ 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 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 Approved Area
12. Crop Type(s)/) i l�2 i r 1 StnolrAc.t
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WN ❑ 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
EErNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EN ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr/ns
❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspecti❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [—]No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacilfty Number
Date of Inspection: fa. —XI —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
ZooNo 'NA ❑ NE
❑NE
❑ 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 o A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o ❑ N, ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
[—]Yes ❑ No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain: situations (use additional pages as necessary).
5�h 45P Sur✓Q y the coir4w, 104
44j -;yrz. '�O,iue—
Ci4-1,y G, -20t 2
Reviewer/Inspector Name:
Phone: i l p 7 L/ Y Z'no
Reviewer/InspectorSignature: 86. �G l&lelf Date:
Page 3 of 3 21412015

>4 • Uivn of Water Resources
Nacility Number - i I J ' I 0 Division of Soil and Water Conservation
�—�—� 0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 'I 732 /
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
ILayer
IDai
Cow
Wea oFeeder
Non -La er
Dai Calf
der to Finish
-1400 41so
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Ca tacit
$o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
—TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes g5t ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural`freeboard?
❑ Yes
[�] NA ❑ NE
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1� r-S . S
Observed Freeboard (in): ( 20
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes f n N ❑ 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 �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes _E3'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes El 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 �Io ❑ 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
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ef No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ i<lo ❑ 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 N ❑ 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

LFacUity. Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2<o �❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NE
❑ NE
❑ Yes
0-1qo`_ ❑ NA
❑ NE
❑ Yes
❑ No D<A ❑ NE
❑ Yes
ETNo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑
I _f'V Yes o ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
NA ❑ NE
NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
e_�r I Ct.,j
6�C-0lu.t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�, F, -50' j
LI c!C%t_� /
Phone: I 10 %q 6 7-50
Date: / 21p/
21412015

Type of Visit: el Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Fla i v\
Farm Name: 1/Y " Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Region: WAL
Certified Operator: AAVvY-D fly '�' W �r .Q�/ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Pouacity
ltry
]Layer
Non -La er
D
Capesign
Gurrept
Pop.
Design Brent
Cattle Capacity p.
Po
Da' Cow
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. r P.oultr.
Layers
Design
Ca aci
Current
P,o
DairyHeifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Qther
01 Other
Turkeys
TurkeyPouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. Wha~t istheestimated 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 YI No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[:]No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection: r}-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I /I No
YY��
❑ 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
VrNo
❑ 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
0, No
❑ NA
❑ NE
g. 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
Pn 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
����{{{{
A 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
R�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VjNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: I Date of Inspection: -�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JV'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VTNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � 6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No ❑ NA ❑ NE
Other Issues -
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I�Ji No ❑ NA ❑ NE
and report mortality rates that were higher than normal? j z
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes eNo ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 00 No ❑ NA ❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
m No
❑ NA
❑ NE
❑ Yes
I��—`1 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: a5',2- U1-Q5a
Date: 16- lrl-13
Page 3 of 3 " 21412011

Date of Visit: I j Arrival Time: Departure Time:F / ZR377 County: U/V Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: �Ca f,t Lr 1V, N\��-�� Inte��((ggy�rraat��ttor:
Certified Operator: 1,,� Nv\ {.... V�JIiA�� CerTilicatiofonNumber:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design -
Capacity
C^urrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
LI�
Da Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr.
Layers
Design
Ca aci
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
101 Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I Tl No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes &No
No
Yes
Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: .—S - Date of Inspection: )3
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: oQ
Spillway?: pp
Designed Freeboard (in): )9.5
Observed Freeboard (in): z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes i No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes YLNo ❑ 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 1No ❑ 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/ Q ❑�E+viidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S G 1�4i� �T� Cow WHLP I Q_2>
13. Soil Type(s): IVO(Urb(AC.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
\W
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
1A No
❑ NA
❑ NE
the appropriate box.
]WUP ❑Checklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �q No ❑ NA ❑ NE
Q Waste Application 0 Weekly Freeboard❑ Waste Analysis ❑� Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall ❑ Stocking a❑ Crop Yield❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -? ) - / Date of Inspection: i % //
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 to provide documentation of an actively certified operator in charge? ❑ Yes �[ I No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,j`7qjNo
Other Issues p,�.�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I N No
and report mortality rates that were higher than normal? t `
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No
❑ Yes 1P No
❑ Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O_No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c(_1L,3V_a-r1dN aGiy
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

(Type bf Visit: A Compliance Inspection U Operation Review C.J Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ] Arrival Time: I Y�1 Departure Time: County: g/V
Farm Name: rI.J�CEiVE LA 4LEy J7-PRAl Owner Email:
Owner Name: �uEI&VE LA__')NACEL Phone: 9Jp-aC1g--SSCO�-1
Mailing Address:
Physical Address:
1 LLAE
Facility Contact: Title: Phone:
OnsiteRepresentative: �U.EiENE �l-}F}L�u InteQ�(ra�J[or:
Certified Operator: MLt 2pit lE , J� HA LEr Cert- ificati'n Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design C•unrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr+Dr+ P,oultrt!a
_a_ci�P,oaci�P,o
,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Puuets
Other
Other
Discharges and Stream Impact
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes I❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: L jDate of Inspection:
Waste Collection & Treatment y[
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
r T
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _I CQ
Spillway?:
Designed Freeboard (in): 1`7. S Q�
Observed Freeboard (in): 9L-4-
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes tkNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) y[
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes I ]�l No ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes O'No ❑ NA ❑ NE
maintenance or improvement? 7777`""'"''����
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 KNo
❑ 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 AcceptableC ❑ Evidence of WindDrift 0 Application\
Crop Window
Outside of Approved Area
/ '
12. Crop Type(s): Q7[�It
S
13.SoilType(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 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes t�No
❑ NA ❑ NE
❑
Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis
0 Waste Transfers
❑ Weather Code
❑
Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
Q Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
[—]Yes [N No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes N No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No DNA ❑ NE
25. Is the facility out of compliance with permit conditions relate&to sludge? If yes, check Yes No ❑ NA ❑ NE
th&a' ppropriate 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
[ANo
D NA
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
No
X NA
D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
No
0 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
D NA
NE
If yes, contact a regional Air Quality representative immediately.
TTTCCC
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No
NA
D NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
No
NA
NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
No
NA
D NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
No
D NA
D NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
No
NA
D NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
SLr'�C'E ��P) �>v7,L a�►y
�A L_16RA-r►oN �tiC ` C) a
W.C+7 � A . cs - P prS A L&A<5) E 4/yt4 / LAS 15 SENT O f F
�llalio ���
p(_AGtn►C1 C.A600nl (Y)
l,po►� i N 7D %- ►cr�Ns��
fi m tq (U� (L (� AN '1 5 1 N I F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: I a a
21412011

IType of Visit b, Compliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I D Departure Time: County:
Farm Name: Owner Email:
Owner Name: 'E\ LGIP��(� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Region:
Onsite Representative: Integrator
Certified Operator: OpAor Ceertification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o =. =" Longitude: =o =, =„
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PfNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: 1 — Date of Inspection '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: oQ
Spillway?: Designed Freeboard (in): I , S 1q.15
Observed Freeboard (in): 31
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 LYl No
❑ Yes �❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 'A No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
_ (Not applicable to roofed pits, dry stacks and/or wet stacks) �[
9. Does any part of the waste management system other than the waste structures require ❑ Yes p(J No ❑ NA ❑ NE
maintenance or improvement? !\
Waste Application �(\
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes yJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
7�\
❑ 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) NC([
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
[IYes
No ❑ NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
[INE
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
❑ 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 additionalTages;as necessary):
Reviewer/Inspector Name I Phone: Q��
Reviewer/Inspector Signature: Date: lib
Page 2 of 3 12128104 Continued

Facility Number:. — Date of Inspection 1 5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ld No [I NA [:3 NE
0 El Design � Maps El the appropriate box. WUP Checklists �l 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA [I NE
0 Waste Application ❑' Weekly Freeboard E] Waste Analysis Q Soil Analysis E] Waste Transfers ❑ teather
al Certification
El Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and I" Rain Inspections 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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No �% NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes r��,,, No El NA ❑ NE
El Yes qt� No ❑ NA ❑ NE
❑ Yes KJ No ❑ NA ❑ NE
❑ Yes '�\ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Additional Comments and/or Drawings: _.. -
W.A.
q poo a q
31,8110
�i �G7 —(O GEi
ao►y
aOI0 - /N `)V_o -s5 T o6SEiAKEN 7H►S
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Arrival Time: O5 Departure Time: County: L) N Region:
Farm Name: EUGENE 14ALESA Era20r) Owner Email:
Owner Name: Et.KaENE 4P(-C-LA n ' (� Phone: liU d7�-pS�5�c9� �
Mailing Address: �l9 � ACK SON �� ZJ J (cULA ly l t_LE NC a0 J ►6 r lid 6�
Physical Address:
Facility Contact: G 1 \ Title:
Onsite Representative: ur.en l= i4L-r lsl
Certified Operator: 1 • 1 V`g�e� wA�
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: T S 2 I
Back-up Certification Number:
Latitude: [� U = [�„ Longitude: 171 o 171, E71 „
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La -Layer
Dairy Calf
Feeder to Finish N 00 y
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Layers
❑ Non -Dairy
Farrow to Finish
El Farrow
❑ Non -Layers
El Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other I
❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes xNo ❑ 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)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
a❑
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

FacilityWumber:
Date of Inspection `-'-�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structurre_2 Structure 3 Structure 4
Identifier: LAGOCOA 69G) >�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes((]
No
❑ NA
❑ NE
❑ Yes
IXl No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes }jJ 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 IoNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
q1 No El NA
[I NE
maintenance/improvement?
, \
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
4No ❑ 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 of Area
12.
Outside
p (�
Croptype(s) SG \JEi��P� 1.�Zb� C_CTW U-'�$AEP J 1
13.
Soil type(s) %%j `-ou<
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ANo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo ❑ 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
[I NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answer sand/or any recommendahonsorxany other comments M
w
Use drawings of facility to better explain situations. (use additional pages-as'oecessary)
Reviewer/Inspector Name I o 1 aAM A C-aAiPhone: 9/6I-456 -33a� I
Reviewer/Inspector Signature: � I Date: I I / Q pa
12128104 Continued

Facliiy Number: 3 —) $ 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IVNo ❑ NA ❑ NE
the appropriate box. 0 WUp ❑ Checklists ❑ Design
g 0 Maps ❑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 ❑ faste Transfers ❑)imual Certification
0 Rainfall ❑ Stocking 0 Crop Yield El 120 Minute Inspections [I Monthly and V Rain Inspections B Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ll9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
06 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LXNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
*o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JXNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JS�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
[INA
[I 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
PNo
❑ 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
gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V No
❑ NA
❑ NE
31►�-10� �. �
PZOGRG-SS
12128104

Type of Visit [,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '"A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � Departure Time: County: L-1 N Region:
Farm Name: C l A C>,ENF (A \W()L E u FpAzm Owner Email:
Owner Name: lttlC1C�%r L&1t1 Phone: �I�O'r�9S" 55Co�
Mailing Address: �1.57 A (' KS O/V Toze-
Physical Address:
Facility Contact: Title:
Onsite Representative: (ADH A Lz_!:�
Certified Operator: JCL LA--) N A LE
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: —4rSS I
Back-up Certification Number:
Latitude: D o 0, [7„ Longitude: n o n n
Desigh Current
Design Current
Design Current
Swine Capacity Population
Wet Poutry C
lapacity Population
e C
Cattlapacity Populatio n
❑ Wean to Finish
10 Layer I
Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
Dairy Calf
® Feeder to Finish
Ljqoo
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Laersow
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ B----------
Boars
❑ Pullets
❑Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 'ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo ❑ NA ❑ NE
[]Yes O.No ❑ NA ❑ NE
12128104 Continued

Facility umber:31 — 1 Date 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: %evjDiy I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): et 5 eQ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
-
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes V No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ,_No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Nj� No
❑ NA
❑ NE
maintenance or improvement.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
❑ No
❑ NA
Z NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JA No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
04 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
% No
❑ NA
❑ NE
sai� sAmpc s #RU& t3GGX Cot-LEc7&L �cz roFt—R, �R43
LAP gr-c r- w / P-�cov�S - 11-L j 45 •vws—
l..E� �� ctxl.�lr� Sv-w•
Reviewer/Inspector Name I rAp-/t/O aS I Phone: Ci 10—
Reviewer/Inspector Signature: aurM Date: j aZ4//da
D--- I _. a 1212RAM Cnntinund

Facility Number: 3 — I g9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t,NO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes ❑ No ❑ NA U NE
the appropirate box. 21 WU, ❑ Checklists 0 Design ❑,Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ )Vaste Application ❑,Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑,8tocking ❑ JLrop Yield ❑ AO Minute Inspections ❑ Monthly and 1" Rain Inspections ❑,Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M 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
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
rA No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2P 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
J�No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0,C,00 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: D IJPC!td Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: C,/G6JE WHAt.Ci Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = ' = Longitude: = o = ,
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry L-_R—PAciApopulation
Cattle Capacity Population
❑ Wean to Finish
10 Layer I I
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer
I
❑ Dairy Calf
© Feeder to Finish L(Lt o o
I L1100
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow Farrow to Finish
❑
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes L13 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
Ld No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection �t tl Ob
Waste Collection & Treatment
�/
d. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
El Yes dNo ❑ 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: VA6r sAk I (A &0-'j Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): laz ]gyp
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes EfNo ❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ld 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 LJ No ❑ NA ❑ NE
maintenance/improvement?
11_ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Pointing ❑ 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. CroptYPe(s) COCAD CtJS
13. Soiltype(s) IJOR-GpuL W�(
14. Do the receiving crops differ from those designated in the CAMP? [IYes EJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E'J No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes dNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L� No
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional fpages as necessary):
kEF(' CAP- iiC A►OUAC, GE1?—T-_rFSCAl-Z01Jr I"MIS06CT
13c uraNC.
A/ Mr-)IJ*A LakA.G My
IReviewer/InspectorName I �TGAiJ VA12/JEL-(_ I Phone:l916)-/q4--/3,66 I
Reviewer/Inspector Signature: t 1 Date: A7 /O to
papa 2 af3
Continued

Faoility Number: 3t Date of Inspection
.Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
u Yes
El No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers
E Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections dMonthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L7 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�L-✓J,�No
Ia N
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Nto
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
,O
LJ 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
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ENo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NoElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
,0
LJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

(Type of Visit (D Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
sit RI
Reason for Vioutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 40 14 o S Arrival Time: 1 1 3v Departure Time: County: 0U9L-MJJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: Ev bC-�J(:' OIA AAt C `i Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: Q o = ,
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Rocket
❑ 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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dN El NA ❑ NE
❑ L1 No Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection t 0
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ata LA(,00t-1 I L(U wo J Z-
Spillway?:
Designed Freeboard (in): (71. S (� .
Observed Freeboard (in): ,,��, //
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes LYNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E 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
Er�NNo
❑ NA ElNE
8.
Do any of the stuctures lack adequate markers as required by the permit? ElYes
Q 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
ETNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need El Yes
(�
L No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KNo
❑ 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 Drifi ❑ Application Outside of Area
12.
Croptype(s) GC-P4.vuopA ( G J' [A) ;Co C.WS
13. Soil type(s) 0 v
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[ --]Yes
��No
Ed No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
4nNo
❑ NA
❑ NE
OWo�Ct� tnt(f� tl3btb V-2Eccso{4fcp �Afz` ,ro,/
t o GET LeVCUS StJ CoNAPLZP- l(,E Fst..,t✓ POA
A) (,CT cRoP Y�t7 faor^ ��Tls.`t N
1CCK— rCLAArFfP_ tAG
«0-r Urrti 54-14.
Reviewer/Inspector Name 1 - `Jc)!.j) (-_U Phone: Ot0)%Cfli' 7ol(os
Reviewer/Inspector Signature: Date: IObyL S-
12/28/04 Continued

Facility Number: ! I — i Date of Inspection 1u -1q 3$
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo
o El NA El NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. VYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Ercrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code '
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2N El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Zo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L-1 ❑ NA El NE
El25. Did the facility fail to conduct a sludge survey as required by the permit? Yes N ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ElYes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes � ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes /N�o [I NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes D4,0 ❑ 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? El Yes [2 o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 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 NNo ❑ NA [INE
33. Does facility require a follow-up visit by same agency? ElYes 940 ❑ NA ❑ NE
12128104

Facility Number 3 8 Date of Visit: I u/ zi cxi I Tune: t o a 0
1 0 Not Operational 0 Below Threshold
p Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 6 RAL-C_i._.Fg6an,__ _ County: ouPuitJ
Owner Name:
Mailmg Address:
Phone No:
Facility Contact: Title: Phone No:
r
Onsite Representative: , Mu2f!k - t:� R-6LEY �Y Integrator. CA�� S
Certified Operator: Operator Certification Number.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• = =- Longitude =• =1 =-
PDesrgn Cnrrent Desrga Current Devgn Current
Swine Ca a Po nlahon:` F°5.. Ca`actt "Po Mahon f,e ..:: Ca acit "rPo Mahon
Wean to Feeder Layer Dairy
Feeder to Finish y 4 ob _ Non -Layer Non -Dairy
Farrow to Wean - - _-
Farrow to Feeder flEl Other
Farrow to Finish
Gibs Total Design Gapactty
Boars
Number et'Lagaons� mEE3
f
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ENo
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 —dNNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Gr1vo
Waste Collection & Treatment -- //
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes ck' o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — 1 2
Freeboard (inches): 27 25
I2112103 Continued

Facility Number: 31 — i Date of Inspection to =t p
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
1
p No
seepage, etc.)
/
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
�J No
closure plan?
(If any of questions 46 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?
❑ Yes8.
rN9
Does any part of the waste management system other than waste structures require maintenance/improvement?ElYesNo
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
( o-
elevation markings?
Waste Application
Yes
MINq
10.
Are there any buffers that need maintenanceltmprovement?
❑
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 &R,11 UbA (,& 4 it r o 05W
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
K�No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
E! rN
b) Does the facility need a wettable acre determination?
❑ Yes
V
c) This facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
�No
p NNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 311,40
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0�
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes QNo
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 p No
Air Quality representative immediately.
�mments (rd q estion0)E�plam''� YES answers a�/or any rcoammmdahons'or any�othsr�commenu. �•"Y�
Usesdrawmg_s of;iariGtyltotbetteracplam �t (use�addthonsl pages as ne�ry)- ❑Field Copy ❑ Fittal Notes
`UPOATS
35,) C" 1 tD �o (Lrn
FA( rh uro IC$ Crop,
NEW wuP sN ?LAC-E,
910 39S - 3�vo exT Zo3
-
Reviewer r Name x
/Inspecto
k� .> _
ReviewerAWspector Signature: Date: t q z i/oy
12112103 Continued

Facility Number: 3 _ 18 Date of Inspection I I*lztlR
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ENo
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 Co
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes L"1 No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes I31i0
28. Does facility require a follow-up visit by same agency? ❑ Yes
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) dYes ❑ NNo
31. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes p N9
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0
O
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ' o
34. Did the facility fail to calibrate waste application equipment? ❑, �Yes o� o
35. Does record keeping for NPDES requited forms need improvement? If yes, check the appropriate box below. G r es ❑ No
❑ Stocking Form mop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit You will receive no farther correspondence about this visit.
12112103

Type of Visit JO Compliance Inspection O Operation Review
P 0 Lagoon Evaluation
Reason for Visit Routine o Complaint C) Follow up O Emergency Notification
Facility Number Date of Visit: Z D
'rjNot
O Other ❑ Denied Access
Time:
Permitted U C
ertified La Conditionally Certified ❑ Registered Date Last Opera"yIJ or Above Threshold:
/_
Farm Name: / L County: ` q'01 ��✓
Owner Name: GNGfi✓,E Phone No:
Mailing Address:
Facilitg Contact: Title:
Onsite Representative: aw_ /fP
Certified Operator:
Location of Farm:
Phone No:
Integrator: 6WO14 5
Operator Certification Number:
m Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude =• =• =-
- Design -;
. Current - - - Design -.. Current-Current
_ C"_
-Swine -Seine - acityP
_..-Desi'
outCa "
latiact Population -Cattleacitv -Po elationa ---
Wean to Feder
❑La ; ❑ Dairy=
Feeder to Finish P
ILJ Non -Layer ti _. ❑ Non -Dairy '
-..- Farrow to Wean
- _ --- -_ —�-:
- -
❑ Farrow to Feeder
j , ❑ Other- -'-
❑ Farrow to Finish
i Tota! Design.Capacit3'
Gilts
- -- - - - -
[I soars
[I
Total Ss] VW:
-'= Number of Lagoons -' ':,©4
❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Holdin .Ponds / Solid Traps '
g
- -
0 - - - ❑ No —Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El 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) El Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes'0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O No
Structure 1 Strp cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Wnn/ pZ
Freeboard (inches): d� %
05103101 Continued

r .
Facility Number: —/Qj Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over applicationj ❑ Excessive
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 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 �No
❑ Yes No
❑ Yes 0 No
❑ Yes io No
❑ Yes ONo
❑ Yes 0,No
❑ Yes �No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
JO No
VfNo
❑ No
❑ No
No
A No
❑ Yes VfNo
❑ Yes XNo
❑ Yes No
ElYes No
❑ Yes 'gNo
❑ Yes ONo
❑ Yes 9*1I0
❑ Yes YNo
❑ Yes [VrNo
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments (refer to`questipn #)' E:phnn any YES apswers and/or any-recommeodabons or.anv other comments_=,,;
Use drawings of facilityin better explain smta6ons. (pse addttronsfpages as necessary) i
•_. tAd __10 Field Coov ❑ Final Notes
_ �- -
r/1F 49,0 /j N>RoG /✓FF�Eo �"gyp , �f /�c / ®asEs lea, P /r�cr
GA,eaC- LhaooAi,
OfySZGN i ,onl
/%lR /�./�c` .sA�o i�il% .� �S�F✓� �f/9y ��Y r��s>o.✓ C.r�s��r
PGs�✓ 1G Gt4w -14i f Gam„/ D�`3z�Ga15 ��y � Gr/oQf y,✓�
_. r.
Reviewer/Inspector Name •
Reviewer/Inspector Signature: Date: %y rii
05103101 t Continued

Facility Number: — Date of Inspection /
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes A No
❑ Yes m No
❑ Yes PNo
❑ Yes P No
❑ Yes ❑ No
Additional Comments:and/ortDrawmgs.--:__ -' - - _- - - _ -, --
.: �... .: .. .. �_
f A ItIrw�1,6-1;rO
O5103101

Type of Visit t0'C,o/mpliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit XJ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
IFacility Number Dale of Visit: ,�
0 Permitted O Certified j] Conditionally Certified [3 Registered
Farm Name: ........ V ehe..... 'fkA..h..l.l..�r✓n.....................................
Owner Name: ..............C.?!�¢nc ti "04 G
Facility Contact:
Mailing Address:
Title:
Time:
Date Last Operated or Above Threshold:
County:.. .... V� �!✓1................................
PhoneNo:_.............................................................
Phone No:
Onsite Representative: ,,.,,..._Y................... S r 1 iJ
Q L1E ��kG�C................................................ Integrator:
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • =' O" Longitude =• =' ="
Design : Current Design Current Design Cart
Capacity 'Po ulatiou Poultry apaiity Cattle a' acitPon%
❑ Wean to Feeder ' . ❑Layer ❑Dairy
eeder to Finish ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑Other _
❑ Farrow to Finish
Total Design Capacity
' ❑ Gilts
= Boars
Total SSLW
Number of Lagoons I� ❑ �Subsurface Drains Present
Holding Ponds / Sohd Traps; 0 ❑ No Liquid Waste Managen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... f!................... ............
Z......................................................................................................................
Freeboard (inches):
5/00
❑ Yes'j2rNo
❑ Yes �o
❑ Yes�No
n a
❑ Yes JYNo
❑ Yes j7NO
❑ Yes )2rNo
❑ Yes fo
Structure 6
Continued on back

Facility Number: 3 — Date of Inspection
-
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes gNo
-�- seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[:]Yes ORri
(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 O 9
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
'Q'f
/Yes )2�No71 3101
9.
Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
8'FIo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11.
is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes O/No
12.
Crop type '6ey'r udci KraZ2 S✓tldll '4tn ✓ee-Se'(,q,i,7 I L✓i cr linnLml
S�, V baal^1
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
es ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
�JYes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes ON-0
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )2110
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 EfNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
/j"PT
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes eNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes�Io
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes J'NTo
24.
Does facility require a follow-up visit by same agency?
❑ Yes/�o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.100
0; iVq•yigla(i¢tis:oe d$ficpencies wgre o0f. O(Wift thjs;visit; • Yo(t 3011-seeeiye titi t'u>j tj.Qr :I
•:•coriesporideuce:aboufthisvisit:�:-:-:-:�:-:•:•:•:•:•:•:•:•:•:•:•:•:•:•:•:•:•:•:-:•:•:•:•:•:•:•:•:•:•:•:
Comments (refer to)q-- on #):-Explam atiy YES answers and/or any recommendations or any other trommenfs -
Use drawings of factlitito better explain situations (use addtbonal Pages,asPec
essi ry) _
J �. Nanbefm�dh grasseseol �o i con fro11eO1 a lie.-mu�lc, 6e1}e,—
eA611 s(oc'' en gelds. l / Z) 4-51
CHI Lip
41f3 rr 1 ••,� -LL L E j-,—i�z�l4 '��_��nly,r %Ne Gif r ve ly'YtG.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility Number: 3 / — Date of Inspection
Odor Issues
-26. )Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IeNo
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 XdNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes,0No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional:Commentsan orDrawings:
5100

S Division of Water Quality
_ - - Q Division of Soil and Water Conservation
_ - O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
13 Permitted ❑ Certified 1] Conditionally
tonalllyy Certified 0 Registered
Farm Name: ..... E.�_rj. e.!lc._�:.:�.%'�..- l ".1....'``.?..........................................
OwnerName: �� � .........................................................................................
Facility Contact: ..............................................................................Title:
Mailing Address:
8 B UO Time: printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: ........................
County':.r.. i,V-f. /.. Z.................................... .
Phone No:
Phone No:
OnsiteRepresentative: ... �7vjeta.-c.._..V...1..9.f.e...................................................
Integrator: .... L.�1..'.'...���.:j...................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F-7• =1 Longitude 0 =1 =i1
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish Q 52-6 JEEI Non -Layer I IONon-Dairyl
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
No Liquid Waste
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed. did it reach Water of the State" (If yes, notify DWQ) ❑Yes No
c. If discharge is observed, what is the estimated Clow in gal/min? M 1A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway XYes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..................................z...............................................................................
................ pp.................................................................................
Freeboard (inches'): 2Q. S
5100 Continued on back

Facilitj Number: ,31 — /g Date of Inspection Q o0 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JZNo
(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 N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jZ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
29 No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11.
Is there evidence of over ❑ Excessive Ponding [I PAN El Hydraulic Overload
El Yes
,9No
12.
/Iapplication?
Crop type Ber^uA0. Con'lrolld 6rgza sal/{leq So beans
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination? -
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
gNo
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 KNo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) '0 Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? []Yes 9 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes +9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes iffNo
24. Does facility require a follow-up visit by same agency? ❑ Yes JD No
r
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �9 No
l'VtiM6fatiolis:o def ciencies were 06ted ditring tbis:visit; - Yoit will reeeiye tio: further
caries orideitce:aboutahisvtsrt_ .....::.. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility tobetterexplain situations. (use additional pages )as necessary)- �/
4. Grower If Ira nS %¢t�/[L> �ro•v 1A9Pdh 2 4r Lq L earl-1 A"d W�I( keive
lxf� Frcobo�rgl t��a� red, Ver ✓ 1; 1,e pJ h
7 p�.nPin�i aj beer[ ne s;nGe
lmaky, ograttier heer(,f -�o use ail �iVai IA61r- /Aild 1) lh d, y1 -Fp 1ot✓e- t4900rwS
7n Ils-l� fur�tp levrl �� try G 1-esfons,b)e ,` /-feel y m0.hhlr,
15- (.Jo/A 4o ;r ,Grove C0 OAl it1 F,-W 1, 6111 2. 1
11. mgke s-vre -)htt4 fvlk ;r1 -Flan r 1-ljch maf. U4 TreIrrf SZSZ -Pvll 3
4 was-(e e1art• New soil +e51 sl"Ottlet be A.,ctlg7-4 i yv„ecj.q��ly. (aoki)
Reviewer/Inspector Name -S:p le t M `/
Reviewer/Inspector Signature:
Date:
5100

Facilfy Number: 31 -1 8 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Hush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments_ and/or Drawings:: 1
I�j'. Grot�er 17/ee6(5 40 have �C�D/rree4 WgSie 4inAI Sit -'h recOr'dl-
�C�✓ ule'Sze AnAl <L%s dale -fSnOYI -
.
❑ Yes XNo
❑ Yes JR No
❑ Yes No
❑ Yes No
El Yes ZNo
❑ Yes J�TNo
❑ Yes 05 No
o F'Aii 9c,,'tuAr, cn v4 ©/IQd AZ&) 64 S0, 7; eIds z) 3) 4 V
IV+ ;s '6��t^��dkPRs�tre. xluve �lah a>1�l lce�� �aac��cP
in ayree "1'?O
3/23/99

Division of SoilandWaterCimse-rvation -_Operation Review
_ [,Division of Soil and Water-Conse -vation =Compliance Inspection
- � mivision of Water Quality Compharice Inspection -
_. [.Other Agency - Operation Renew:
10'Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection c 60 j 24 hr. (hh-mm)
ermitteCertified [Conditionally Certified [Registered [ No[ O crational Date Last Operated: �- P ..........................
Farm Name: ........._.��..._41.6Er. ......vA�.1,Cr �..............................................._ County:............0 . •-✓
...:✓.%...%.................................................
OwnerName: .............................. ............................................-------.._._. Phone No:
Facility Contact:
Title:
Phone No:
MailingAddress: ................................... ................................. . .............................................. ......................... :........................................................... ..........................
Onsile Representative: ,.,,._ _�l GF..rE kt°t A-P- p U + S
................................................................................ Integrator:
......................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:....... �73 3 /
........................
Location of Farm:
Latitude =• =' =1 Longitude =• =1 =11
Design Current
Swine -
'❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
7 []Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
fl Boars
Design'_ Current Design Current
- `.."Capacitv..PopulationCattle Capacity Population.'.
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
1
Holding Ponds / Solid Traps _ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes A?fNo
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 Z No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J21Ro
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P110
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............ ....:6..............._^ZS................................................ ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 — (% Date of Inspection 9 iS
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ YesXj'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
o
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
/❑ jVo
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
I l'No
It.
Is there evidence of over application? ❑ Excessive Pointing ❑ PAN
❑ Yes
❑'No
12.
Crop type L s �eP^��1D� fit A z�0Zgp7 r.G. C_ W_ B
13.
Do the receiving crops differ with those designated i(the Certified Animal W to Management Plan (CAWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
,,❑{No
,�I 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
16.
Is there a lack of adequate waste application equipment?
❑ Yes
7No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ZNo
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
o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
[]Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge? -
❑ Yes
ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) _ ❑ Yes PINo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 940
0' iVo ..... tiol....... e.... were il... during ihis:visit; You witl•i eceiye lid further • ;
:: correspotideilce: about: this visit: .: . :...::::::::....:........... .
awings of facility:. to better-explarn situations: (use additi&ial-pages as necessary)
4zsP oar ru 4�K ; r* wA-SS r. BA^f ,xs t jrj , LEo ;,J 6a A4-4 S af- A- U t—Aw &4 �
t�A$s sa ma.e.9 kuG S9 -
Atafzr�o.J - /h ,ram '_j:
S'4tA1F4_ ^r4k.S qt, ScABiLiZE .
Reviewer/Inspector Name { -"
Reviewer/Inspector Signature:
Date:
3/23/99

d
Facility Number: ,� �— 89 Date of Inspection
Odor Issues �T'T
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes V(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 �a No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VNo
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 XNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KN6
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ZNo
3/23/99

W-.., t
❑Division of Soil and Water Conservation ❑ Other Agency
ivision of Water Quality
jQi Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection Facility Number
Time of Inspection ri �/ 24 hr. hh:mm)
13 Registered [3 Certified [3 Applied for Permit 'Permitted 13 Not Operational Date Last Operated:
�tJ J' lYh4� "\ Countv:................. 1'^^ FattiiName: ....................#._�k1.................W..............................................................................
................................
Owner Name:.....
....�1a1G.............................(/Ui!..... ................. Phone No:...........%..5s%�4.....................................
Facility Contact:................1 57 (.
............................................................. Title:........ . 50 .........................................................., Phone No:... g..... V / /7!�.�...............
Mailing Address: ....J&.,1...... v...... 5..:�"fi!%-�. — ........... ........... zS�.....................................
�( z Sr 3 tY
Onsite Representative: ....... 5-46, 4*n...........l1�/,fF.t<!YL.`J................................... Integrator:.......G ? d.. l...........................................
Certified Operator;..... !0.. ................. ... I t'S✓���................................ Operator Certification N'timber:.........................................
Location of Farm: /
Latitude 0' =' 0" Longitude =• 01 ="
Design. Current = Design Current Design Current
Swtiie a Capacity Population � oult'ry Capacity- Population • Cattle Capacity Population
°-
-
❑ Wean to Feeder
❑ Layer
��
❑ Dairy-
[LTFeeder to Finish
Farrow to Wean
❑ Farrow to Feeder
1
❑ Non -Layer
I
I
.',--'.
❑ Non-Dairy
':_ .
-
" ❑Other
Total Design Capacity
Total SSLW `
❑ Farrow to Finish
❑ Gilts
❑ soars
Number of Laguoni / Holding Ponds ❑ Subsurface Drains Present ❑Lagoon Area I[] Spray Field Area
®a
z e , `. ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
19,No
2. Is any discharge observed from any part of the operation?
❑ Yes
[�No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
t® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
RNo
c. If discharge is observed, what is the estimated Flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Lallo
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
b/] 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
0 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
91 No
7/25/97
Continued
on back

�i
Facility Number: `� ( —i M
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures (Lasoons.Holdine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Q No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft):...............:...Q..................... .......................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
ER No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
Q No
12.
Do any of the structures need maintenance/improvement? I
l9Yes
❑ 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
1ZNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type......................................................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
5 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Jallo
18.
Does the receiving crop need improvement?
❑ Yes
P No
19.
Is there a lack of available waste application equipment?
❑ Yes
10 No
20.
Does facility require a follow-up visit by same agen� y?
❑ Yes
XkNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ANo
22.
Does record keeping need improvement?
❑ Yes
evo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J@ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
14 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
42LNo
D
No.vitilationsor deficiehdis.were noted during this.visit. You:will r&eiv& ntvfurthei-
correspindehO ahout this:visit:• : ::: : � : : : : • • : : : : : : : • : •
.
�ttrm'q(i
3JYy»t.vJ ,�� i�SL
'� i�.'u5f �7AiJs h�w'vj
�fs"•'i''(�!./+,V"a�"' i P�h �uwS,
auto �ta4�..WAI/pa
5pe-'.`
,"as
-/V Ax— (2eyo4iQ£d� (vyS(iyKt✓!
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:_ Date: J

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
{�I61 RRooutine O Complaint O Follow-up of DNVQ inspection O Follow-up of DSWC review O Other
Facility Number 1
E 3 t Date of Inspection 9
1
[Time of Inspection 24 hr. (hh:mm)
Megistered ❑ CCertified E3 Applied Ffoor Permit ;[ Permitted 0 Not Operational Date Last Operated: .......................... .
Farm Name:......... SrVA2kJ.......!N.��lnyyhu.......t.I.f!\........................................................ County: .....
b4h........................................ .......................
.C.�. Owner Name:........` . .. ..........U.lrf...................................................................... Phone No:..I Q�.. .$.-S ...........................................
Facility Facility Contact: ... cIsV3 w.......... W .................... Title
:.......00. ! T............................................ Phone No:..l�g1Q Zgg.'.. 7.......
` -`I...........
Mailing Address:.....s&.&.....ik e&r.......�1C.![�............i ............................... .....&4Vt.tkt..jSjC..,................................... ........
Onsite Representative: ......... G-ot. L-4....... Integrator: ...... f..d1:tC611A..........................................................
({r ' I ......................................................
Certified Opera'to�.:....1G 1A�Ctc...........tN�......................................................... Operator Certification Number ;.....1.233.1......................
Location of Farm:
Latitude =• =' =" Longitude =• =` ="
��- Design Current. design Current'.'" `Designs Current" -
Swme ; Capacity Population > Poultry Capacity,,Population.--'Cattle; e ; . Capacitpi Population ��
❑ Wean to Feeder e' ❑ Layer El Dairy
Feeder to Finish 14aW ;" ❑ Non -Layer I ❑ Non-Dairy
y ; Farrow to Wean
[]Farrow to Feeder =' ❑ Other"-
❑ Farrow to Finish Total Design Capacity.` Lqj
❑ Gilts
❑Boars Total SSLW ,'
Number of Lagoons [Holding i ❑ Subsurface Drains Present ❑Lagoon Area 10Spray Field Area
s,
a
❑ No Liquid Waste Management System°.=` �,."i
General
1. Are there any buffers that need maintenance improvement?
2. Is any discharge observed from any part of the operation?
Discharge ori-inated 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 DW Q)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any pan 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 laeoons/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 IP No
❑ Yes INo
❑ Yes 1P No
❑ Yes
( No
T
❑ Yes [ No
❑ Yes IANo
❑ Yes IN No
UYes ❑ No
❑ Yes R'No
❑ Yes 1p No
Continued on back

Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laaoons.Holdine Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3
Identifier: _......... —1. ......... 'Z ............... ..................................................
Freeboard(ft):........ Z:3................................tq............................................
10. Is seepage observed from any of the structures?
❑ Yes JA No
❑ Yes PNo
Structure 4 Structure 5 Structure 6
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 Aoolication
❑ Yes (tNo
❑ Yes )d No
?RILYes ❑ No
❑ Yes ®No
14. Is there physical evidence of over application? ❑ Yes P No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type............CMt).�.......................................... ` s..�.1. grn......................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes I;NO
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems.noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies were noted during this,visit:.You will recdveitaftirther
.........................................................
correspondence about this:visit:
❑ Yes f�l No
aYes ❑ No
❑ Yes 'RNo
❑ Yes fiSNo
❑ Yes Pq No
l,Yes ❑ No
❑ Yes V,No
❑ Yes ® No
❑ Yes Q9 No
S. Farmer 6s %?6-% :o l rl I t r. (tcl,) �` i itl�ts at,J eomloiew Melds to,l O V
iL. �ro5:or oreo5 on inner wall shook foe- or-�k ts'y et,v.d
resee��, t3n-�- ta+t.cs s{�o�(� (o� reseedC�. I
IS-&rmode, ewe it,. \ilr) #z st1•�Iuld lie irnprove� 1 rin)t9g /1
LZ. S l7rbq *ecora s bt to�d �1 � 1 tv ( f UA nuln6e O j 7 AI Ilm6er. Co rite& AQ
huM1M%S sha)IJ be Osei) wl.e.I. comkwt), krio„ des;jK S61d be �� �(av�•
7/25/97

Site Requires Immediate Attention: "J7
Facility No. 3/-Z92
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: n `a--6 . 1995
Time: I .4 S
Farm Name/Owner: Q 0
Mailing Address: 31-b J OLCV-S w- (3fJ ' N" I le 2 0 5l o
County: D J P Ut 0
Integrator. C"f*n— r t ko L'-s Phone: C 110) a-58 "SS6 i
On Site Representative: Phone:
Physical Address/Location: 1 N I OLC rp_� C-TtD '' O F ntcs2 1 9 6 6 1 +. D 19 6 5
Type of Operation: Swine ✓ _ Poultry Cattle
Design Capacity: 3 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 5 D- Longitude: -7-7 4 1 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) Dor No Actual Freeboard: -5_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or'kLWWas any erosion observed. Ye r No r^, to
Is adequate land available for spray? Yes or No Is the cover crop adequate? (Rbr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? rid :nor No
100 Feet from Wells? (�5 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(n
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
-!
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management records (vAmes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or o
Additional Comments:
L)e51
Inspector Name
\m l/v
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.