310204_INSPECTIONS_20171231

NUH I H CAROLINA'Am
Department of Environmental Qual

Type of Visit: Q Co Rance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit�Rouutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ZO Departure Time: F -170-7 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t C "/ N. re-. f
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator*
Certification Number:9
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oul
Layers
Design
Ca I
Current
P,o
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
—TurkeyPcults
Turkeys
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes
[—]No
❑ NA
❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes 0 No 0-NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

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

Facili Number: 31 - 0..0 jDate of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ' /j N� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 Signature:
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Ej No, ❑ NA ❑ NE
❑ Yes Ejj?�'❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Date: 'S/ q r %
Page 3 of 3 21412015

Reason for Visit:
Date of Visit: El
Farm Name• i
Owner Name:
Mailing Address:
Physical Address:
O Complaint O Follow-up O Referral
Other O Denied Access
Arrival Time: 0 cd,yh cparture Timer �ounty:
Facility Contact: Title:
Onsite Representative: ZCA ` ^ &'Ca
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: ZB
Certification Number:
Certification Number:
Longitude:
Region:
Design C•ucrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D­vyjP,oultr.
Layers
Design
Ca aci
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
El Boars
Pullets
lBeefBroodCow
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 ,ONo ❑ NA ❑ NE
❑ Yes 2!1 No
[—]Yes J�j No
❑ Yes
Yes
gj'No
No
❑ Yes
eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Ins ection: 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes )2 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 2-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Ej'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Ye�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,E5—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 El —No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E]"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;3'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ja-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ETNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes -El-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ETNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes .ENo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0-%
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,E]'No
❑ Yes „e o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412077 Continued

]Facility Number: Date of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ 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 ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oaees as necessarv).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
3/aa/i

F/
Type of Visit Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 Arrival Time: E td eparture Time: County: !1 Region: '
Farm Name: / (/ C?&11 ri t"" Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Ni
Back-up Certification Number:
Latitude: n o n' n Longitude: I^i o i I
a
-
Design
Current u�
D`estgn# Current "'"`;,�„,Destgn"°� Current"4y
Somme
,-apaci
#-
Population _ Wet Poultry
Capacity Population'- ,Cattle Capactty�PopgXglation-
❑ Wean to Finish
1„ ❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
=.^ ❑ Feeder to Finish
El Dairy Heifer
.� ❑ Farrow to Wean
p" Dry Poultry
= . El Dry Cow
❑ Farrow to Feeder
�
� El Non -Dairy
- El Farrow to Finish.
x ❑ Layers
❑ Beef Stocker
❑ Gilts
x ❑ Non -Layers
El Beef Feeder
. ❑ Boars
".` ❑Pullets
J ❑ Beef Brood Cow
A❑ ther:
❑ Turke s
m.
* t ❑Turke Pouets%
�; ,,„m. _
�. #+ r r
= Other
f ?. [I Other
ui'es:=l
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
Vj No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
'V No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

i Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure i Structure 6
Identifier: 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
e/ large trees, severe erosion, see ❑Yes ❑ o ❑ NA ❑ NE
(�targ page, etc.) ,� /
6. Are there structures on -site which are not properly addressed and/or managed Yes LYNo ❑ NA ❑ NE
through a waste management or closure plan? TTTT
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 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Auplication
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
)6No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
VJ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
G/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
WNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
44
Reviewer/Inspector Named Phone:
Reviewer/Inspector Signature: Date:
121281041 f rantinued

. Facility Number: — Date of Inspection 3 Q
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Aj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Id No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZjNO
I ❑ 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?
❑ Yes
UNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/UNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
TT
❑ NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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
EfNo
❑ 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
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,(�
L"J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
Additional Comments and/or Drawings: s V
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit J2-- ,',"oommpliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit p routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: `-`—"'-`Y� ' eparture Time: County:
Farm Name: J C' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
OnsiteRepresentative: _L2�'�t `t+v.�' Integrator:
�r
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: M o F-T [7« Longitude: [7 o
Region:
Design Current Design
Current
,SNtue'CapacityPopulation =:` WetP,oultry
-Capacttyop,;ulah"o"n•n.
,„.Gapacity•P.opulatlon>Cattle
❑ Wean to Finish
❑ Layer
Dairy ow
❑ Wean to Feeder
❑ Non -Layer
$W
Dairy alf
❑ Feeder to Finish_
eifer
❑ Farrow to Weanw❑
-Dairy
Farrow to Feeder
•.airNon-La
❑ Farrow to Finish
tockerGilts11
eeder❑
Boars
rood Co
"
Other
�:
" ` Number o Structures
� " er U�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ 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
Page I of 3
12128104 Continued

Facility Number. iL— Date of Inspection
o4aste 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
St e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
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 ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #):. Explain any YES answers and/or any recommendations�or any other comments
a tea. m
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name -
"w'„. Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12178104 Confinued

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

y
Number
JaWivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit siO C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ElDenied Access
Date of Visit: rival Time: Departure Time: County: h Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
OnsiteRepresentative: ('f�✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator: r�(/?
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =. = Longitude: =o =, ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P[No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes IQo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
—Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes )3No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
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 � 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? El Yes KNcn El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 41'0o ❑ 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 Po ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes <0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
lKo
[I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ 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
,LEI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
L] Vo
❑ NA
❑ NE
Comments (refer to question°#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings'of facilityYo�better explain situations. (� a additional pages,as necessary)i
Reviewer/Inspector Name L Phone:
Reviewer/Inspector Signature: Date: c� i
Page 2 of 3 12/28/04-f Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes KrOl
El NA ❑ NE
El WasteTransfersnnual Certification
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Weather Code
Did the facility fail to install and maintain a min gauge? ❑Yes No ❑ NA ❑ N
22.
E
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
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
//
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,_,/�
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yest/�
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�Q o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
( No
❑ NA
❑ NE
Additional Comments and/or Drawings: _
� O��C�r� A5OK /C7� F
12128104

Fi'
ADIDRivision of Water Quality
Facility Number � _ ,�O 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a ' Departure Time: County: A92L Region:t/���
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /i Title:
Onsite Representative: l9/ca C %_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
L Longitude: = U =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
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
E]Dairy Cow
E]Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =1
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
Q-No
❑ Yes
J�No
❑ NA
❑ NE
❑ Yes
_' o
❑ NA
❑ NE
12/2&04 Continued

Facility Number Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EXNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�Vo ❑ NA ❑ NE
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [fNo ❑ 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 [ 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 EYNo ❑ 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 [Y No ❑ NA ❑ NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [No El NA El NE
maintenance/improvement? 0�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes Ld No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
pNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ YesNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
P�No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[/No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:

Facility Number: 3 — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
rrr---KKK
t o 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a min gauge?
❑ Yes
Jallo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dIVo
r�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
i No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CiNo
❑ 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
L,d No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments and/or
12128104

..
^� ��ivis-on of Water Quality
Facidty Number 3 Lt Division of Soil and Water Conservation
- — O Other Agency
Type of Visit (3r-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit QrRoutine O Complaint O Follow up O Referral O Emergency 0 Other ElDenied Access
Date of Visit: / Arrival Time: �(% De arture Time: County: )L(Ote'e�.'o Region: �L
Farm Name: �G2�i/Ul/IG�i,_ YiY Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &4:;r./
Certified Operator: C.//
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = " Longitude: = o = ,
Design '! Current ` ' Design Current Design Current
Swine - Capacity. Population Wet Poultry Capacity Population Cattle Capacity Populatom
Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
❑ Dairy Cow
❑ Daity Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ='
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

yFacility Number: — Date of Inspection
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):
IReviewer/InspectorName I I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

i' Facility Number: — 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�P[o'rA
Page 3 of 3 I2128104

Type of Visit 9Z'ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 8 o rrival Time: Departure Time: County• Region:4e��'
Farm Name:_ c OL✓ / Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
= « Longitude: Q o =
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 1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes rrNo
El NA ❑ NE
El Yes ❑ NA ❑ NE
12128104 Continued

FacilityNumber• — 0 G Date of Inspection a D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in):
5. Are there any immediate t eats 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 P1�o ❑ NA ❑ NE
❑ Yes j2rNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [3'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑.No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) l
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑o ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ld No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes �P No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,❑ [IDt"o NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes LJ ❑ NA ❑ NE
Reviewer/Inspector Name M.Q h Phone:
Reviewer/Inspector Signature: Date: K / o bs—
Continued

�aciiity NumDate of Inspection 8 o a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P<0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fait 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 CA WMP?
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
❑ Yes ❑ No
❑ Yes ONo
❑ Yes rNo
❑ Yes )mif No
❑ Yes [--]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ NA PAE
❑ Yes
L� NNo
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes 1 NNo
❑ NA
❑ NE
Ely es X NN
❑ NA
❑ NE
El Yes IJ No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
.Zo) �l2ase Pfov�dn� de��SYvzd r�� f�c
12128104

IType of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 95 Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit:
Permitted 0 Certified [3ConditionallyCertified 0 Registered
/Farm Name: 441/ut_J rA F,P(n
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 2C VOT.4�' S
Certified Operator:
Location of Farm:
Date Last Opera d or Above Threshold: _
County: t[f
Phone No:
ryry����ll Phone No:
Integrator:.
Operator Certification Number:
Swine ❑ Poultry []Cattle ❑Horse Latitude F---I*=, =- Longitude
Design
Current Design
Current Design Gurrept
Swine Ca achy
P,o ulation Poultry Ga achy
P,o ulation Cattle Ca acity P,o ulation
Wean to Feeder O O
❑ La er
❑Dai
- Feeder to Finish
/Dz)o
JLJ Non -Layer
❑Non-Dai
arrow to Wean
r7
,"
❑Other
'Yu4il�ilr9Ya . n
Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps
❑ No Li uid 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 stone 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 ❑ No
❑ Yes/No
ElYes m No
❑ Yes ([J No
Structure 6/
Continued

.r
Facility Number. — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ �trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? / ❑ Excessive
12. Crop type
13. Do the receiving crops differ with those designated in/the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ PAN ❑
Waste Management Plan (CAWMP)?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
❑ Yes P(No
❑ Yes No
❑ Yes �_,t No
❑ Yes No
❑ Yes ,,�___...���+++No
4 Yes IJJ No
CJ Yes Ill No
❑ Yes m No
❑ Yes /� No
❑ Yes No
❑ Yes 0 No
ElYes VNo
❑ Yes 2 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
No
0
0
�fN
I(J No
/No
No
�dNo
IPNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-'#: ,ram-.
Comments (refer to question !�: Explain any,YES answers and/or any'recommendahons or ai y o er_comments
Use drawiri s I facility to better explain situations (usV
itional pages as necessary) Field Copy El%Final Notes
,a
Qom,'�cG ���T� �S �cG ,g���9zr✓�, E�'O,e s
//
��1f%
�nl OiQO E
,4E0 � �y�ff,Ej� l�t�G� STJ� >� �-,�� /✓�iA�/
Reviewer/Inspector Name
Reviewer/Inspector Signature: - Date
05103101 t/r Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes �No
❑ Yes No
❑ Yes 3&
❑ Yes YNo
o
El Yes
El Yes ❑ No
Additional Comments and/or Drawings: v .: .4.. S
05103101
05103101

y`
i
r-
r;
l

ii
ton
Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
for Visit <Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date. of Visit:
Z O e
XPermitted 0 Certified �0 Conditionally Certified [3 Registered
Farm Name: ........ N tr_q_ ..... /SL-v�!..F--r.pn.............................................
Owner Name: ......QV.�A'r?!!'J... !...I...G::°tin...S...........................................................
Facility Contact:
Mailing Address:
Title:
Time: �Printed (,n: 7/21/2000
Date Last Operated or Above Threshold: ..
County:. .......................................
Phone No:
Phone No:
Onsite Representative:....1'..C,.k.` �/ N O'rr!f..........................................Integrator: , /41) /�s FA ✓..t
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry []Cattle []Horse Latitude Longitude �• �' �"
Design Current
owwc
PS Wean to Feeder
%Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Ca aci Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area. 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
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'? (lf 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
Identifier:
Freeboard (inches):
5100
Structure I
36
Structure 2 Structure 3 Structure 4 Structure i
❑ Yes 'gNo
❑ Yes ,'$(No
❑ Yes 5'No
"/,q
❑ Yes 0No
❑ Yes ONo
❑ Yes 5No
❑ Yes R No
Structure 6
Continued on back

FaciQty Number: / — 2 Date of Inspection 3 /5 O Printed on: 1/9/2001
k 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes MNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes
] No
9.
Do any stucmres lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
JdNo
Waste Application "
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
0No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
J9No
12.
Crop type &rVV%vda. Y. 6reize, Mdu�i /1VZcepl ,S';,ml/ 67i n
13. Do the receiving crops differ with those designated in the Certified
14. a) Does therfacility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Management Plan (CAWMP)? ❑ Yes PNo
❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
J. (Vq•yiulati¢fjs;ojr tl$fjcpencies •we re pgfetk d�triu ' tLls;visjt;, Y:oo wdl-tecgipe o cu'
corresporidence:ahotitithls'visit ..........................
omments (refer to question ft ;Explain any YES answers and/or any recommendations or any ottie%eomm
gcr'114y otnd reeards aloe well
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes -A No
❑ Yes No
❑ Yes No
El Yes iffNo
❑ Yes JWNo
❑ Yes ONo
❑ Yes �fNo
❑ Yes §(No
❑ Yes 0 No
Reviewer/Inspector Name S "---ZWR
Reviewer/Inspector Signature: Date: S 5/00

Facility Number: 31-20
Date of Inspection Printed on: 7/21/2000
s� Wor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below
NrYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
((No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ONo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
gNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
5/00

Facility Number Date of Visit: 2'? OO -time: � Printed on: 7/21/2000
20
Q Not Operational Q Below Threshold
Permitted ❑ Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........................
Farm NameF�r m
............................................................
Owner Name:..... _U qr e ...........
!� f................._...............................................
Facility Contact:
Title:
MailingAddress: .....................................................................................................................
1 lV orris 9
Onsite Representative. - -tG AEd .._._...._._}.._ kn.._p.! 2 tG
Certified Operator:
Location of Farm:
Countv:..D.V.vl i...................................
Phone No: - 7 _
Phone No:
Integrator: _Vr ..A r`'t `r W) s
i......1�....................................................
Operator Certification Number: .......................... _.............,
OSwine []Poultry []Cattle []Horse Latitude =• =' =4' Longitude =• =' ="
Design Current
Swine Capacity Population
Wean to Feeder
$'00
Feeder to Finish
/ OQQ
Farrow to Wean
3566
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry capacity Po ulation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I�� ❑ Subsurface Drains Present ❑ Lag,�nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
DischarLes & Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes 15-No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? []Yes ,EfN0
b. If discharge is observed, did it reach Water of the State? (If ves, notify DWQ) ❑yes [!�No
c. If discharge is observed. what is the estimated flow in gal/min" h /,1
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
5/00
Struc�lurc I
....................................
'f3
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 8 No
Structure 6
Continued on back

Facility umber: ;j/ -Zdy Date of inspection Id % b Printed on: 7/21/2000
5.'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
❑ Yes $ No
❑ Yes 9 No
❑ Yes 9 No
❑ Yes %No
❑ Yes B No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN J❑ Hydraulic /Overload ❑ Yes RS No
12. Crop type 66 r ✓✓tyda 6Z r-o e, M4+yci OVerse-eq s—,.g 1/
0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)'? ❑ Yes ®,No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? '
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
. .I.0 VI. . . .I. . . . . . .e,. . . . W. . . . . .. atH'l-9{�11S,VISIt.-Y,OIt Wlt� l'eCQ1VC i. t�. . I1C .
.......
about: this visit:::...:: ............ ............ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes ❑ No
"Yes ❑ No
❑ Yes PTNo
❑ Yes A No
❑ Yes &No
❑ Yes 0 No
Yes ❑ No
❑ Yes 0 No
❑ Yes 9 No
❑ Yes ® No
❑ Yes J5 No
❑ Yes El No
❑ Yes X No
lq•rcjlr4 i.r fl5n4e/t te,- -Aw4able gcreS dP e✓✓hi, /'dvt�
/°I, t`j/o/ol/,o44,iopitve-y4s 4o� 4e sawfe-rieldlpv%/ dveih�kesa+�e
cro� SEgSor. qre ?-eeoede4 ot-t, d:{L,-ep) j SkR- Z).<;_4h1s w1Gy be
odve �o isdakes i>7 ¢rothrF�rrirt� inFb.nt�;o>7. 8e -<a" io Aecord
odl eves on 6ne =(?R_z G.- A y;�ey) Pvll "'n g3;ve� camps eel
13e Sv✓^c ->O use pe,rey l/ ot44Cd wgrfc a�glys;� en /1RyZrs,
ReviewerAnspectorName .54o/1Ew4
ReviewerAnspectorSignature: /t(/ M/UJX*T_ Date: /O/L'W/O 5100

Facilif Number: 3 / —�j Date of Inspection Printed on: 7/21/2000
Oifor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
)f 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
El -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
k.No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
R No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
A Yes
❑ No
J
s/00

E3 Division of Soil and Water_ Conservation -Operation Review,
D,Division of Soil and Water Conservation-CompGancein§pectiop -
'Division of Water _ - ,4 _ -
® Qualtty'CamplianceInspection
' t • 0 Other Agency = OperatiomReview-
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number _ o1QLn Date of Inspection ®/J-03-W
Time of Inspection ly.'y 24 hr. (hh:mm)
Permitted E3 Certified 0 Conditionally Certified E3 Registered 0 Not Operational I Date Last Operated:
Farm Name: ......XGf/L.....,.-.11�h!tjj................//.................................................. County:........�:./�.......................
Owner Name:....... ll/. ............... _L..N,f?il.Lll...........�. r%n.:5........... Phone No:
.. /........................................................
FacilitvContact:..............................................................................Title:................................................................ Phone No:.....................
MailingAddress: ................................................................................................................. .......................
Onsite Representative:/P.[/�1...........t`1....GY..�... Integrator......... l..CL.f..f..................................(.�...�..))..��.........._`..
Certified Operator: ................................................... ............................................................. Operator Certification Number: .... Z��. Aie 611+ck
r{uu k Location of Farm: I V s
Latitude =0=' =• Longitude =• 0' =K
Design Current ' Design Current Design
_- - `-Population
Current-
Capacity Ca acity PoultrY Cattle Capacity ty Populatio
nSwine Po ulation Caacity o ulation - ® Wean to Feeder r ❑ Layer ❑ Dairy
Weeder to Finish ❑ Non -Layer ❑ Non -Dairy -
Farrow to Wean 5A2D-
❑ Other
[IFarrow to Feeder
❑ Farrow to Finish Total Design Capacity
-_ ❑Gilts
❑Boars _ Total-SSLW
(Number of Lagoons 0 Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
` . Holding.Ponds /Solid Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
L 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)
e. 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
❑Yes ANo
❑ Yes ZLNo
❑ Yes UkNo
❑ Yes No
❑ Yes ,� No
❑ Yes No
❑ Yes [a No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �(/p
Freeboard(inches): ..............1..................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes - ® No
seepage, etc.)
3/23/99 Continued on back

acility NumDate o1Inspection
v$.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
RA No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
El Yes
rp�I
K No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
CK No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[A No
12.
Crop type S&
13.
_B1
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[g No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
t4 No
b) Does the facility need a wettable acre determination?
Yes
❑ No
c) This facility is pended for a wettable acre determination?
Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
PQ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
QA No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
rVNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[$i No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
P No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
{Vd yiul'atitil... deficiencies •mere note$• ditrif. 9 this:visit; •You :... eceiye iriO tui•thtr
: � :' conesnorideilce: abovti
3/23/99

Facility Number: 31 — 0 Date of Inspection (�
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Z No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
V�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
PQ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
RNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
P�No
3/23/99

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
L Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Olher
Facility Number —� Date of Inspection q
1
Time of Inspection lA ha (hh:[nm)
0 Registered E3 certified E3 Applied for Permit 0 Permitted 13 Not Operational l� Date Last Operated
Farm Name: ...............1'.!�Yy.7.1Y4�4....._.r�...!<.r.....N�:......................................:....... County: ......Xu�,i..r....................... _................
OwnerName: ............... ailudiltr..................................................... Phone No: ................ _.....................................................................
Facility Contact: ............. �av i.....�3�.LC.IL�tY..... ............ Title: ..... _......................................................... Phone No: CRi o�2 `l.L.:.AI�A.... _..........
MailingAddress: ..p.....S.._X... Io..0..-7............................................................................... ....... ROR..... iillt..Nk........
..... ....... ....................
Onsite Representative:.......G..tKG: _...... Integrator: ........ sI.Ip ...........
_..................�....A....�....5._�................
Certified Operator;..........................................:.................................................._................ Operator Certification Number ;._......................................
Location of Farm:
Latitude Longitude �• �' 0°'
a: Design, .Current
>�
Design. Current �Destgn '.Currents
Svvme _- Capacity;Ropulation
--- ,_+
<, Poultry,`; ;Capacity, Populattou Cattle Capanly Population 11
- Wean to Feeder
_
- ❑ Layer I
airy'
00 Feeder to Finish abo
�- ❑Non -Layer^
❑Non -Dairy
Farrow to Wean
❑ Other
❑ Farrow to Feeder
Total Disig n Capacity_:
❑ Farrow to Finish
�:
❑ Gilts-
.; Total SSLW.'
❑Boars
Number of+Lagoons / Holdrng Ponds_;
0 ❑Subsurface
Drains Present ❑Lagoon Area 10Spray Field Area
"❑ No Liquid Waste Management System �t�„ T
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made9
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes i�] No
❑ Yes ® No
NIL
❑ Yes
W No
❑ Yes
(N1 No
❑ Yes
0 No
Yes
❑ No
❑ Yes
0 No
❑ Yes
lA No
Continued on back

Facility Number: � —
Ir 8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes No
Structures (Lagoons,Iloldine Ponds, Flush Pits, elc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l 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 integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
0 No
Structure 5 Structure 6
................................................................
............................. ... _...............................
❑ Yes
W No
❑ Yes
® No
Yes
❑ No
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 .............. LtY..D'..O!n............................. .... yAx, ft...........................................................................
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..You will receive no farther.,
correspondence about this visit ,'..
❑ Yes ® No
❑ Yes FANo
❑ Yes I.No
❑ Yes q No
W Yes ❑ No
❑ Yes ® No
❑ Yes [31 No
❑ Yes [) No
Yes ❑ No
❑ Yes T No
❑ Yes 1A No
❑ Yes 19 No
S. f • AL; �) k, dter..� t* I _s 1ACO J Is.. rrrirea . '
tz $tz�c p+Vw5 -oxcvw 6e--rntn.L'w�cd/. ©uf IoJde+• t% ke w 11 S�tev(() rhOWtt]. tm{
W&Sk s�t Lw L r`Ci..o f&) 4� , �otAaz,.. p f
M. Cor ktNJa 4" r. YO�t %Q'yW t .� tied •
2z. Cd 4 01 Cc�C �PM+aa� �ext*it s�:l� be fi WC4— 4'V'A
( &Ik drv.�y vls nvavler Qkov Ci'ttddivl�s nt� q,• 0.t l'-C'�eo,; tpp J&U gv-qv�Cxl T-dl slWA
I),- 11't - j W rt.w4s, Awl rMYrey« rt,t uii�r� eJ Lr,, (� e ctdd (tcw .� _;Al/ac at.- �4Gt
fir` bt aaa�t ,� ►.�� :� gg. 7/25/97
Reviewer/Inspector Name k'-
;r
tna�/r� f�irt
ti.v. _
'.. Reviewer/Inspector Signature:
A!— Z -
/ -�
Date. -I !I/n

Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
❑ Not Operational Date Last Operated:
Farm Name:_.hi..0...1w.r�..au....S.p,.1...1.__ :S—"_r+^ ....._..___...._._.... County: _D?.1-.1-is:�__�..__....__.....jd„�.1.R-a
Land Owner Name: _ . 10
u�........ Phone No: __....�.
Facility Conctact: �%o ui.t.....LQ.S�..i. �...._... Title:._....._.....__......_. __ Phone No:�9
__. , I __... ..... __....
Mailing Address: ... P,..:.._g.frx..._...._.... _....... __..... ._..... .............. _......
Onsite Representative: J..£ _Q. r_�..,__ Integrator:
Certified Operator: ... ..... — Operator Certification Number:
Location of Farm:
Latitude 35 • ©� �� Longitude �• �©"
Generai
1. Are there any buffers that need maintenance/improvement? ❑ Yes EkNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/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
4/30/97 maintenance/improvement?
❑ Yes f9 No
❑ Yes E No
❑ Yes
® No
❑ Yes
® No
❑ Yes
RrNo
® Yes
❑ No
Continued on back

Facility Number:.,....._—...ZQ
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Laaoons and/or Iioldinp Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Freeboard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
1...3...._. _ ....__.._.... _....__.._....._ _...._.
10.
Is seepage observed from any of the structures?
❑ Yes
E] 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?
® 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
91 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type $racy.Lt..r. .......�..__...._...._.... ._...._ ..Y...._..... _....._
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
J'No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
®•No
18.
Does the receiving crop need improvement?
❑ Yes
10 No
19.
Is there a lack of available waste application equipment?
❑ Yes
EC No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®•No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ELNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 19 No
24. Does record keeping need improvement? 19 Yes ❑ No
Comments (refer to, reco
queshon :,Explam'any YES-'answers'and/or anymmendahons or any othercomments —
Use drawings of facility to better ezplam situations (use`ad�tronal "pages as necessary)
"�.
$ . R x�a-I-a a• e. b �e a,�e-a..r o-.nL w cu � o � 4-c i.� S f --+--� �� 4
1L,P-A-�e,taf- to0-It pvea or 1 po wu!I. 1t i.!o t�L b o `]oo-c(
l \.J LLa -er %vy,o-v
" i c,
Provti Ft \ Ea.fior. PVis0, 1v \-Q,�CJatI o� (1
Nt a IC Q S v r,4- i �t d r v 1in rS W U .t t-t {ry Q wl 1 P l w
/ P-41 1 .t
-CL � V � 4 •� L 4 r, V rY�✓L 1L
Reviewer/Inspector Name
T
Reviewer/Inspector Signature: Date:
cc: Division ajWater Quality, Water Quality Section, Facility Assessment nit 4/30/97

Site Requires Immediate Attention:
Facility No.*; 1 - T
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: 4- 1995
`` Time: 2 • Dr.
Farm Name/Owner: ijl'� �u ff e Fgy ov, p p
Mailing Address: 2Z5. W-&c15 & d• LW52o
County:
Integrator.
On Site Representative: " r
Phone:
TO Z (e 11 ZD
Physical Address/Location: FT"Oht r' Ville- ` 0 I V , I ffff- Otl SF —
Type of Operation: Swine ✓ Poultry _ Cattle
Design Capacity: 51300 Number of Animals on Site: ?(050
DEM Certification Number: ACE DEMCCCeertification Number: ACNEW
Latitude: 35 ' Q�' � Longitude: �' �' � Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (S)Dr No Actual Freeboard: Ft. _�2 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes o No
• Is adequate land available for spray? es or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: FJPr-mu 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
L - L gk,�s
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.