310213_INSPECTIONS_20171231

NUH I H CAROLIN .�
Department of Environmental Qual

r3
(Type of Visit: Qj Cotq¢[iance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / / / / / I Arrival Time: 9 Y Departure Time:©© County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: � /I,t / c-k`' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: 4` q -3 �-
Certification Number:
Longitude:
Sw' a
can to Finish
Design - rrentM
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
u 09 a
Non -La er
Dai Calf
Feeder to sh
Dairy Heifer
Farrow to an
Farrow to Feeder
Farrow to Finish
I) , P,oultr,
Layers
Design
Ca �aci
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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 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 TNER[0:]
NA ❑ NE
❑ Yes NA ❑ NE
Page I of 3 21412015 Continued

]Facility Number: jDate 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): 37 3 G
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
[3'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
uhreat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
1� " ❑ 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?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
rN
❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 2 Date of Inspection:7/727
24. Uid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No - NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E]-No
❑ 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
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
❑'fto
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EJ-11-o—
❑ NA
❑ NE
t::omments (refer to question #): Explain any YES answers, and/or any additional recommendations�or,anyrothet comments.=.
Use drawings of facility to better esplain'situations (use additional pages as necessary).,
a5 5C�9. y„r oki ;s Sep %�pr 6wf ;s
r[l+i��
S 0 17 t/�i N n �. r S7' DO G �i L<o G� / S
f� r +4- .'S r r op.
Reviewer/Inspector Name: 0'V'/ tit l� o .tee. // W *,� �i(�U
/� GY, (,(Q7 Phone:
Reviewer/Inspector Signature: ��✓" V ( � Date: Y / 17
Page 3 of 3 21412015

(I ype of Visit: (j Co}rfpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: C1J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S V Arrival Time: QS" Departure Time: S County:DO PI!_ -
Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Z'G.,� ,v pTGIaGLI�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1,9 4 39
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Curren[
C•a[tle C6 —ity Pop.
Dai Cow
Dai Calf
Wean to Feeder
Non -Layer
Feeder to Finish
Farrow to Wean
Dr, P,oult
Layers
Design
Ca acity
C•unrent
P,o .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
I
Pullets
Other
101 Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes [-]No
[-]Yes ❑
❑ Yes [ No
❑ Yes Vo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Ins ection: �L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3
Identifier: e AGyol J I LA6r ly
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA El NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 1No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZI No ❑ 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 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?
��s No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ,� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Oth r:
21. Does record keeping need improvement? If yes, check the appropriate box below
RYes [—]No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ,E S/oil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[Judge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [3No
❑ 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: 731 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes
25G Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
EJ ❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes I �I ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
No
No
0
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #)::Explain any:YES ansdersand/o„„'many additional recommendations o�-anyrother comments:= ^^�
Use drawings of facility to better explain situations (use,additional.pages as necessary). ?.
15,) SG C) NEE vi fi 13e ;�emovc o ASt?2 fi P2cV lS -5l t R rCST
TO 66: C_iT .
;�l) SLd�GE �v2VEJ 7ysck/JESS fA)1g000AATE- RFc�LCvL %.
casc, ,UAVJ
WALLS !AAPPV�P!
Reviewer/Inspector Name:
Reviewer/Inspector Signa[m
Page 3 of 3
Phone: 7 b - 3
Date:
214,4015

Reason for Visit: C) Routine
Date of Visit: (p t t y
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Referral
0 Other 0 Denied Access
Arrival Time: bS Departure Time: County: t PI Region:
Title:
Owner Email:
Phone:
Onsite Representative: Art- MmrcAc ,� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: IM n
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
��
]Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry P,oulty Capacity P,o P.
Layers
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
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 DW R)
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
Page I of 21412015 Continued

acili „Number: I Date of inspection: t I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ]]No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A6-6inq}'/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ili 1'1� 9_
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 6No
❑ 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 env'ronmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? 57Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes E2rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�o
❑Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
20
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [nN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNoNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes O Nf
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Ld No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Check] ists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Q Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections E2vronthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R�No ❑ NA ❑ NE
Page 2 of 21412015 Continued

acitity.Number: 1 . Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes N�1�
o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA 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 EKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [T 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?
to
answersand/or`any
❑ Yes ❑'<o
❑ NA
❑ NE
❑ Yes 10
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ENo
❑ Yes
❑ Y gNo
or any
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
use arawmgs al tacutty to better explain situations (use-aamnonat pages as necessary).
�(.� zNSzY)E t Krc \/VAUL— u AS C- M-0SMVn/ . ?LASE A OO2S-155, �
�I,� 1'" 12�1tn1FA�L .sNL'U--AL-S S(a,/iq -2/(P/ 5.
Reviewer/Inspector Name: �p{J,��t,�- L
Reviewer/Inspector Signature:
Page 3 of 3
Phonce I � m
Date: 1p 11
21412015

3
Type of Visit: �(Z) Cogipliance Inspection U Operation Review U Structure Evaluation Q) Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other' ,r0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: tJVr�LxtjRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (0. R Si'V1- . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 11B 4"; It
Certification Number:
Longitude:
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
Non -La er
I IDai
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult ,
ILayers
Ca aci +
P,o ,
Dry Cow
Non -Dairy
I I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
OtherI
—TurkeyPouets
it—
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 n NY ❑ NA ❑ NE
❑ Yes =iJ/No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: Date of inspection: 5
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 Structnur"'e2 ' Structure 3
Identifier: 0 LAGO^2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� Q
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes CNo ❑ 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 structures lack adequate markers as required by the permit? ❑ Yes 6/Noo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require ❑ Yes C "o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes in No ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I — YNo ❑ 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 [/r
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes F
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 2 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2f/o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io
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 to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g ❑ 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?
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 ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
❑ Yes [/� ❑ NA ❑ NE
❑ Yes [JN ❑ NA ❑ NE
❑ Yes 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). +
r() zMP2 RASS CojEbL O, i_V_E � Aus l° j�12 0Lo r
CR.osnl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
14 L/ Phone 16 {? —
Date:
2/ O11

Type of Visit: (Z Cooq�pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (� Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2 Arrival Time:® Departure Time: County: � Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: iF dz (,Y J h&ZT li
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
I ?Y3 b
Design Current
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
Da' Calf
Feeder to Finish
Farrow to Wean
D , P,oultr, +
Layers
Design
Ga aci +
Current
P,o ,
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Brood Cow
Other
11 Other
Turkeys
Turkey Points
Other
MBeef
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 ❑ o ❑ NA ❑ NE
❑ Yes L "N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: V( tA6a?6_2_
Spillway?:
Designed Freeboard (in): c
Observed Freeboard (in): 3U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes n 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 L�< ❑ 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 I XN0 ❑ 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 E2 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes IDo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PI'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
bIo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [v No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

jFacHity ],Number: -A Date of Inspection, 5 2. 1 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C
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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 Io ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes E ]_No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E N ❑NA ❑NE
YV NA NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
�JUto Aft-tj Phone :CQI 73�
Date: § -L-
4/201

Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tL Arrival Time: i o Departure Time: 9 6 County: 0 UP(;t�j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: RlL 22`( §Wt1T1�l
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1143.6
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
(�4o0
mb
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult .
Layers
Design
Ga aci
Current
P ,
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes []"'No
[—]Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: 943 Date of Ins ection: 9
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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: LACuJ LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z- 41
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2/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 dNo ❑ 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
0 fIo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - al$ Date of inspection: glIt 11 Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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)
❑ Yes
gNo
No
W❑ o
NNo
E No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
NA
NE
❑
❑
[3] No
❑ NA
❑ NE
E3�No
❑ NA
❑ NE
[i]No
❑NA
❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: QIZOC(I,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CQp) em - 73 o p
Date: Q 1-
21412011

w
Drvtsmnrof WaterQuahty,
`(FaCthty Numb¢r" Drvtston of Sod and,Water Cause rva ion
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: j y Arrival Time: Departure Time: tics County: l l.L*_ Region: _
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative, i EM < �M-rTH Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ° = [� Longitude: °
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
s
❑ Yes in No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑NA
❑NE
El Yes
❑ Yes❑
ON,, NA
❑ NE
❑ Yes
L No ❑ NA
❑ NE
12128104 Continued

Facility Number: 31 —a13
Date of Inspection J 4
Waste Collection & Treatment
y 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 � r /S�tructure 2 Structure 3 Structure 4
� l. Identifier: LA6-I G-66.0 2-
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): 33 Jfo
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 LI No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No
El NA ❑ NE
❑ Yes C 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 Ld No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes L—i/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement? _ ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes !4 No []NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.) ,
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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 ©,do ❑ 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 dNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
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) _
IReviewerMspectorName I- :JUWtJ ELF% 'IPhone: D I
Reviewer/Inspector Signature: Date: g
r
__ O _ra 12128104 17ontinued

❑ Yes [)"No ❑ NA ❑ NE
❑ Yes [}'No ❑ NA ❑ NE
Facility Number: 1 -ate 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
�N
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
❑ 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
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain r-ainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,�
L Xo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,�o
D<c
❑ 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 CA WMP?
❑ Yes
EX,00
El NA
[I 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
UKO
❑ 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
01o
❑ 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
ETC
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

(Type of Visit ('C
Coompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit (J Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Y�/U I Arrival Time: �'30 Departure Time: County: Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: I G-RR.Y SMi-}I
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=o =' = Longitude: =o=,
a
Design Current
Design Current
Design Current
SwineNNNLC.wpacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
® Wean to Feeder
6kW
4=❑Non-La
er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non-Dairy
❑ Farrow to Feeder
Farrow to Finish
Ela
❑ L ers
El Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ 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?
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
0
❑ NA
El NE
❑ Yes
❑ Yes o
�
El NA
NE
❑ Yes ZNo
❑ NA
❑ NE
Page I of 3 11/18104 Continued

If acility Number: — Date of Inspection
Waste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo
❑ 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: LAC>ctyz ) I iAr a u
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
dNo
❑ NA
❑ NE
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? El Yes Y'No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? - ❑ Yes 1_Ji 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 El_
Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W(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
dNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
dN'
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IJ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
dJ o
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments f efer to question #) ,Explain`any YES answers and/or any recommendations*or any other comments rr ,
Use„drawing`s. of facilffy to bettei•:explain situations. ,(use addittonaUpages as necessary)
Reviewer/Inspector Name ; x= , , x Phone: CR1a %R6" I✓�D
Reviewer/Inspector Signature: Date: 14 (� l0
. or- 1

Facility Number: 3► —,A3 Date of Inspection
Ee uired 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes 7No
0
ElYes
❑ NA ❑ NE
❑ NA ❑ NE
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 min gauge?
❑ Yes
,CCENNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<O
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,�
I,Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
d1No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eYJ No
❑ NA
❑ 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
R(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
[/7No
❑ 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
,�/
i, YN-
❑ 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
P'�o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
w
Page 3 of 3 12128104

Division of Water Quality
Fa1[v
cility Number 31 o`tl3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit 1'a o4 Arrival Time: Departure Time: County: bUPL tO Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: �E rt < Sv ^ _t(� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: M o F71 0« Longitude: F-1 o n I I u
Design Current
Design Current
Design Current
Swine Capacity Populafion
Wet Poultry Capacity Populatioo
C>attle
Capa�ciTy Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
® Wean to Feeder
6 400
14000
❑ Non -Layer I
Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Non -La ers
❑Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turke s
Other
❑ Turkey Pouhs
❑ 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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes L/J No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — a Date of Inspection 4 1 S 69
Waste Collection & Treatment
4. 19 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: LAC,-- O I ( Ac-oo0Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes LI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 6 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes OlNo ❑ 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
[2fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(2fJNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
L�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2(No
❑ NA
❑ NE
(refer to:question #): Explain any YES answers and/or any recomi
CAW Nat PL,v F oa SGo 0U4LSNC, OE(. -,SAW WsT14 rWC 100 Igo "6UC=f-5E.Ep
c,,,,E TuLL. wr 5B-Vb ALA oTA eM ASS TWAo So I6 RAT&, , ?LcAse P�E CA
I(N,o CVANG-E Wl)P `ra S o 177 V-ATC
t.,ACsaoW l fk--AIZ VOWC l_60lL5 Gvop,
Reviewer/Inspector Name I V o Id J I phone: mm al - Z37t S
Reviewer/InspectorSignature: _ Date: gIfd"9
P n' 7 nr 4

Fscility Number: \ — k Date of Inspection V tS
Rebuired 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IJ Yes ❑ No ❑ NA ❑ NE
Eg'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?
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 2(No ❑ NA ❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�O//No
No
❑ NA
❑ NE
❑ Yes�(No
❑ NA
❑ NE
El Yes
E No
❑ NA
❑ NE
❑ Yes V(No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes
Ef No ❑ NA
❑ NE
❑ Yes
21 No ❑ NA
❑ NE
❑ Yes
� ❑ NA
❑ NE
El Yes
Zo ❑ NA
❑ NE
Additional Comments .and/or Drawings: -• '' - - `
Page 3 of 3 12128104

t! Division of Water Quality/
11
Facility Number 31 2l3 0 Division of Soil and Water Conservation ✓
0 Other Agency
IType of Visit Q,C,00 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit lD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4�Sr Arrival Time: ij4s Departure Time: County: 17tpL--�i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t?C "ti ? S rv<arlH
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = , = Longitude: = o = ,
Design Current
Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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 ,;
Cattle - Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 E14 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31
Waste Collection & Treatment
Date of Inspection x' - of
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: (Aaotsri L.Af vw 'L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Icy 21
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to.the integrity of any of the structures observed? No
❑ Yes 9❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [,2No ❑ 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 ff—No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 [I Yes DNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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. El Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
U'f4o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name `.jo1-lrl Phone: �%Q)'�?O
Reviewer/Inspector Signature: Date: gift o
12128104 Cantinued

Facility Number. 3 1 — Date of Inspection
Iteauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ ❑ ❑
❑ WUP Checklists Design Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
_ (/
LI 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
0"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0It o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
—Q/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0<0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fNo
❑ 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
LI 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
[I Yes
,_/
E3 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?
El Yes
L7 NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:,,.
Page 3 of 3 12128104

0 Division of Water Quality /
Facility Number O Division of Soil and Water Conservation v
O Other Agency
Type of VisitC(ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S a o Arrival Time: Departure Time: County: fl/Pl _t-i—) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: P(-'awe &-wic w
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude:
Design Current Design Current
'Sµne Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ La er
�® Wean to Feeder I (7 ti 0 a I dd �'. ❑ Non -La et I I-
Dry Poultry
Other
❑ 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
T A
Design - Current
Capacity Population;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Ek/ o ❑ NA ❑ NE
El Yes u No ❑ NA ❑ NE
12128104 Continued

Facility Number: — 13 Date of Inspection
sWaste 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: UQ (scp.J / (A (.,ant) Z
Spillway?:
Designed Freeboard (in): A J,
Observed Freeboard (in): 3`4 3 j
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 E"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EdNNo ❑ NA ❑ NE
❑ Yes EYE o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ U
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? El Yes EdNo ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E/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
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
,E�INo
LEA/No
El NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E!rNo
❑ NA [INE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
O
El NA El NE
18.
Is there a lack of properly operating waste application equipment? El Yes
(No
CYNo
❑ 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):
24) 59NO CO?r W oZ( 1.266 M 7d D/✓ Q
Reviewer/Inspector Name Phone: (17,01)
Reviewer/Inspector Signature: Date: p
12128104 Continued

Facility Number: — 3 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 gn ❑ Mans
❑ Desi p El Other
❑ Yes Zo
❑ NA ElNE
ElYes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
do
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E2KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
EYes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ 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
E J 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
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?
❑ Yes
2(NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
l�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number n , 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit C pliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: T & V-� Ste _yh
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
LALongitude: 0 ° r
Design "Current Design Current Design
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity, P.
-Other
❑ Other -_---- ---�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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?
Page I of
❑ Yes IQNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑I No
❑ Yes
2 NN
❑ NA
❑ NE
❑ Yes
�No
❑ 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
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: GA ( aunt LA c- aa...1 L
Spillway?:
Designed Freeboard (in): try
Observed Freeboard (in): 3 ( 3-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[JNo ❑ 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
�J
Ld 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? ElYes [! lt/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Id N 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 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 ZNo ❑ 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) aEtt,w- .yoNLLO S a 0 C.Lij
13. Soil type(s) Ain" y S.E
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfNo ❑ 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 Lam' No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes rN(
❑ Yes
❑ NA ❑ NE
El NA El 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):
fArz v--L ANh (7—E 0,0 �a1C Crook.
Reviewer/Inspector Name Phone: 4/0) -X& - 7
Reviewer/Inspector Signature: Date: 3 1 _ o ✓✓
Page 2 of 1 12128104 Continued

Facility Number: — Date of Inspection
Reauired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
[I NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[;2 &o
❑ 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 InspectionsWeather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
3�'NN�A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
2/NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,❑,
Ll'No
❑ N
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
V
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�LXo
❑ 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
U<0
❑ NA
❑ NE
31.
If yes, contact a regional Air Quality representative immediately
Did facility fail by
�
the to notify the regional office of emergency situations as required
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
WNp,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes[I
NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
Page 3 of 3 12128104

I Type of Visit P
Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit o Routine o Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: tYi /-!/(/7Arriival Time: Departure Time: County:
Farm Name: `i1,QA1G 1jdWZ / /r/[/I'��j ? - i% Owner Email:
Region: eWl"
Owner Name: px-"V /_1 6&a;EPhone: 20 _S5w- 9�0)7'67
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: %I - 1�7/112
Certified Operator: fR
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
�!
Phone No:
Integrator: GOCD5'.6mo
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
10 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
ElNE
ElYes
,,,gNo
IxNo
[]NA
❑ NE
12128104 Continued

f !�
Facility Number: — , Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l4 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): N
Observed Freeboard (in): Z 1- 3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
ElNA ❑ 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
PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
VNo
❑ 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 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
0 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
PrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes VNo ❑ NA ❑ NE
Soze _6105-r
IReviewer/Inspector Name I r� - Phone: Q" fY&^ l!O I
Reviewer/Inspector Signature: ACAVI Date: ce o

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? I'Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ElNo ❑ NA ❑ NE
the appropirate box. ElWUP )z Checklists ❑ Design []Maps[:]Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 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 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
A No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ NoXd
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
ElYes
/0
No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Draw* gs: ,u
i✓�fO O ERA�� i Z7.y G'D/tD5 �� /✓wlre
ATE
FC'rtz6"o r.
2iW��►F,ec��cy �cr�o� �%� C,/�Lzsrs t:v��rt
N64—DS )�50040 ro ✓%yty
r / �SF �O.Zett C? IivR57� /%/1%f��%Szs. ZOds kVPA
���
Sh gcc GR,4 <a 5 AIA.E , •O v 4610'- �f_ /�f1fViG Gjs 2 C'oR�tlsCT
S
W191JI,rl

of Visit orbompliance Inspection O Operation Review O lagoon Evaluation
for Visit routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
IFacility Number I Date of Visit:
Permitted 13Certified 0 Conditionally Certified /0 Registered
Farm Name:.. o!_tJ� A71I(.d 1, /gt lYli. tl�
Owner Name: P,C/.,Y.....,?..(.tlltff..J/:............
Mailing Address: ................................ _._.—_._.......
Time:
Date Last Operated or Above Threshold: _
County:D.fV-.1tA-j_.......................... _
Phone No:
FacHityContact:... ....... _......................... _.__.....____—__._Tide: ... .... .................................. _._.. Phone No:____.------
Onsite Representative: ,A{ & .___ ................. _.............. Integrator: _.�41�?<GOC2—........ ............
__.__. _.
Certified
Location of Farm:
Operator Certification Number: .......... .........................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' ="
Design
_Current Devgn 'Cur ent `' Destgn Current -
Swme , Ca acrty
Po`uhttion Poul _Ca"aci
d Yam.. _
:Po"alahon -Cattle _ . _ _.. Ca iad „Po ubtion ._
Wean to Feeder
Layer
r'� ❑Non -Layer;,
❑Dairy
❑Non -Dairy
❑
Feeder to Finish
❑
Farrow to Wean"'=
❑ Other
=
Farrow to Feeder
Total Design Capacity..'_
El
Farrow to Finish
(❑
'
r Total SSLW / 000
Gilts
Boars
❑
umber of Lagoons �
kN--1-1161dijur
EEI.J
-
Ponds t Solid -Traps
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
�tle 1 Strycc�e 2 Structure 3 Structure 4 Structure 5
Identifier: ........._._...._._............ _._...�..__.................. ........ ........_............_. ...._._.__..___.._._. _. ........... ...
Freeboard (inches): a _
12112103 4'C
❑ Yes .t'I No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J�No
❑ Yes No
❑ Yes ,el No
Structure 6
Continued

acility Number: 3� — 2/3
Date of Inspection �3
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 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?
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/rmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
[]Excessive Ponding []PAN []Hydraulic: Overload []Frozen Ground, []Copper
12. Crop type
13. Do the receiving crops differ with those desigdated in the Certified Animal
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?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes UNo
❑ Yes O'No
❑ Yes XNo
❑ Yes 'ONo
❑ Yes Y(No
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes I0
❑ Yes /❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes WNo
❑ Yes 9No
❑ Yes X'No
❑ Yes XNo
❑ YesINo
Comments (refer to gtiesbon #) fix`pbna any YES' -answers -and/or anyrecommendahons or any gther comments
Use drawings of factlrty totbetter eiIna onal pages as necessary) --i[]Field Copy ❑ Final Notes
2�iq/off So2G l�5> e/OVAP7' SAWAV ; o
L� /vOF'D /. to rtat,S lee'
LAle /vecv40
A)ee o W-5d 0akKde-y W145>F 4Aj4,Lt'L15Z5,
n`o
200 ( �b
TZ�S, S/fdULO USE Z/2d�pYN�}L(/5�5
' CGZCfI
— `1 �PPf�CRTZONS '0 Sfh Hu- aI RAN L nr �A� • /�'�[�Cf}7: o
Qu15ZD� �.t%—r)CpW. S E� /JrlRAT�d�,
Reviewer/Inspector Name
Reviewer/Iuspector Signature: Date:
12112103 Continued

Facility Number:3/ —��31
Date of Inspection S /3
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes eNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes /No
23. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ 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
Rj No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
eNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
R�No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
�No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required fortes need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop 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
23) L�}�oo� Zkoto ©F 2'' �3y /,�
�A-o.F,or p G�
C� /�i8o v� �rzv,os
y b()r1z' /14) a)6:-5T 1 FCoRo S
12112103

Facility Number
/ Date or visit: /�"'*' Tune:
^T'-�--��
0 Not Operational O Below Threshold
Permitted ❑ Certified ['] nditiionnally Certified ❑ Registered
Farm Name: .f .'__.__.._.
Owner Name:........... _.._. r12if{
Mailing Address: .................................... ..
Date Last Operated or Above Threshold:
it ..
Coun: -.Y�`tte:C�l !✓_..._.._.
Phone No:
Facility Contact: ......................... _.....
.._.............. _......................... the:........................ ....... Phone No:..........._...........
...............................//1l ...........................
Onsite Representative:. �� ?C/iElL rFi,._. Tntegrator..[I,OGOS6DX0
z1�
. _ ..............._......._.
Certified Operator. .._...........PFQ 5�,7f< ............. Operator Certification Number: ....... ----........... ____
Location of Farm:
•
Swine ❑Poultry []Cattle []Horse Longitude • < kHorse S !__j
Other
Present
No
Discharees & 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?
Lagoon Area
El Yes /No
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes jo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes /P No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑Yes �No
Suture 1 Strpcture 2 Structure 3.............. Structure 4.............. Structure 5 ........... Structure 6/1111
IdentiSer:............... �..----......_...._. .._......... .........._...._... ................. ...........-._.._. ...... —._..
Freeboard(inches): ................ ".......... ..........33............................_............................................. .......... .............. ..................... ..........................

Facdit Number. —y
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site winch 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 maintenancefumprovement?
0 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
//I
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenanceltmprovement?
❑ Yes
No
11. Is there evidence of over applicati n? ❑` Ponding ❑ PAN ❑ Hydraulic verlo
❑ Yes
VNo
Excessive
12. Crop type
U V/�% GJ!�W4_z'rjJ�/i5� �nI lit/
p
13. Do the receiving crops differ with those designated in the Certified Animal ante Managem Plan (CAWMP)?
Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
[] Yes
INo
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
[] Yes
1�No
l[j No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[] Yes
fit No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
777
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑Yes
1No
(/� No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
, ((No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
/(� No
22. Fad 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 reviewlrnspection with on -site representative?
0 Yes
XNo
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
TTTXNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Gummgw (€ efer`i gueaimnd4) jiiaht any YRS amatae s amlT.ior angrepmmmtenila8ama tt}} am �iberxxmtmemts ;
�s9 a1 fstdlffym`hetterespia#tt sitar# (mseaddilknlalppgs aS ttefca8a .-
Freld COPY ❑ Final Notes
/.� �/E9�J O F nocJ6' �F �cc, R-z�✓ v� ��..� �S
o�✓
�
A� 145'6041�-C, DU11VO P�-!r-o
NoyF : ,sr�F `ooK 5 , KE 7"_15 1EXO&LF,17_ S�fo_
Reviewer/InspectorName 5
Reviewer/InspectorSignature- 1X04h5-1f ���,/!/ Date:

Facility Number: — Date of Inspection D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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?
Additional Comments and/or'prawings:.:
❑ Yes l/No
❑ Yes �[J No
❑ Yes No
❑ Yes {[J No
❑ Yes I�No
13
❑ Yes No
ElYes ❑ No
05103101

Divfsion of,
Water Quality r
Q Division of Soil and Water Conservation
C Other Agency
(Type of Visit 9kCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine O Complaint O Follow up O Emergency Notificatiop O Other ❑ Denied Access
—wA Date of Visit: Q 91 Time: �15 Printed on: 10/26/2000
Facility Number %)
Q Not Operational 0 Below Threshold
Permitted 13 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
/" f Nk.U( r!Y County:........... D!:?:p.L.k�.....5.. N........
Farm Name: .................................................q......F:....................................................... f
OwnerName:...,,",�,,,,�{yt .......................✓.p�yt/ rt/Yv...................................... Phone No:.....................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ................................. .................................... ..........................
OnsiteRepresentative:_UtIK�.....lrll (/.l.'......_ y S".f ................... Integrator:........._7.C).f0[S�rv)...... �.1./!.....................
�i ,,ff ...... 1
Certified Operator: ..... Operator Certification Number :..........................................
......................... ...........
Location of Farm:
j6Swine []Poultry ❑ Cattle []Horse Latitude • =' =,, Longitude =• =' =11
Design Current
o w...c t-apacity ro mauun
Wean to Feeder
Feederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current
Poultry Capacity Po uI tion n❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle _ Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
I
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area
Holding Ponds /Solid Traps ❑ No Liyuid Waste ManagementSystem
❑Spray Field Area
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
_NH_
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
We,
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
[:]Yes
PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
KNo
Struuct re I Structure 2.. Structure 3. Structure 4. Structure 5.
Structure
Identifier: ...........lif ........ .....2 .....
. ... .6.
.
�
Freeboard (inches): r'Yr't' - "Att
5100
Continued on back

FV
Facility Number. — ,13
Date of Inspection e' 09 ji
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway
[]Yes
ANo
W Scture.I Structu^rel Structure 3 Structure 4 Structure 5
�/ 2
Structure 6!!!!
StructureIdentifier:
]F /OAII........ ..._._.. a
Freeboard (inches): ........ .................................. a.1....••!.............. ............................... .... .................................... .................................... .._
.......................
.........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
Mo
(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
>0No
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
elevation markings?
❑ Yes
D�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
71�00
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
Yes
❑ No
l
12. Crop type (/V I D % 5 tt
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
;i�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
17. Are rock outcrops present?
❑ Yes
❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown ❑ Yes ❑ No
❑ On -site ❑ Off -site
Required
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
gNo
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�No
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
X` Yes
❑ No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑Yes
I
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?,,..,r
(ie/ discharge, freeboard problems, over application)
❑ Yes
tip No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
26.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Ayes
❑ No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�,..{
p[l No
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes hd No
01/01/01 Continued

Facility Number: — Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
N0
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
�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
/
j( No
Lion omments wings: -' - - -_ I I- . .
%Sl-f Ityum-
w&dd e
-i --//m) U)Jo°
C /n/7 C�57
14LL .
of P AA-01- T2
a
(0n
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�; /S
I -L"`I
aAUV
t
5100

Division of Water Quality `
0 Division of Soil and Water Conservation _
0Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: -1 -!a) Time: /L - Printed on: 7/21/2000
Q Not -Operational 0 Below Threshold
Permitted kertified 0 Conditi pally Certified J3 Registered Date Last Operate or Above Threshold: .... ........
Farm Name: / 1 County:.,..,„ `
..... ..............................................
OwnerName: ........................................................................................................................... Phone No:.......................................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ....................... .................................................................................................................... ..
Onsite Representative : ............. .... ..... ZCTI{.`......................._ In[egratoc ........ �GrY
....... ..... .............. .........
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =* =, =^ Longitude =• =' =11
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder
❑ eederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
[]Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1 2 JU Subsurface Drains Present LJ L= Ar
Holding Ponds / Solid Traps == ❑ No Liquid Waste Management System
Discharges & Stream Imuackc
I. 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. It 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
Stryurc I i i N" Situ4Wz ii 2 Structure 3 Structure 4 Structure 5
1h
Identifier: .........................Iff............................ :!-.(!.�u/�t ....................................................................................................
Freeboard (inches):
5100
Area
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑No
es-
A //t4
❑ Yes ❑ No
❑ Yes 153:�o
❑ Yes [21�o
❑ Yes VNo
Structure 6
Continued on back

r
Facility Number: Date of Inspection Printed on: 7/21/2000
U�
5. Are there any immediate threats to the integrity of any of the structures ob erved? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which arc 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 pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding
12. Crop type
13. Do the receiving crops differ with those designated in the Certifie
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 ❑ Hydraulic Overload
Animal Waste Management Plan (CAWMP)?
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?
fVti violatioris:oi deficiencies were potea during this:visit; You will ..... r... further
. coriesnotideitce: abotit: this visit: ::...::.:::::..................... .
❑ Yes VNo
❑ Yes ,jrNo
❑ Yes ONO
❑ Yes l[No
❑ Yes r0
❑ Yes 01No
❑ Yes ®allo
❑ Yes DdNo
❑ Yes 500
❑ Yes (�io
❑ Yes {` O
❑ Yes _ jqo
❑ Yes WNo
❑ Yes XNo
❑ Yes gNo
❑ Yes 53'No
❑ Yes _INo
❑ Yes q1O
❑ Yes kNo
❑ Yes [5LNo
❑ Yes [ANo
❑ Yes C.No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName rtc-tl e"( -
ReviewerAnspector Signature: Date:

Facility NumDate of Inspection 1/ ciJ 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 Wor below ❑ Yes M 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
';1'N0
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
1� No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
®'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
ro
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
5100

Divisionlof Soil and'Water Conservation -.Operation Review ?
p Dtvtson(of 4oi1 and:Watec Conservation_- Compliance Inspection .
' p Division; of Water Quality -Compliance Inspection
p Othergency,- Operation Revtetir
Routine m p Complaint p o ow -up o inspection p o ow-upof review p ter
Facility Number Date of Inspection
['Time of inspection ..24 hr. (hh:mm)
0 Permitted p Certified E Conditionally Certified p Registered c t of TVp—e—ra-MoMaTj Date Last Operated:
Farm Name: Longl[auLFarms.Sites.#1.&.2 ................................................................ County: Duplin WIRO
Owner Name: Stephen. A. ........................... Draugltan.................................................. Phone No:(91f1.).285.044.................... :..................................
FacilityContact: ...............:...............................................................Title:............................................................... Phone No:....................................................
Mailing Address: 14.7..Candle.wood.Dr............................................................................. .W.allace..N.C........................................................... 2846b..............
Onsite Representative: Steve.Draughou........................................................................ Integrator: Goldsbaro.Hog.F.arms.......................................
Certified Operator: .................................................. ............... .............................................. Operator Certification Number:.........................................
Location of Farm:
Latitude ®• =' =" Longitude ®e ®' ©"
Swine `
® can to Feeder
❑ ee er to mis
❑ arrow to ean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design: urrent _ '- '`Design -_. Current
Poultry Capacity Population Cattle- Capacity. Population.
❑ Layer 10 Dairy
p Non -Layer ❑ on- any
❑ Other
Total Design Capacity 6,400
TotitUSSLW - 192,000
Number -of Lagoons L I I❑ Nunsurlace Lrams t'resent Ilp Lagoon Area Ip spray rteul Area
Holding Ponds /Solid Traps 7f I . , ❑ No Liquid Waste Management System
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: p Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ®No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ®No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes N No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment .
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard(inches): ...............3.6..............................2.6............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes tg No
seepage, etc.)
3/23/99 Continued on back
Printed on 11/23/99

Printed on 11/23/99
lFacility Number: 31-213 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p Yes p 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?
p Yes
[]No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
(:]Yes
p No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes ;
p No
11.
Is there evidence of over application? ❑ Excessive Pending p PAN
0 Yes
p No
12.
Crop type Soybeans Small Grain (Wheat, Barley, Coastal Bermuda (Hay) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p Yes
® No
14.
a) Does the facility lack adequate acreage for land application?
p Yes
p No
b) Does the facility need a wettable acre determination?
❑ Yes
p No
c) This facility is pended for a wettable acre determination?
p Yes
p No
15.
Does the receiving crop need improvement?
p Yes
®No
16.
Is there a lack of adequate waste application equipment?
p Yes
H No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
p Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
®No
21.
Did the facility fail to have a actively certified operator in charge?
® Yes
p 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?
p Yes
®No
24.
Does facility require a follow-up visit by same agency?
p Yes
®No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? p Yes ® No

Printed on 11/23/99
Facility Number: er: 31 _213 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
p Yes
® No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of property within 24 hours?
p Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
p Yes
®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.)
p Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
p Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
p Yes
® No
3
`5s
£
ni
&
t
_
_
1
f
g
S £
A�
Ei
9
lIfy
_
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Printed on 11/23/99

70 Division of Soil and Water Conservation Operation Review - - -
` E3 Division of Soil and Water Conservation - Compliance Inspection w -
ivisionof Water Quality -= Compliance Inspection - -
r: , [3 Other Agency -Operation Review
Routine 0 Com laint Q Follow-u of DWQ ins ection Q Follow-u of DSWC review Q Other
Facilitv Number 3 Date of Inspection
Time of Inspection ®24 hr. (hh:mm)
I] Permitted Certified E3 Conditionally Certified 0 Registered JE3 Not O crational Date Last Operated:
Farm Name: \ T�`��T............. Cotmtv:......................._ �.................................... :......
... .k ... ........................................................ a ..- u(
Owner Name: ........ .. Phone No: 1'U —a'D �—�g .. \ .............
J
Facility Contact: l`�-�X ...5`�v"v_................Title:...-16`.......J.:�2!r..................._.... Phone No: �Q
- ........................:'....................................................
MailingAddress: ............................................................................................................................................................................... .......................
Onsite Representative:_^...._................................................................. Integrator:....... '- ............................
.. .. .........................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude O•=' =" Longitude =• =` 0"
awrne t-apactry ropmanon
Wean to Feeder OO
❑ Feeder g
[IFarrow❑ Farrowder
❑ Farrow to Finish
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I _ ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons I IJ- I❑ Subsurface Drains Present �J❑ Lagoon Area J❑ Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream ImuacLs
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated aC ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'!
b. If discharge is observed. did it reach: ❑ Surface Waters []Waters of the State
c. if discharge is observed. what is the estimated flow in aal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the Slate other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Frceboard (inches): ................. ...........................................
❑ Yes
KNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
allo
❑ Yes
"4No
❑ Yes
KNo
Structure 6
1/6/99 Continued on back

Faci ty Number: 31 —', , Date of Inspection
t 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 top of dike, 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'? ❑ Ponding ❑ Nitrogen
12. Crop type ....�1.Wl.S� ..... .v...t.......... .....�.!���./....�501tV Rl�l�� C:7 �
............. .................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes .< No
❑ Yes N�No
❑ Yes XNo
❑ Yes ONo
❑ Yes WNo
❑ Yes gNo
❑ Yes NJ No
❑ Yes NtNo
❑ Yes KNo
Yes ❑ No
❑ Yes gNo
❑ Yes ONo
)dYes ❑ No
P(Yes ❑ No
❑ Yes 9No
❑ Yes XNo
❑ Yes ( rNo
❑ Yes W1 No
❑ Yes gNo
U* No.violations or. deticiencies .were Hated during this visit:. ,You will.receive na further . .)
bdrresp6rideitce: 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) 3 :=
� � we� tit: - �;a•t�� r�- �� {- a.� �-e-c�t-�, P(e�d
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( ��� �, Date: 3
/6199

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
review
� Date of Inspection �(I2'j(9F I
Facility Number 3 Time of Inspection : 00 24 hr. (hh:mm)
E3 Registered 0 Certified E3 Applied for Permit E3 Permitted 113 Not Operational Date Last Operated:
Farm Name:...... .... ... &SA ... 5 t..................................................... County:.......11........�`.!....................................................
...
S e 1e� .(3 Q I 2 - t
OwnerName: .... .....................................................`.:1.................................................. Phone No:........1..1.- 33 1.................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:..................................................
Mailing Address: ..................................................... ..... [ _
Onsite Representalive:..... tm—z"'1........................................................................ integrator:....
Certified Operator :..... `.i.................................... Operator Certification Number:........................................,
Loatioriof ' rm:
.....11 ..... ...jt.............................................. r............ .a.... ...... ........ ....\...... ?I`S\.-.......('�^..... ......... .. !^`.'ti.]C:A.°J. .......... �`..'.1............
.'F"�r+„•�.. �...f<.�.._�...�.�.14.�.....�vt:-.�\5.....�—....�14.....o.A`^��cS.._fe.-a_Y.�.����:.......................................................... �
Latitude 00=, ='. Longitude 0' =' 0"
Design ,'` Current: d Design'y:Xurrent„ .z ' Design Current ,
Somme Capaaty'Populalioti Poultry ,Capacity Population Cattle n Capacity Population,
eeder
=-RFeeder
GG 's ❑Layer ' ❑Dairy
Finish
❑Non -Layer
Non
"Wean❑
Eto
Other ,aAIFeeder
Total Design Capacity-
Finish
❑GiltsTotal
''.
.'
- ' • .. - SSLW
❑Boars
aNnmber Lagoons 1 Holding Ponds® I[] Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
of
r.
r
a
t yy t
❑ No Liquid Waste Management System '
T
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes V(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 10 No
c. If discharge is observed, what is the estimated Flow in gal/min? 911,_
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes KNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 1P No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 14 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes D,No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes VrNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes CdNo
7/25/97

��^Facility Number:3t —'a1
8. Are there lagoons or storage ponds on site which need to be properly closed.)
Structures (Laeoons.Holdine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2 Structure 3
Identifier:................................................�...........................................
Freeboard(ft):... ....... ............
........ 2.,.6 .............. .............................
10. Is seepage observed from any of the structures?
❑ Yes KNo
❑ Yes C4No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of W//MP, or runoff entering waters of the State, notify DWQ)
15. Croptype.1..^..�C...t..:`..i.5j...f...S..1................................................................................
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.violatiousor deficiemies.were notedduring this:visit: You.-wi l receivenaf1iri1 ei-:
correspotideitce about fhis:visit:
❑ Yes "No
❑ Yes [5kNo
OYes ❑ No
❑ Yes IN No
❑ Yes 0 No
gYes [I No
❑ Yes E N0
❑ Yes 19 No
❑ Yes P9 No
❑ Yes ,M No
❑ Yes tY No
ru", ❑ No
❑ Yes N No
❑ Yes 19 No
❑ Yes C9No
ja) �-�.�a��_ this sake t,..ee�\ csJti�-sr\ a�•-� �e��l�t.� a-� I�,� �r�y: M� •
sz-
a�S�fM�S S �t 4 `� 2ve 3 t1 6 f 7,25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1��1_, �9_ Date:

d A YOperation
. ElDWQ Animal Feedlot OperationSite Inspection
ti
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection
0 Follow-up of DSWC review 0 Other '
Facility Number Z13
Date of Inspection q L
Time of Inspection � 24 hr. (hh:mm)
E3 Registered QQ Certified E3 Applied for Permit 13 Permitted
113 Not Operational IDate Last Operated:
Farm Name: ........ %r..6Y .......... 4!!....._Ir.?.1:..h5.........{'�f.' ..........................
County: .....L.L{l�.fl......................................... :........................
Owner Name:........ ��. C��IA .:................DV.A..!I%1Fh......................................................
Phone \o:.- 91p).. .'..ZLia.........................................
Facility Contact ......1........_N"Wi[ttts.........../....... Title:..........QW..Nib
................................... Phone No: ..�4>9�_z%�-... �/a...........
MailingAddress:....:M......6.f& 's .....my .... ..... th.......................................
..
.......w.AY.SG.IJ.t......bis........................................... ...2`a.3%........
OnsiteRepresentative:.......SCL�iAh .......INaV. is ...............................................
Integrator: .... t.�.olds.61ro.... 1d5-............................................
Certified Operator: .......... garb4,_1:.... V -OV.SS ail ...............................................
Operator Certification Number:_ ..A;........................
Location of Farm:
'
Latitude E 14 • ®' ®°°
Design Cut
Swine Capacity Popu
Wean to Feeder 6
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
Longitude ®• ob Z.'1 "
Poultry Capacity Population Cattle Capacity.. Population
❑ Layer I 1 10 Dairy
❑ Non -Laver I I ILI Non -Dairy
❑ Other
Total Design Capacity Lt 400
Tota1SSLW Iq z,000
Waste
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any par[ of the operation? ❑ Yes 10 No
Discharge orimnated 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 gallmi0 NIT
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 EA No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes §1 No
5. Does any part of the waste mana-ement system (other than lagoons/holding ponds) require ❑ Yes allo
maintenance/imp rove ment?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �a No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes C' No
7/25/97
Continued on back

Facitfty Number: 3 — 2f3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Layoons.Holdine Ponds, Flush Pits. etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 . Structure 4
Identifier: ........... #..I ................. .............#.............................................................................
Freeboard(ft) ......... z:.5 .................. .............. 14!............. ................................... ..............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AmAication
❑ Yes PjNo
❑ Yes
® No
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
(9 No
❑ Yes
MNo
® Yes
❑ No
❑ Yes ® No
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type!.eXmtlr).Q......... 6_4.................................................................................. SWtAI.I...... gYttL�.................................................................
16. Do the receiving crops differ with those' designated in the Animal Waste Management Plan J(AWMP)? ❑ Yes DdNo
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 Pennitted 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?
U9 No.violations or deficiencies were noted during this.visit..You .will receive no further
correspondence about this visit.
12. WcJi5 4 tz5oor% 40 Skodd be mowed. &m &etas o" 1_oc3ee(' *L 5h
it. fermt)a cizP sane L is�t roved`. \ I A
�. s RGol S6,46 ( ;; wit ruvt -# fw� A -A �, A map A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes 64No
Ayes , ❑ No
❑ Yes No
❑ Yes No
❑ Yes ®No
1KYes ❑ No
❑ Yes � No
❑ Yes ® No

•
Site Requires Immediate Attention:
Facility No.�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Farm N;
Mailing
County:
Integrau
On Site
Physica
L (A )Q'1saw
Type of Operation: Swine Poultry Cattle t f A
Design Capacity: �32'za Zi Number of Animals on Site: l
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: 3'/_" L' Longitude_N�__ ` 06 ' 33 " 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) 6 or No Actual Freeboard: __j_Ft. C _ Inches
• Was any seepage observed from the lagoon(s)? Yes or(9)Was any erosion observed? Yes or
Is adequate land available ,for spray? Aor No Is the cover clop adequate? Yes or No
Crop(s) being utilized: i'�M rrt uc
Does the facility meet SCS minimum
? 200 Feet frog Dwellings?� or No
100 Feet from Wells? 05wor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 0<5
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or V�o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 00 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)?or No
1 v . .
Signa e
cc: Facility Assessment Unit
Use Attachments if Needed.