310192_INSPECTIONS_20171231

NUH I H CAROLINA
Department of Environmental Qual

lype of visit: fQ Cydtpliance Inspection V Operation Review U Structure Evaluation () Technical Assistance
Reason for Visit: �� Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: r MD Departure Time: 123Q County: _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
((
Onsite Representative: /`�^ t^ 1 A__1 cN
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: �/
Certification Number: / 3 2/>
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
I Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
W n to Feeder
I
jNon-Layer
I
Dairy Calf
eeder to Finish
Farrow to can
Farrow to Feeder
Farrow to Finish
157 o 510 ry
Dr.' P,oult , r
Layers
Design
Ca aci
Current
P,o
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesFNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
41 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �l L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNO
NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment t real, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes V ❑ 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 7No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes❑ 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)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
0pe ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 7�❑
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, 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 EdNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
�❑
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
2 ,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 Io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EffNo ❑ NA ❑ NE
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t/ ( t' Co -,•-t l
❑ Yes
❑ No Q41A ❑ NE
❑ Yes
ONo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
❑NA ❑NE
VNo
No ❑ NA ❑ NE
❑ NA ❑ NE
Phone: 7 0� 7.3' y% 1 �y 7-1' y
Date:
21412015

Reason for Visit: (6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: i ( ) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: i5ou �f� y►/(�i_j.,tze'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 ! 3 t•,l)
Certification Number:
Longitude:
Design Curren[
Swine Capacity Pop.
Wean to Finish -
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ,ry P�oultgy
Layers
Design
Ca tacit
Current
Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of inspection:
Waste Collection & Treatment
4. Is 5iorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ul<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7�
5. Are there any immediate threatstothe integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) pi"
No Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1 /1 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 environment 1 threat, notify DWR
es N
7. Do any of the structures need maintenance or improvement? ❑ Yo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E?<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;No
2No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LV o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
❑ Yes
ff No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes 0<0 ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
Page 2 of 3 21412015 Continued

[Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ej No
1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C240
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 Y N ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes � ❑ NA ❑ NE
❑ Yes 7I Xo ❑ NA ❑ NE
[-]Yes El -No ❑ NA ❑ NE
❑ Yes ED N ❑ NA ❑ NE
❑ Yes
[!rNNoo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to questions#): Explain any.YES answers and/or.any additional recommendations or any other comments.
Iice. lrawin¢s of facility to better explain situations (use.additional pages as necessary).
�; ��i)1 %GJ r . �' 11 I N
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint 0 Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: z i— Arrival Time: Departure Time: County:
Farm Name: NYM Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: irt�t k ri L C{ yl (p f Integrator: �"
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Region: • i n-
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , r P,oul
Layers
Design
Ca aci
Current
Pao P.
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Imoacts
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 ONo ❑ NA ❑ NE
❑ Yes ,,f No
❑ Yes 6No
[:]Yes [No
❑ Yes C:fNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Date of Inspection
Facility Number:
Waste!Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J?rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
;ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,,(
,CJ No El NA El NE
through a waste management or closure plan?
1
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
lL��l,, NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1(d No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ICI No
[I NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
/� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
j2rNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Coinments.(refer [o question #)::Explain any;YES answ'ers and/or any, recommendations �or any other comments
Use dtawdngs of facility to betterexplain situations. (use additional pages as necessary)
IReviewer/Inspector Name I - Phone: I
Reviewer/Inspector Signature: Date:
Page 2 of 3 11/18104 Continued

Facility Number: jDate of Inspection: 7 71f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
i'
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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
,�(
❑ Yes I/ I No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes VfNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes oNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes P/ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
r
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes 96� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
C:] YesNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 7No
❑ NA
❑ NE
Comments (referto question ft Explain.any YES answers.and/or;any,additional recommeudations:or any other' comments. -
Use drawings of facility to better explain situations (use additional pages as necessary).
o Pet nec,: CCO p CPfil ,/
09efc t (fir C CIA I() ire 1 C-e C C r rdiE6'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L
CG n xM e fkt?5 1 c 5-0o l U`
57GLAr\AcNer Grr
4-6rdr45 .
far,,-, d-- re c P Ids lf6k 360
67)
.
Phone:
Date: G $-
2/4/2014

Type of Visit: rO Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: [ij-r)-141 Arrival Time: Departure Time:EHTEQV County: XPL Region: 4AM
Farm Name: �jn KAn F/ ,ywro� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: / ' 1 cwjl . Wpt) `a�vt
Back-up Operator:
Location of Farm:
Phone:
Integrator•
Certification Number:
Certification Number:
Latitude: Longitude:
j rn�n
Swine
Wean to Finish
Design Current
Capacity P.op.
Wet Poultry
jA
I ILayer
Design
C+apacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
3
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oulh.
Layers
Design
Ca achy
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes !;�,No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes
❑ No
[-]Yes
�No
❑ Yes
VrNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

I
acili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J!fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
PrNo
❑ 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 VrNo
`(VT
❑ 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 PTNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo
❑ NA
❑ NE
❑ Excessive Pointing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes gfNo ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
❑ Yes FNo
❑ Yes Kilo
❑ Yes F
o
Yeso
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes O'N
[:]Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facili y ?kumber. '; - q Date of Inspection: '7-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;,Er No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Jf 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
Z No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
�'No
T�i
❑ NA
❑ NE
❑ Yes
No
'jZ'
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes VNo
ElYes V1 No
❑ Yes KNo
❑ NA ❑ NE
❑ 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).
Reviewer/Inspector Name: �t 0 0[.�
PSignature:
Reviewer/Ins ector
Phone: 1 & f 2a
Date: 9 d1 I
21412014
Page 3 of 3

(Type of Visit: 0 Compliance Inspection Q Q Operation Review Q Structure Evaluation Technical Assistance
GI I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: - � � Arrival Time: �—W Departure Time: County: VN(f/l�t W Region: 04
Farm Name: —�rp� /� F —ter —6�&,M!�1 Owner Email: �—
Owner Name: t f .ej I 1. 114
14II owt Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: La jY'i�(' Integrator:
Certified Operator: AA�p1 —3, . .Iyf/, Certification Number: 11-1320 !
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Curren[
Pop.
Wet Pouliry
I 11-ayer
Design
Capacity,
Curren[
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
0
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oul
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBcefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2(No ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes ❑ No
[:]Yes [—]No
[:]Yes dNo
❑ Yes [Z"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZrNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [;� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 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 dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZfNo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2rNo ❑ 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 CNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Ef No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ZrNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes R] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0!1'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 [%f 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;_g�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2r1Vo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!�No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ZNo
❑ 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 rust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
V6 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
eNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�.y{
VT
❑ NA
❑ENE
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
05 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Z No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
6 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
[6No
❑ 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
[7f No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G� P
Con+,nkip� worNk�,, ©^ 6G' s 7 � oar gyp ,:
weq wtt�S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:O��d-)�
Date:
21412011

Reason for Visit- $ Routine
ti0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I S/4c/ I •eL I Arrival Time: Departure Time: j 1 County: Region:
Farm Name: / v l I—/- ` F'4eM S
Owner Name: M1C_h( 6(_ _�) (A._�RLLACe
Mailing Address: Cn1) ��O(3C>LANF-) CHLt(LC4
Physical Address:
Facility Contact:
Onsite Representative: SQff9u
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
;5�arSc, NL
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
C•apactty
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dm P,oult ,
Layers
Design
Ca acit
Current
P.o -
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
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. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No
[-]Yes []No
[:]Yes [—]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
/4421-
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Faci ' Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yeso
tNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Mac�
Spillway?:
Designed Freeboard (in): lei. S
Observed Freeboard (in): -LIL4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�] No
❑ NA
❑ NE
maintenance or improvement?
TTd
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive 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): w o6A T ��i
13. Soil Type(s): W 0. (?->
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IoNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EZ 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?
r
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
PkNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
0 WUP QChecklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �Kte Transfers ❑ Weather Code
M. Rainfall []Stocking 0 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci ' Number: I I - /9 jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes %L.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Yes
[:]No
❑ Yes
No
❑ Yes
����((((
10 No
❑ Yes
No
❑ Yes
No
❑ Yes
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Comments (refer to question /I): 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).
(fPLieaa %1CW b.tC o�l�
-S7/LL SovAC- C-_ (o-vgyv aN 04cry[P (3 F t_46GON - KFF f) A -iv Ct C- cry/ i
.k'T(tLA,TU CC% Son^[ VFCE74?1UE Couf=ram
►aU1c t.�/ Cc _bS-w1c�C�uC �JMs
5tA&C. Q IC IS 1407 106
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q/C) —+56 430
Date: 5 AM
21412011

Date of Visit: iD // Arrival Time:® Departure Time: ©County: 1\�.(J9X/ Region:
Farm Name: WC M EA Z WS Owner Email:
Owner Name: Ir 11�N/�EiJ. w��-LWl or1SS�- 5w- (0(o44cw�
Mailing Address: LI (,k o Z>LtPNC) COUZCN J-6 LG(j: SOx/ /t/C D650,k
Physical Address:
Facility Contact:
Title:
Onsite Representative: K IIS4 .A S-(rl / T14
Certified Operator: n cg4_C-L- S . ��O_ Pc&
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
a© I 1
Certification Number:
Certification Number:
Longitude:
►­43aC�)
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I INon-Layer
IDai
Calf
Feeder to Finish
Farrow to Wean
Dry $oulh
Layers
Design
Ca aci_
Curren[
P,o ,
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
113cef Brood Cow
Other
OtherI
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes $No ❑ NA ❑ NE
❑ Yes [—] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: —Z' ( - j cj Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
TTT0 ____No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LgaXw
Spillway?:
Designed Freeboard (in): i 9.s
Observed Freeboard (in): l_f
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
'tp_No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �[
9. Does any part of the waste management system other than the waste structures require ❑ Yes Iy.LNo ❑ NA ❑ NE
maintenance or improvement? iii"'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�/ I No ❑ NA
maintenance or improvement? J�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O-No ❑ NA
❑ 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):
❑ NE
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
to
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
����CCCL
❑ Yes ko
❑ 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
E.YesNo
I
❑ 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 0 Weekly Freeboard ❑Waste Analysis ❑Soil Analysis
❑ y3/aste Transfers
❑ Weather Code
Q Rainfall ❑ Stocking n Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall) Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a min 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 Condnued

Farili Number: R
Date of Inspection /I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes V�No
and report mortality rates that were higher than normal?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 1
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes K I No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) "`111"'CCC
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Q§_No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments;;;
4 t
Use drawings of facility to better explain situations (use additional pages as necessary). 7
NeEO Amelvom6N- To PLAN To ArCCcwxtT (7-0R W+414T-IS PLRAITEI> ON FIELDS
05%Attt6AEQ"f1MC-E0E-Al If-J4bT PtwM?iNCON/r T14EFIE02.IS /!V-fife U-)LAP`i
IT v�LV> SAVE Satv,C CoivF"S(CyV
L,gQgj� CGZz? 5` Fin C-o'�L s c
Ca�la¢aTlov C�c�E �-0M
cN.A.
SoMG G_IaOSICVV 0At G4C-ICS i DrE O F L ACZC)OAI - KFeP AA1 ELtE oN 1.- t
(Ly i U G 6%SOME- VAC, �TATIvE co�E2 `1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %T _-4/6p -�ad_4
Date:
21412011

Type of Visit JG Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /\/OArrrii'v'al Time: Departure Time: County: LI A/ Region:
Farm Name: 1 ' I l� I � Mi t'-Pams Owner Email:
r,�t (Hl'a-SbP-Z'St5
Owner Name: ,l 11CNIClFL � • wALCiaCE Phone: Cwl95a-5(a0n-(Coto4}p�z75ti/�/�
Mailing Address: -I i�iC�09C�i%VV� HuiZCFf Jd HLXSC-q-iXYtJ�,n%C
Physical Address:
Facility Contact: Title:
f� -
Onsite Representative: �1Lt 4 1��-1 L AM OL
Certified Operator: /tltG9'46L WPLLQCE
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 = ' = « Longitude: = o = , = „
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes fid_No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number:
Date of Inspection'-= J
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: M KM
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): 3 `�-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �LQ No
❑ Yes l❑0 No
El NA El NE
El NA El NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes '�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 19No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No [I NA El NE
maintenance or improvement? '
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes p� No El NA ❑ NE
maintenance/improvement? -\
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 9No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes � No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #):, Explain any YES answers and/or any recommen'd'ations'br any other commegts
Use drawings of facility to better explain situations. (use additional pages as necessary):
_
w•A•
_
��4/,0 3 • I
a.N
Reviewer/InspectorName NNOf� tiAl 3 - - -•'� �•_:-:
Phone:
Reviewer/Inspector Signature:
Date: S�oi�//p
Page 2 of 3 12128104 Continued

Facility Number: — a Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ElNo ElNA [INE
the appropriate box. ❑p [IChecklists 0 Desi gn (
❑Maps El 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 0 Soil Analysis ❑ Y/aste Transfers ❑ AAual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes ',No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
'KNE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes 'ANo
XNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
;dNo
❑ NA
❑ NE
Addrhonal=Comments,and/or'Drawin sue"& j"
AEI GUP�OF �09 SOup6GSu2uE)w*PUT w/V-ECOAS 108R,4,-,o O.`d►
c tBRRsIoN pL.tG DCA l
W%Jk? NOT JN OO'A —WAS NOT JAI EWX, FO(Z- SN�l INSPEC7/0/X - �LLRSE C;Ei
(Zpx w) ucc DS ^t S e//D 03PL_�'TcU
AMANO19 C11/.vES
IQ� CAR-OINA()- ,V- GxT 09 F-pL TO . q%() - 350 - 00c) /
WtL�mtNSTONI NC
aeyos
5END wIJN 3o DABS
LgC)ATE COY) taIELD— NO p9 �IEGOQ�S
JF
NFr6� to A? o F' I C cDS LA-)J -CC(30 S
12128104

Type of Visit �C(ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: T Region:
Farm Name: m tc m PAem S Owner Email:
�y'� ' \
Owner Name: It IICf1Al 6L- N • �AL-LACE f� ' nPhone: '`o2Sa-5(o0 [0/04��r�>344C��t.t)
Mailing Address: I-1'� 9 U0goDLAN6 l�ltn (ZGN
Physical Address:
Facility Contact: \ Title: Phone No:
Onsite Representative: � L4cl xi c12— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
U f -10 ^
Latitude: Longitude: I I I ^ Ii f «
Design11
Current
Design C>unrent
Design
Current
Swine
C>apacity
Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
airyCalf
Feeder to Finish
SoiO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ ers
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Pullets
Pullets
❑ Boars
ElBeef Brood Co
❑ Turke s
❑Turke Poults
Other
❑ 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?
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
[]No
❑ NA
❑ NE
❑ Yes
9. No
[3 NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility NamDate of Inspection EAW
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: L460CVV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 10 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) rrrr{{{{yyyy
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 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [54 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. Croptype(s) Q'se-(L(_I.1> SG' 'I�L Cn" (2(_lCucnooes
13. Soil type(s)
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
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
%No
❑ NA
❑ NE
3. I
ReviewerAnspector Name I I
Phone: `910-
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number: 3 ) —19gj Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropimte box. ❑ WUP ❑ Checklists 0 Design
g ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No/
❑ NA
❑ NE
[I Yaste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ WAte Transfers ❑ q mual Certification
0 Rainfall ❑ Stocking 0 Crop Yield ❑ A Minute Inspections ❑ Monthly and V
Rain Inspections ❑
y(eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ 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
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'\
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
i�A] No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
pprNo
❑ NA
❑ NE
Additional. Comments and/or Drawingsd.
SLUZ4G 12eMOUSts /1Y )A, Ug4ua 1oFf- No iskx�" c% F uc-X%S s//✓CE -THEN
ell
E-T /Ocl pl C CflaD r+ ( i W (LEeC�DS- C�Q jlt s y Ol Cf}eJ l of
LkFOA E WUU ' Tc.3 tact-AC3& 9-0w CRs.VS NZCM A/A�ii V-#P/lam c* HAND
W(UT°re/v NO?r--S
�(ngLL_ qw-IChi OF �PSJSidv ON `l�\KC - NEED5 r�g"IL* CRASS
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 I eJ a O Division of Soil and Water Conservation
— — 0 Other Agency
(Type of Visit 0Coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Q(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ay Arrival Time: dt) Departure Time: County:
Farm Name:
Owner Name: M I K E �] A _Ljq C_G-
Mailing Address:
Physical Address:
Facility Contact: \\ Title:
Onsite Representative: Jcs{wN Ln/v 1 i�_
Certified Operator: I' I y�/�t CHAEL w QC�aC�
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Region:
Operator Certification Number: ' _,� J g(723
Back-up Certification Number:
Latitude: a o = , = Longitude: = o = ,
Design Current Design Current
Capacity sPopulation Wet Poultry Capacity Population Cattle
❑ Layer EEIDai❑ Non -La er Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cow
Calf
Heifer
Cow
Design 1
Capacity Pt
LJ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 'KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
DkNo
❑ NA
❑ NE
❑ Yes
_D(No
❑ NA
❑ NE
12128104 Continued

Facility Number: i — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;RNo
❑ 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: Laonew
Spillway?:
p C
Designed Freeboard (in): (• J
Observed Freeboard (in): 96 t
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
JXNo
❑ 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
UNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[]NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
J�rNo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? rrrV
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes yy No [I NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload [I Frozen Ground El Heavy Metals (Cu, Zn, etc.) - 1
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,yam No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
[I NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
I No
11
ElNA
❑ NE
17.
Does the facility lack adequate acreage for land application?
[IYes
; No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
DNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
NEED �PDA-, wIP-t,--, t­IEgT 14 4NtJ AODEN �'Gt^Q-RENT
J)l-4AI hoF_3
�
HaT 040E 1&1v0u81i WETT[b Orc(LFS Tc Abbs LQik4GAI — Np1- Plttt pIAl�
ON WHEtVr 0-1 r- 'd � — S014AINL W 1Lt_ R G n0 �LA1V
�C,E�T CGof COC.* Ef"", 1 T J-PLA-T (CZO
Reviewer/Inspector Name I NES Phone:
Reviewer/Inspector Signature: Date:
//
l.tt
Page 2 of 3 12128104 Continued

Facility Number: — 19 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? M Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall E Stocking Ya' Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
k No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
( No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
qNo
❑ 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
KNo
❑ 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
IN
[INA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ YesgNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
ai• C'lEl v.C�ORT�D C�� t \SL� Fo4? 'a�w'og *pLA wJ c�co9
Lst�I�C.�F ►A U� C}NNkAL S j�C4CtAIr RECORDS
rllOw /,A)SIDE o1= wRl-L
F 4R_AA - Looks G 4 0
Page 3 of 3 12128104

Facility Number
Division of Water Quality
Division of Soil and Water Conservation
0 Other Agency
Type of Visit j0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit �'(�'O Arrival Time: eparture Time: � � ,County:
Farm Name: ������ Owner Email:
Owner Name: t / // ZY� �iPhone: _
Mailing Address:
Physical Address:
Region: ZVIQ�
Facility Contact: / Title: /f Phone No:
Onsite Representative N�L?/✓2F//j//';g2 ��� Integrator:�LJ�/POift�—�llot�%n�
Certified Operator: �'2 , f v" *ZZ AZC, Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = [1 , F7« Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r�l ❑ Non -Layer
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 Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes VJNo ElNA ElNE
ElYes x No ❑ NA ❑ NE
12128104 Continued

FacilityNumber: ) —
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
Identifier:
tol /
Spillway?:
l�
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ,,ONo ❑ 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 ,,❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes, YJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) to
9. Does any part of the waste management system other than the waste structures require ❑ Yes .C.I No ❑ NA ❑ NE
maintenance or improvement? /—
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P�No ❑ NA ❑ NE
maintenance/improvement? ,,,,,,[[[
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ICJ No ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Ayllfyl a'06 C��✓� . S.G. (f/l/EOSF�LJ I �5. o , 0— &) se.,
13. Soil type(s) Itil
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes IQ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes / No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[ --]Yes; o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes //Id No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑Yes QJ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other corirments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
15) 20 Sau iFs; —� 0>K
2)) /v im C.�oP �c6�9 �•L Zc9©lp -zooz.
Reviewer/Inspector Name Phone: !7
Reviewer/Inspector Signature: / Date: p iCf n -;z-
Continued

Facility Number: Tj
Date of Inspection EOy r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Z(No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA [INE
the appropirate box. ❑ WUP ❑ Checklists ElDesign ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking XCropYield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�GI No
[I NA
❑ NE
23.
If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes
�(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VJ No
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
l,' No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[I Yes
/////���1<��7"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ 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
L/J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
/
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
21) /t1�60 E D�A,� r
eov��
_ Zfwk
11-2,11 Z11 97-
12128104

Division of Water Quality
Facility Number ��� I 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit fEy.J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �n�pArrival Time: 0/Ss Departure Time: i 5 County:
�I
Farm Name: / / I A-f✓l /5�i44-7) 5 / Owner Email:
Owner Name:</i 6 LL//1 L� SCE Phone: _
Mailing Address:
Physical Address:
Region:&Z/�
Facility Contact: Title: Phone No:
Onsite Representative: d O 64Ahr1_-.2. 'CJ F Mojzw �ttegrator: Z /C/.�i l 41- 'oado
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
wine Capacity :Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
L3152ej
-1&q0
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: = o = I = " Longitude: = o = ,
Design Current
Wet Poultry Capacity Population
"❑Layer
- ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ZgNo
❑ NA
❑ NE
12128104 Continued

i
Facility Number: — Date of Inspection 6 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 5
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 �KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ANo ❑ 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? XYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markets as required by the permit? ❑ Yes �No El 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;dNo ❑ NA
❑ 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 t
12. Crop type(s)
13. Soil type(s)
❑ NE
❑ NE
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ 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?
/Ef
❑ Yes XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName Phone: W0-�10—�Zlv��
Reviewer/Inspector Signature: Date: Ob
Page 2 of 3 12 8104 Continued
0

Facility Number: ,31 —/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;21No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [KNo [I NA ❑ NE
❑ gn ❑Maps ❑Other
the appropriate box. WUP ❑ Checklists ❑ Desi j
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes /ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
9Yes ❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes zNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[--]Yes ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ;KNo
❑ 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 XNo
❑ 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 J9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ YesXNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
/V D z4510
Page 3 of 3 12128104

of Visit Ocompliance Inspection O Operation Review O lagoon Evaluation
(Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
C Not Operational Q Below Threshold
Permitted M'Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .... !-',XA_C.- County: tlJun................. ......... .........
Owner Name: •,•M&..Oc1.-Ilacer._......... ............... Phone No: .... .......... ...... ......
_._.._.___.
Mailing Address:
FacilityContact: .._ .... _.............. _....................................... Title: ... ......... ._... ............................... _.... Phone No: -•-----_._.___.__.-_---.
Onsite Representative: r,.j._{_f�{.�Q�In
Certified Operator: •_ ............................ _..... .. Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J iWo
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 gallmin?
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 12-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes jago
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Struc %I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.__(...--_..---_........_......_.___...._____.........._......... .._.....................__...... ................ _......_.... ................. _._...
Freeboard (inches):
12112103 Continued

Facility Number:j — Date of Inspections
5.
Are tb--a any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
GQNO
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
��""
Mtvo
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?
Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
dNo
9.
Do any stuctures lack adequate, gauged markets with required maximum and minimum liquid level
❑ Yes
E(No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ETN'o
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Q'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ErNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
2 fio
b) Does the facility need a wettable acre determination?
❑ Yes
[2rNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[T&O
15.
Does the receiving crop need improvement?
❑ Yes
2rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
LT&o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑'No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 0140
Air Quality representative immediately.
Co�tttments (refer to gnesLon R) Facplatn anytYES answers and/or any recommendations or any oUtecommmts t} -`
Usedrawtngs of facthty to better atplam stltta6oas addthonal pages as necessary)0 Fteld Copy ❑ Ftnal Notes`
7) flea5e G,5y)4) nu.e -b -e.5- v.n) sh CAdle7UCL
G r i ag oG✓1 �a1 S .
Reviewer/Inspector Name Qfil _ urct
Reviewer/Inspector Signature: Date: % d
12112103 Continued

Facility NuDate of Inspection ,
Reouired'Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
A214o
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
13No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
['No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
©'No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[2'No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑`No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EINo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
01No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0'No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
0 No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
ji Yes
J!(No
❑ Stocking Form Xcrop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddmonal Comments and/or Drawrpgs i e t `.
35-)-F °4,V leGor� crap yle%/
`
10fP4S2
_ Xeel,el ��j2 !% c✓/rail i/i�2 /os� �ar�iS orr si
12112103

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ;�M O/� Arrival Time: Departure Time: County: AZZ/'1 Region: z_,( ,D
Farm Name: �t/t /� In //44%lln-.5 Owner Email:
�/
/
Owner Name: dj"'6 A rz"4L-C%L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = M , M Longitude: E__1 U E__1 I M
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Condnued

L
Facility Number: — 92 Date of inspection 30
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
,,//
El Yes XNo
!❑
El 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: Iml
Spillway?: A/D
Designed Freeboard (in): a:�
Observed Freeboard (in): 150
5. Are there any immediate threats to the integrity of any of the structures observed?
rrr���ttt
El Yes y� 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 XNo
❑ 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?
XYes ❑ No
❑ NA
❑ NE
8. Do any of the smctures 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 VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
of
El Yes w No
❑ NA
❑ NE
maintenance/improvement?
l___
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
///
ElICI Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
p
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
4 �3� 6".SO�/lSEI�S
12. Croptype(s) 'vt6ft4'041 4
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes XJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
S�A46-1a 6: 0--51
Oil/ 1-6-o�.J Gc>�
.0VC-41).
❑ Yes JZ'No ❑ NA ❑ NE
IReviewer/Inspector Name I CM6(� J Phone: 0 S a9 .2MI
Reviewer/Inspector Signature: Date: 3 _ O�

Facility Number: 3 —/%Z Date of Inspection 3i7 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Oyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 13 Crop Yield m 120 Minute Inspections VMonthly and I" Rain Inspections A Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
/11�
❑ Yes 7" No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes PrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Y1No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
rat
❑ Yes t/� No
El 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 PKNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes /" No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
❑ NA
❑ NE
Additional Comments and/or Drawin s: z° r
S xs
— /20 ^07 4_
bvw
1212W04

l
(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit fir Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit: "
Permitted E3 Certified
�� 0 Conditionally Certified 0 Registered
Farm Name: .............
Owner Name: ........... m• GLtD1
Irals I&( ..........................................
Facility Contact:
Title:
Time f d
Date Last Operated or Above Threshold: ..
County:.... p y pl i. �. ..............................
Phone No:
Phone No:
MailingAddress: .....................................................................................................................
OnsiteReprese.ntative:./...:.k..k�k.c...........................QIIAG6 g.D.�l..........................................................
.................................................... Inte rator:........ r r S
Certified Operator:
Location of Farm:
Operator Certification Number:
_511swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design
Current
Design Current` '" Design .. Current .
Swine Capacity
Population
Poultry Ca aci Po alation Cattle Ca aci Po ulaboa .°`
❑ Wean to Feeder
Feeder to Finish 3 $20 3 ZD
Farrow to Wean
❑
❑ Farrow to Feeder
❑ Farrow [o Finish
❑ Gilts
❑Boars
DlsenarLeS & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Lagoon [3 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? [I Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .............. j .................... .................................... ................................... .................................... .............................
Freeboard (inches): 1.5
5100
❑ Yes Jallo
❑ Yes � No
❑ Yes No
hla
❑ Yes ONo
❑ Yes [21 No
❑ Yes IffNo
❑ Yes ®No
Structure 6
Continued on back
DlsenarLeS & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Lagoon [3 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? [I Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .............. j .................... .................................... ................................... .................................... .............................
Freeboard (inches): 1.5
5100
❑ Yes Jallo
❑ Yes � No
❑ Yes No
hla
❑ Yes ONo
❑ Yes [21 No
❑ Yes IffNo
❑ Yes ®No
Structure 6
Continued on back

Fafcility Number: 31 — 112_1 Date of Inspection t9 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 5dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes K) 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 JRNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes dNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
It. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type teeerr•Itac, �k­-n-"etk 6M-,lI1PSA12at", C61ft -17, 1%rCr"'eve; tm17c,- Io&"Coo
13. Do the receiving crops differ with t ose designated in the Certified Animal Waste Janagement Plan (CAWMP)? ❑ Yes RlNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes _W No
b) Does the facility need a wettable acre determination? ❑ Yes PTNo
c) This facility is pended for a wettable acre determination? ❑ Yes V No
15. Does the receiving crop need improvement? ❑ Yes jig No.
16. Is there a lack of adequate waste application equipment? ❑ Yes Fi jNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 2fNo
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 jRrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) _WYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'K No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Ir No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes 19 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes §ffNo
•yiolatidlis:odeecsendugi:iitwilct.fine-wroedithvYoulKtdo furth:sser:
cories otideitce:about:tM visit.......... .
Comments (refer to question #): Explain any YES answers and/or any recommendations of any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): _
1'7 • AJ ,e_d - us
e sa� e A wev-la gly s;s o(a4rd w;4k 6o cf a7s Of `a��l; cq{ fort oh
%t(IC I- Lfjni" 2ts • wh Ph warFe C)=1 yyst r W h.d, wa1 "LltX-ttI rer'irer-wtBpt Gonte S
bet4k1 11 eed 4,o redo 4eces5c+� y s•�kU
2,2 . _i-eebmgl d record s AOt ky6O1"- level as nahca''""��li`unt dvr; t9 e�rf y
r,,.IC 2000. 6rowg' rios-l- I ikeI drd .to+ t164;F, j. Ajee4 4e n;,.f,p7
,PwQ r{' layoor, /evel +s ✓1c1Z to++trl �aN i ,
Reviewer/Inspector Name Sao 17e t. •,i u
Reviewer/Inspector Signature: Date: Z.Z. DI 5100

acility Number: 3' — Z. Date of Inspection 2 O( Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Q1jNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P'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 KNo
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 FZ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JR No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

Division of Water Quality
11 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit r Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit
0 Permitted 13Certified D Conditionally Certified 13Registered
Farm Name: 00
& M FAR m 5
Owner Name: 1zez,
Mailing Address:
Facility Contact: Title:
i ^
Oosite Representative: Kr L—
Certified Operator:
Location of Farm:
Time:
Date Last Opera" or Above Threshold:
County�G�PMIV (/t /
Phone No:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =` 0- Longitude =0 01 =`
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle
Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I I I ❑ Non-Dairy
Farrow to Wean -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity—�j
El Gilts
❑ Boars Total SSLW
Number of Lagoons IEJ Subsurface Drains Present ❑ Lagoon Area IDS ra Field Area
Holding Ponds /Solid Traps �I, ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑l No
ElYes 4 No
❑ Yes XNo
❑ Yes /YM No
Structure 6
Continued

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
VNo
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
(I[ 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?
❑ Yes
dNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
P(No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
V(No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
W(No
11.
Is there evidence of over applic tion? Excessive Ponding ❑ PAN ❑ Hydra tic OverAlt%ad
pYes
dJ No
l❑
LOP
S
12.
Crop type V G V
13.
Do the receiving crops differ with those designated in the Certified Animal Was e'Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
jJ1No
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
4 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & Getieral Permit readily available?
❑ Yes
116No
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
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
/�No
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
eNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1I�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
YJ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo

� 1
Facility Number: — Date of Inspection. Printed on: 7/21/2000
Odor Issues �//
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes I ,TNo
liquid level of lagoon or storage pond with no agitation? 77777
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 )1No
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 f7�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or r
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes ❑ No
5/00

v,
0 Division of Sod and Water Conservation Operation Reviewjz
0 Division of Sod and Water Conservation Compliance Inspection s
r _,�i Dion of Water Quality "Complance Inspection x
0 Other Agency = Operation -Review , . .
Routine O Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection �
Time of Inspection ;3v 24 hr. (hh:mm)
0 Permitted 0 Certified 0 Conditional) C rtified 0 Registered 0 Not O era[ional 13lt Last Operated:
Farm Name:County: ......:..........j�„Q,..........................:......
94.11 ..........................................................................
OwnerName: ........................................................
Facility Contact:
Rf.Cr�
......q...........:.............................................
�Glj�i...,.... Title:
Phone No:.................................
/.1..'.'.!!�t1vY Phone No:
.............
........
................. ...........................
Mailing Address* ............. ............................................................ ......... .........................,
...../......
Onsite Representative :....... .......................... .. (-C_....................... Integrator:............. r....../ l5
CertifiedOperator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude =•=' =" Longitude =• =' =`
Design Current.
Swine . Capacity Population
❑ Wean to Feeder
[Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current
'Poultry ".:t`annrity _:Ponnla6nn i Cattle
❑ Other
' Total Design Capacity
Total.SSLW
Number of Lagoons- 0 ❑ Subsurface Drains Present ❑ Lagoon Area
Holdiug-Ponds"/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If ves, 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
ray Field Area
❑ Yes Pd-No
[]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes D(No
❑ Yes ZTK�o
■ M.
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Al
Freeboard(inches): .....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
3/23/99 Continued on back

Facility Number. — a— Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plankTt;�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes t�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 5?f_No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes U-No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes F2LNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes [F No
12. Crop type '<6 .. ,,..__,,// ""
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El �vo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EfNo
b) Does the facility need a wettable acre determination? ❑ Yes _E34fo
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? ❑ Yes KNo
16. Is there a lack of adequate waste application equipment? ❑ Yes B&
Required Records & Documents ,{..,�"g..nt 17. Fail to have Certificate of Coverage & General Permit readily available? Eld Yes er
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �i�U
(ie/ WUP, checklists, design, maps, etc.) El Yes /
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ,�
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes -EPNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes V40
22. Fail to notify regional DWQ of emergency situations as required by General Permit? ' "'
(ie/ discharge, freeboard problems, over application) Yes ,�t-tvo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Wit
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? [:]Yes �VfNo
0' (Vdwigl'afiofis:o� deticie:ucies were noted during this:visit: You :w3t1•receiye �iti fufr : :
.
Use drawings of facility toe better explain situahons.'(use addititinalpages asnecessary):_.-�
__.e ti _.r ..
IReviewer/Inspector Name I .` h`��'i�"- >`"%�!"��/(!� _ `. 5>-
Reviewer/Inspector Signature:
3/23/99

Facility Number: 3I — Date of inspection T41ip
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes .mot 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 I�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 )y No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes j�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNO
3/23/99

Pp,Al cos z. ,z &OD
I

.!
Division of Soil and Water:Coaservation - Operation Review'
Division of Soil and Water'Coirservation .Compliance Inspection
ODivision of WaterQuality - Compliance Inspection ` >
Other Agency : Operatiow eview Y
. y
Facility Number [—Date of Inspection 9 2
Time of Inspection 24 hr. (hh:mm)
#Permitted lyCertified 0 Conditionally Certified Q Registered Not O ¢rational Date Last Operated: `
t . j
FarmName: ........ �...k�r../�................................................................................................ county: ......_Q.J.....f...................................................................
Owner Name:
Facility Contact:
Flailing Address:
Title:
Phone No:
Phone No:
Onsite Representative:..,t1A.j.L�C. °SI t........................................... Integrator:........_ .Aft. - �� ..... ................. ........... ............... L.. . 5...................................
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number: ..........................................
Latitude =•=` =11 Longitude =•=' =-
Swine '
❑ Wean to Feeder
Weeder to Finish
❑ Farrow to Wean
;r.. ❑ Farrow to Feeder
❑ Farrow to Finish
Curren[` ' -Design Current Design
onulation Poultry - :. Cimacity Population Cattle Cavacit
.. ❑ Other -
Total DesignCapacity
Total SSLW
_ 'Number of Lagoons - Subsurface Drains Present Lagoon Area pray re Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System - -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other �/
a. If discharge is observed, was the conveyance man-made? ❑ Yes fa No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ,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 XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .............N.......................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
3/23/99 Continued on back
A

K
Facility Number: —19 Date of Inspection z,
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
O'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
,Of No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
„KNO
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
VNo
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ErNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
ONNo
12.
Crop type C.. 1rSA-0 J A to 6 J
13.
Do the receiving crops differ with those de 'gnated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
.2rNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
PTto
c) This facility is pended for a wettable acre determination?
❑ Yes
]z(No
15.
Does the receiving crop need improvement?
❑ Yes
[;�'No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
eNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
10<0
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
PTo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
&NO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J2-90
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
P40
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
12-wo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O-KO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
id'rsu
ttld vibl'atitiris:oi deficiencies •were itgtea• during this:visit. •You will reeeiye do fui then
.:
ctirresnotidence:abotitithisvisit..::::::•:::•:•:::...................... .
f7q rf FZ9 Pac It,: rrES F Mus r es' *4 c le�cy ,� eAB� t_a6. I
kr1'e-c.i *) 39 s -
9
Reviewer/Inspector Name
Reviewer/Inspector Signature,._ /J — +7: Date: .Q N72 177
3/23/99

Facility Number: 3 — Z Date of Inspection 1a Z
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
2f%o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
RTNo
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
LRONO
31. Do the animals feed storage bins fail to have appropriate cover?
El Yes
EZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
C;�No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
let Routine 0 Complaint 0 Follow-up of DtVQ inspection 0 Follow-up of DSWC review 0 Other 1
Date of Inspection t 9
E Facility Number Z Time of Inspection 1 t® 24 hr. (hh:mm)
0 Registered 13 Certified E3 Applied for Permit El Permitted 113Not Operational Date Last Operated: ........................
FarmName: .................WLA.......T.: ixtn.,...................................................................... County: ...... pi.`a'................._............................................
Owner Name: .............. Jskuv ..................... ........ WS:.IiaG.?c........................................... Phone No:......C4I�.... S g... ... 3315.......................................
Facility Contact:
Title:
Phone No:
Mailing Address:......q.2q....... aa�.l�wJ...... ........ gj .............. .................. ........ii.l.2t:�.: u:'...1.N...C.c..........................................4. M.........
Oosite Representative:........ 7M:t �........WA..UrAr z....................._............................._ Integrator: ...._�4v.X t.113..............................................._.........
%�.(t i-.... C9- ....... Operator Certification Number;......Zo
Certified Operator; ......................
Location of Farm:
Latitude EEO '�,FEET, Longitude ©• FT5_11 0fl
_;Design Current Design Currents Design Current
Swine Capacity=Population �' Poultry `°Ca_pacity Population Cattle Population'
�' ❑ Wean to Feeder - Layer El Dairy
® Feeder to Finish 3 SZO < ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
'-.': ❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity. -579
❑ Gilts
❑ Boars ram. =Total SSLWr475,2�
Number of L ootts7 HoldinPonds ,F Subsurface Drains Present ❑Lagoon Area Spray Field Area
10 No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? AI IA.
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ®® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
Maintenance/improvement?
& Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IUD No
7. Did the facility fail to have a certified operator in responsible charge? - ❑ Yes N No
7/25/97 Continued on back

Facility Number: at — M Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (IaEoons,lloldinp Ponds, Flush Pits, etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Strucnue I Structure 2 Structure 3 Structure 4
Identifier
Freeboard (ft):................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integritN of any of the structures observed'?
❑ Yes [9No
❑ Yes JZ1 No
Structure 5 Structure 6
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 r health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application .
14. Is there physical evidence of over application? -
(If in excess of WMP, or runoff entering waters of the State. notify DWQ) _
15. Crop type ............�.¢ t u�_................................1 ma .... s�.q"_.............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No violations or deficiencies were noted during this. visit..Yotimill receive no further
...... . ...... . ...... . ...... . ...... . ...... . ...
correspondence about this:visit.
❑ Yes
RNo
❑ Yes
O No
❑ Yes
N No
❑ Yes
® No
❑ Yes
[$No
.......................................
❑ Yes
M No
❑ Yes
® No
❑ Yes allo
❑ Yes ® No
❑ Yes DO No
❑ Yes ($ No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
Comments;(refer to.question #f):.Explain any It answers and/or any recommendations or any other comments ,
Use drawings of facility to better explain situations. (use additional pages as necessary AP
z�. wok ply s. s s► o ld bz Ueda l _
la. "WulJ 6e V4 try 4
7/25/97
Reviewer/Inspector Name jo 1
Reviewer/Inspector Signature: Date: i,&Ak

Division of Soil and Water Conservation [3 Other Agency
I I Hill Division -of Water Quality
F9 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
I I I Time of Inspection BL�in 24 hr. (hh:mm) 1
D Registered UCertifled E3 Applied for Permit E3 Permitted JE1 Not Operational I Date Last Operated: ..........................
1
Farm Name: ... "..Lm ...... ................................................................ County: ..... ................................ L44-4>n
�
owner Name: _Mi..LiiL ..... W.L.Jjj. . ............................................................Phone No:
L.111) .. s.b.,& ...... 31.5.........................
Facility Contact:
Title:
Phone No:
Mailing Address: .... ....... W .. .... ... N ..... ......................... Z1.5 ....
Onsite Representative:..) A.j...X-e ......
.......................................... Integrator: .....C%,m.y.-nA.LS .......................................... ...
Certified Operator,U..z1.'E1............j..Ixa..o ................................ Operator Certification Number,.... I73z.0.............
Location of Farm:
Latitude FT —1 0 FT471 =I I Longitude F7--ne �l =11
-,De'-signi —,,'-1, Current NxCurrent %
1. n, '.Cattle,
a 0 0
0 Wean to Feeder
Wean o Feeder
'pu
—T----TA0Da1ry
10 Layer I
to Finish
Feeder to -jr,-7
10 Non -Layer P10 Non-Dairvi
rFert
w to
Farrow to Wean
W I"!
a.
R,
'10 Other I
'
�A-�"'-Totil'Desigfic, Capacity;
'q
to W
Farrow to Feeder
0 0 Farrow
0 Farrow to Finish
0 ow to s
0 Gilts
�gq" -N,
Total
N,
.Vl�oars
cr Numb�et'df,Lag /,Holdinl;Ponds FO Subsurface Drains Present 110 Lagoon Area 10❑Spray Field Area
EJ No Liquid Waste Management System =110
Zu U Mana
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [I Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in pl/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? _
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
[3 Yes
JR No
0 Yes
®,No
[I Yes
tA No
0 Yes
JR No
0 Yes
91 No
0 Yes
JgNo
[I Yes
RNo
ER Yes
[I No
0 Yes
2) No
0 Yes
PINo
Continued on back

Facility Number: 191—
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
10 No
Structures (Laeoons.Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RNo
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ...... ..x. ........................................................................................................................
......................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
O No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
ER Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
-
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
UtNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..Ia..D.l..r.rt^..r. ..s,.........Svtr..4..[....A.tca..i.u�.................. Ln_r.:.a........ 5........ W.k1.V_f.............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes IgNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18.
Does the receiving crop need improvement?
❑ Yes
MNO
19.
Is there a lack of available waste application equipment?
❑ Yes
t7-No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ELNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
22.
Does record keeping need improvement?
NLYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
IR No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
51-No
�Naviolationsor deficiencies. were noted during this;visiL You.will receive no furftier -
correspondepce about this:visit:::
�. a V RP-& J , b v . tA- V P a L e.�-r.•, .+J-eA.... �,,..� d�v-a.... t-s p-"-JL 0--wy d. i 1'�t�R-s / w of-Q✓--
ol i [, y O V ",Jt.d- y, t S o P u a ILvim. I l lie ,,,.'(-o� , v. w�yf r, �I a�✓p-v ✓4 -�.kRn,�
u.s w-t -1 ; a w s•t.aL�
s
���-t-d- fie. W,,�,-�I b u,,,.•t. SP a f-s c �,. [cy o o �. wall
• �iG')- w r'✓v0.p T .f S t'`C Lj i t-0 rPR.L.}V
llS1+td i.� p.�r �nrti e� F,ttwt. A1Sot v_"
V JI.a_.ln�t p vt i rr : 4 a }i 0, r eL c.a .—a�i c-0 r vim- S P 9 wd �V Vn u
•t�. pt� . V
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: