310234_INSPECTIONS_20171231

NORTH CAROLINA AM
Department of Environmental Qual

of
Review
Reason for Visit: jo Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 2q Arrival Time: ��'' e Departure Time: County: Region: W I U
Farm Name: L c'I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: AIM l M W— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I 1) 13
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean [o Feeder I
eeder to Finish
Wet POUItry
]Layer
INon-Layer
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Capacity Pop.
I Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult . r
Layers
Design
Ca act_
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 I R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [:]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Y 9No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Factli Number: Date of Inspection: I lize
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes/10 No
a. If yes, is waste level into the structural freeboard? ❑ Yes❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [)(No ❑ NA ❑ NE
❑ Yes oo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
l 7. Do any of the structures need maintenance or improvement? ❑ Yes y{ rvo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I�(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 b(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
f 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
btNo
❑ 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 [yNo ❑ 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 yANo ❑ NA ❑ NE
T
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I N No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacilitY Number: jDate of Inspection:
24�Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
o No
❑ NA
❑ NE
❑ Yes
❑ No
[&NA
❑ NE
❑ Yes w No ❑ NA ❑ NE
[—]Yes bf No ❑ NA ❑ NE
❑ Yes [,&No ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
❑ Yes FNo
o ❑ NA ❑ NE
Yeso ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
-S1UCye dwvt�, d� 6� e+,I 4 2Vr7,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: i(i' tiU I30
Date:
21412015

Date of Visit: Arrival Time: V j— Departure Time: t(( County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 4I (e� jot-19e- 6F
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: / 7173
Certification Number:
Longitude:
Capacity
Current
Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
sh
Layer
DairyCow
7Design
der
Non -La er
DairyCalf
ish
H2O
72
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
ean
toFeeder
eder
Farrow to Finish
Design Current
Dr..RP,oul_tr, C_a aci_ $o ,
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
.Oth—er=
01 Other
I
Turke s
Turkey Pouets
10ther
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 to ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes LJfN
- ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412015 Continued

Facility Number: Date of Inspection: Z
Waste Gellection & Treatment
4rls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
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
[J'No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes } ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 N
❑ 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
N
❑ 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
❑ 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 El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections �/❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 117�I/No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facili Number: 2 i Date of Inspection: 2.._ f2
24. DidShe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfTNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5-<O ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ef
❑ 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
E7No
❑ 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
PrNo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
LLJ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[d N
❑ NA
❑ NE
Comments (refer to question #)._Explainany YES answers;and/or anyadditional recommendations or„any other•!comments.
17,
Use drawings'of facility"to'better `eiplaiu`situation's (use additional pages as necessary).'-:m
Reviewer/InspectorName: r/ ` 0 (
Phone:
1 �� 7PO 73C�r
�
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412015

(Type of Visit: Q"Coyrfliance Inspection U Operation Review V Structure Evaluation CJ I ethnical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '2.P( Arrival Time:O Departure Time: 7 9 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
A((C, Al. (_k
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 7
z
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
Non -La er
IDai
Calf
ceder to Finish
5 V Zn
o t(
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design f urrept
C•a tacit � P,o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El 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)
.gWhat 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?
r3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes
I_J "
❑ NA
❑ NE
[:]Yes
[No
❑ NA
❑ NE
Pate 1 of 21412015 Continued

[Facility Number: - Z) Date of Inspection: 2 $
:Waste` Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): j S
Observed Freeboard (in): 2 `(
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
b_ "'o ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [a'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑'moo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes <o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 01IV0❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE,
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
- ❑ 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
/Nn ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes b ❑ 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: 31 1 Date of inspection: 2
`24. 'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a'go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L7 lqo ❑ 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 Q- No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ff NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(A, ,
3 answers and/or any
as i
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
[ No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
Ff�No ❑ NA
❑ NE
or any
Phone:
Date: ' c{
21412015

Type of Visit: (j Co fiance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 111,zhij IArrival Time: j D Departure Time: County: .� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: A ufa) i EL C{L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity P.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
6t5
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ILayers
Design
i_
I
P.o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
I
Pullets
I
I
113eef Brood Cow
Other
Other
IOther
Turk s
Turkey Poults
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 ❑N ❑NA ❑NE
❑ Yes ;/o
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Fac I
ility Number: jDate of Inspection: it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
'' Structure 1,\
Identifier: l_ 6ct5h
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
M/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[—]Yes No ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hreat, notify DWQ
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 �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Oo ❑ 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 12 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ 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
Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
" N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ek<O
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectionnss /❑ 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 —�N/o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

jFactity Number: Date of Inspection: It
24. Pid 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 question:#): Explain any YES answers and/or
acility to better explain situations (use additional
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
❑ Yes
❑ Yes
y, ❑ NA ❑ NE
❑ NA ❑ NE
E] No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
M,19/
❑ NA
❑ NE
❑ Yes
—3'N/o
❑ NA
❑ NE
Date:
a
ti

Type of Visit: ,0'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: FITI—F—TI Arrival Time: '; sN Departure Time:County: 0u %)n Region: —. kb
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
A, Rnir,�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number. 0�;
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry _
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) .+ P,oultr.
Layers
Design
C_a aci
Current
Pao .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes P No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili' Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes .Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JZ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ .Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes p 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 ZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement? ii
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement? 77YY7"''''""'''""'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
No
V1
❑ NA
❑ NE
❑ Yes
r
No
(
❑ NA
❑ NE
❑ Yes
jZrNo
❑ NA
❑ NE
❑ Yes
gl No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [?fNo
❑ Yes (2fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facil Number. Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 6 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes eNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes VI No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes I /I No ❑ NA ❑ NE
Po
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?
,r/
❑ Yes I /I No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes P] 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: --�W+VN D[!-/Y'
Phone:��� 2�5�
_ �j�^lv-��
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412011

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival
C- -ATime \ - Departure Time: County:
Farm Name: Ct4 mot-L -, AQtCG SCW V�� /Owner Email:
Owner Name: CAa.nou_ _\_,jAc.K_sc / Phone:
Mailing Address: \A , C2EE1_ (� 1 (Z �,,�C,61 ,/VG Q'S3?
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative: A ((,F l� Integrator:
Certified Operator: 1�� A . � Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to FeederI
INon-Layer I
Dairy Calf
Feeder to Finish
aQ
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I) , P,oult . Ga aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBecf 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 �(No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Faciti']number: 3i 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 o . ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /_9
Spillway?:
Designed Freeboard (in): 1 R • S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
T�\
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑Heavy Metals
(Cu, Z.n, 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): L�C�-/t► �E/4,'/T S9 6_(R b
�Ll
13. Soil Type(s): Nye- A LxTgW 17-Le
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes % No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ANo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ODesign ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1A No ❑ NA ❑ NE
Q Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑taste Transfers Q Weather Code
0 Rainfall 0 Stocking Q Crop Yield Q 120 Minute Inspections 0 Monthly and l" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ectiou:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [:] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
Non -compliant sludge levels in any lagoon ��p)
List structure(s) and date of first survey indicating non-compliance:��$ Soy /o
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes NNo 1❑-] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑D No 'ANA ❑ NE
Other Issues T�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes t No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [�LNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
V�No
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes J2No ❑ NA ❑ NE
(Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
r
z).
5�%
- 1IA5 u�v�iz
lfll9o/14 T���7 UM /n/ia comPua,vcE
W•A
(019s//a
A 15/I rd
�1811/
wr, I,l
e>a.a-=nay/ & dal�1
Liu
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1 a Sol � sRm Q,6S
Phone: 9/y _-+(3G3d/
Date: 6119kia
21412011

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0,Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ( ► I Arrival
(Tiime:� �Departure
Time: � County: � Region:
Farm Name: �Q(t�4( C- q'1'�UtCE,gczs( v \'}JIt.INOwierEmail:
Owner Name: (2_AQi .00,t`
S AGKSc iy
Phone: q j 1
-�35- JL1 (DQ
Mailing Address: \I J�Ef��
-E�C�
�,�o��.0 INC
QB33
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: NLLe_N Y-20G%
Certified Operator: _c)
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1�+ 1'4 3
Swine
Wean to Finish
Wean to Feeder
Design
Capacity
C+urrent
Pop.
I
I
Wet Poultry
ILayer
INon-Layer
Design
Capacity
1
I I
Current
Pop.
Design Current
Cattle Capacity Pop.
2EX Cow
Dairy Calf
Feeder to Finish
58.96
5-4-4
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r. P,oultr,
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
BoarsI
Pullets
jBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
L 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 Y\No ❑ NA ❑ NE
Yes ]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Yes
tNo
❑ NA
❑ NE
Page 1 of 21412011 Continued

Facility Number: f Date of Inspection: )
.,y
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: LAC-00N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �[
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 A 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 ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive 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): CCS-N "EAT S \\
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
❑ Yes
No
"
❑ Yes
\o
No
❑ Yes
No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ Waste Trans ers
Q Rainfall Q Stocking Q Crop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1C%Lt6Ft0loN
Reviewer/Inspector Name:
Facility Number: (L23 971 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
0
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. ,
Use drawines of facility to better explain situations (use additional paves as necessary).
�'O. A.
(yI15/11 a'_�>
oopl 1, 8
��'�tGEi ill Sa(- sAPcE ' (-Gain
�
o/_ NEC� f }11N KING i} 60� G
-Iq o
�t mac ek&F a o I a.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gn-_49 (0
Date:
2/4/2011

(Type of Visit 5KCompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit &Routine 0 Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of visit: 9��/,,�_ Arriva/lTime: / Departure Time: County: Region:
Farm Name: l,(�Wt- U-+V)UtCf- �L)U-SOh% FgQm I Owner Email: n
Owner Name: ciL ax_ �Rcx&cw Phone: CP- 35-jL1(9Q
Mailing Address:
Physical Address:
M•
Facility Contact: y� Title:
Onsite Representative: ALL G>J &J30<
Certified Operator: EGu A.eocic
Back-up Operator:
Location of Farm:
Phone No:
Integrat9or: ((��
Operator Certification Number: 1�41 _i
Back-up Certification Number:
Latitude: = o = . = „ Longitude: = o = , = „
Design, Destgti renttw �D.estgnuent"
&F,
.Current �Cu y
^Swore '' :.'.. "Cspactty Population,.. Wet Poultry ,Capacity.tPopulati Cattlean-
-apa..,�cty Populition
...
❑ Wean to Finish
jr,111 Layer I
❑ Dairy Cow
:x�
❑ Wean to Feeder
Cs ❑ Non -Layer I I
❑ Dairy Calf
Feeder to Finish �3 C="—i'-��,"'r*.,
❑ Dairy Heifer
Farrow to Wean . `-"� -,
Dry Poultry
.- ❑ D Cow
❑ Non -Dairy
.-1
n�%
❑ Farrow to Feeder h -'
❑ La ers
❑ Farrow to Finish
El Beef Stocker
❑ Gilts x. ❑ Non -Layers
❑Beef Feeder
_; El Pullers
El Boars
- ` ❑ Turkeys
❑ Beef Brood Covi
k
----
Other.. �. w�:- `=- `` ❑ TurkeyPoults
_
Number of Structures:
' ❑
Other
4 ❑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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

1�acitit7Number: j / -a34 Date of Inspection I T //o
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El�.
Yes d 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: I-AC0014
Spillway?: p
Designed Freeboard (in): 1 .5
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
10
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes
9 No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�fNo
❑ 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
PdNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? Y
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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 types) CowG'34*67 ' 1) Req_( "r) %
13.
Soil type(s) NO Old F(XA/,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�5
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JQNo
❑ NA
❑ NE
tiLyv M1e
Comments (refer, torgnestion #)::tExplain`anyYES ar siwirsrtand/or any recocnmendations.d� any other comments*
x.;
Use drawings of facility to better explain situations. (use additional pages as necessary)
•• • • 7... w. vm.v_`(fu'^�i _ �". .ram .�i ram. tsr 'M1NY/` ^%
wer/Inspector Name M qly ♦♦, 'GR /X/E S ._ `� „'� ` "-„" Phone: ��r/Inspector
tRewe
Signature: Date: ��.09 ��0
Page 2 of 3 12128104 Continued

yFacility Number: 3 i -�/ Date of Inspection Z
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes Id No
[:INA
❑ 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. El WUP ❑ Checklists E]Design M Maps ❑ Other
✓���,,\{{(
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes y�J No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑/aste Transfers \❑ ual Certification
0 Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
'No
El Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PkNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes J'r� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
R
aJ9s/rc� l• a
Cgc,t3�►iloN �•` �Jp
Page 3 of 3 12128104

Type of Visit `0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: f 5 Departure Time: County: —ram Region:
Farm Name: C^^Fl[Z2�L-L d' 'A U 1 GL S RCK soy E—IaM I Owner Email: nn
Owner Name: C _ A(MoLc S A CIc3cw Phone:
Mailing Address: 1�g Sueep Ok-EEK 'NZ LC -Lk D832�
Physical Address:
Facility Contact: I^Title:
Onsite Representative: 42ILL���`Q0C1C_
Certified Operator: pJ• `�" W-C—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = ' = Longitude: = o = ,
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I I
❑ Dairy Cow
❑ Wean to Feeder
❑Non- La er
❑DairyCalf
Feeder to Finish 195990 1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow Farrow to Finish
❑
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
El Pallets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
Number of Structures:
❑ TurkeyPoults
❑ 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 ICI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)VNo
❑ NA
❑ NE
❑ Yes
)�No
❑ NA
❑ NE
12128104 Continued

IaciIity umber:31 —0L4
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
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 -0 No ElNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
p No
' \4No
El NA
❑ NE
El Yes
❑ 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 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IoNo ❑ 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 El Yes
�,/
L�SI No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ANo
❑ 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�7 ❑��Application Outside of Area
12.
Croptype(s) Cp`LTt wffER'f 5 Q SC BEI 64)
13.
IF
Soil type(s) Nat FC3-1<
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
PNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ 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
S�No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
PNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations ,or oy other comments
Use.drawmgs of facility to better explain situations (use additio'n'I pages as necessary) «
w /t f Fat FARM
ti) ialoq 9. t •�
Reviewer/Inspector Name AIDA �j UyQ S � Phone: —/ IO/iD tr 30'j
Reviewer/Inspector Signature: Date:
a oo 7 , r v 12128104 Continued

Facility Number: 31 d'y Date of Inspection /
Reauired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropirate box. 0 WUp ❑ Checklists GI
_ Design Maps Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Vaste Transfers ❑ nual Certification
El Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
'''X
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yeso
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
A NA
[INE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes )0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
[INA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 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 ?7Vx Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: . Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /J Title:
Onsite Representative: n l—1 N &1 '0 c
Certified Operator: (�` ,Rfa--`C
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Region:
Operator Certification Number: ,' 414 S
Back-up Certification Number:
Location of Farm: Latitude: = o =' = « Longitude: = o = ' =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PRNo
❑ NA
❑ NE
❑ Yes
P(No
❑ NA
❑ NE
12128104 Continued

Facdity N mber. — Date of Inspection UUW
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N 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: �Gl
Spillway?:
pp
Designed Freeboard (in): -1 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Im 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 M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PfNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
9No ❑ NA ❑ NE
4 No ❑ NA ❑ NE
No ❑ NA ❑ NE
C(No ❑ NA ❑ NE
❑ Yes EM No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName -q��g(n/�S Phone:
Reviewer/Inspector Signature: T l ot� Date: 2/�410f-
12128104 Continued

Facility Number: —,5,9 3qDate of Inspection EzJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4d1 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
,
[)(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
b�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t6No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[fit No
El NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
gNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
00 No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Division of -Water Quality
Facility Number i J a3 _ 0 Division of Soil and Water Conservation
Other Agency
(Type of Visit QrCo Inspection O Operation Review Q Structure Evaluation Technical Assistance I
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: o e7 Arrival Time: I l op Departure Time: County: hurt'Zkj Region:
Farm Name:
Owner
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: AU C," R tLeuc Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: l l o l l' n" Longitude: [-I 0 I--'' I 7 '
Design Current
Design Current
Design Current:,,]
Swine - Capacity Population
Wet Poultry'
Capacity Population Cattle
Capacity Populaiion,r
'' ❑ Wean to Finish
❑ La er
` ❑ Dairy Cow
ElWean to Feeder
❑ Non -La et
❑ Dairy Calf
® Feeder to Finish 2 7A:9U
❑ Dairy Heifej
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
` -:. ❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
" ❑ La ers
❑ Beef Stocker
El Gilts
n
❑ Non -Layers
❑ Beef Feeder
El Boars
❑ Pullets
� ❑Beef Brood Co
_-- — -
� ❑ Turkeys
Other
❑ Turkey Poults
❑ Other _ _ _
� ❑Other
`
N
J umber of Structures. aF
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 0 No ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes AI
,,,�//o El NA [I NE
❑ Yes I"No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3l — Z34 Date of Inspection to 1 t
yWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑moo ❑ 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: LA(y600-1
Spillway?:
Designed Freeboard (in): 15. j
Observed Freeboard (in): 3 .
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�ji No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
E�N o
❑ 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
notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
threat,
I" No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ENo
❑ 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 El2 Yes
//
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElO Yes
�/
No
❑ NA ❑ NE
maintenance/improvement?
/o
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E7 ,.,//
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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
2No
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
IQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U-I/ o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[I Yes
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name 40shaw JOPIJ q(w( 0 Phone: 7 % - 3 6V
Reviewer/Inspector Signature: Date: 1 b
12128104 Continued

Facility Number: 3 1 —;t Date of Inspection Ic o
Required Records &Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
2(/No
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
� No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
N(
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
I� No
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
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?
El Yes
D No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[I Yes
..._� '��/�7No
[INA
❑ NE
Does facility require a follow-up visit by same agency?
❑33. Yes
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number 3 0 Division of Suit and Water Conservation
�. 0-Other Agency
Type of Visit om liance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other
� ❑ Denied Access
Date of Visit: $ I S o(o Arrival Time: gt70 r�r,� Departure Time: O County: N�/Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone No:
OnsiteRepresentative: ALLc.J adofk Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = , = Longitude: = o = ,
Design Current
Design Current Design 5, Current r'
Swine
Capacity: -Population- = -Wet Poultry.
Capacity1'opulahon _;Cattle ,CapacdyhAPop aho
❑ Wean to Finish
❑ Layer
�I" Dairy Cow
'❑ Wean to Feeder
11 . ❑ Non -Layer
I I I' ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer,.
❑ Farrow to Wean
Dry Poultry.
❑ D Cow
❑ Farrow to Feeder
I-- ❑ Non-Dai
"- El Farrow to Finish
r- ❑ La ers
f ❑ Beef Stocker
❑ Gilts
❑ Non -Layers
I
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
- — 54
Other-`.
.,;. ❑ TurkeyPoults
.,,.
❑ Other
L. El Other
Number of Structures.''
,....
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Cl/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 6 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3— Date of Inspection I Qo
Waste Co ection & 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: (A & 06 N
Spillway?:
Designed Freeboard (in): 19 - J
Observed Freeboard (in): 9-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C3No
❑ NA ❑ NE
(ie/ large frees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
--
CKo
❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? [I Yes
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El/NYes
7o
U 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
an
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C;rNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[,Vo
❑ 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) V (i 3 6-v _ _ CivS
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
[I Yes
,2
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,[24
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El
rrrE���d',,'No
[I NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El 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):
Reviewer/Inspector Name To114/.l l phone: /Q —% 3 3 !
Reviewer/Inspector Signature:Q=S�LDate: g IC
Page 2 of 3 / 12128104 Continued

Facility Number: 3) — 3 Date of Inspection IY •L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? ❑Yes IQ IN El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IrJ1/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
tR<o
❑ 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�1
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
�uNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
El NE
1NNo
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,
I No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[j,'lo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
G/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
J
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
E 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
��,,��
2fNo
❑ 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
ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EI/No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: /t7 O Arrival Time: : 5 Departure Time: %County: lIAw Region:
'T'
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative""tg'l wboA
Certified Operator: r A29Cks
Back-up Operator:
Location of Farm:
Swine
Email:
ne:
hone No:
Integrator: /lllS11ellG.L
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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: EL
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 I/J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes I/J No ❑ NA ❑ NE
❑ Yes lq No ❑ NA ❑ NE
12128104 Continued

Facility Number:,�j — 2
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stru ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: N22
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
P3 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
�2rNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�No
El 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
JZ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Z No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
10
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Area ,
12.
Croptype(s) O 4 A­'Fi2M4GA¢ !
J Uu4e56fo
13.
Soil type(s) AL'eOL(C �/T�P+/ ✓ZLGi
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
J(-,1 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination,[:] Yes k'-I No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
j2rNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ff No
❑ NA
❑ NE
z4� /Fs� /over Si���p _ , 2 7.�'•G//tmd,
to.
I
Reviewer/Inspector Name - - 1 Phone
Reviewer/Inspector Signature: Date: IO S

Facility Number:Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
y, No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JJ No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? •
❑ Yes
VNo
❑ NA
❑ NE
}, 26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El
,t
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
'Additional Comments and/or Drawings:
20) elx204-re L�/�7l� 7 Ssku/ !o>!�G /�z215 44 Z6 Alm
3A • � T
- (�pDA-r�' Lh-��✓ y�s-sac.-n� F.e Z��Q - Z�l�z ST�e�
A44e �I�D arc 0 .�F_ 20 Svc'q!'S
12128104

of Visit O Compliance Inspection O Operation Review O lagoon Evaluation
IReason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Dt{ Time:
Q Not Operational Q Below Threshold
Permitted �C+errtified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .............
ed
Farm Name: ......5_ Elfi lf! QtJ� .._ Af K$<?M_._Z*!( M...._........._...._......... County ........ �t �yP-L-Dj._............... ...... .._.....
Owner Name:
flailing Address:
Facility Contact:
Title:
Onsite Representative: .._AL cO.. `�'.�.__.._.__._.
Certified Operator: ......... _.................................. _..
Location of Farm:
Phone No:
-.__.__...__.__._.. Phone No: _._____.......___.._.
Integrator* .... ..... _...................._._...._._._......
Operator Certification Number:.. .............._.._...._.__.......
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =1 =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes m No
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)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............ I .... _............ _._......................... __ .._......_...........
Freeboard (inches): .34
❑ Yes
Structure 6
❑ No
a o
0No
No
12R2/03 Continued

Facility Number: 3— Date of Inspection
5. -Are there any immediate threats to the integrity of any of the structures observed?? (ie/ trees, severe erosion, ❑ Yes 3/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes p/No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [ `No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes EYNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ®No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type GSaJ aceyKDF ( NAY SGO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yesr—/No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 2/No
b) Does the facility need a wettable acre determination? ❑ Yes �QA
c) This facility is pended for a wettable acre determination? ❑ Yes 90
15. Does the receiving crop need improvement? EYes ❑
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues /
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 2No
Air Quality representative immediately.
Field Covv ❑ Final Notes
15) CotJftOUE W*4L W& TSFLD 2 boa- (JeGb C04VOL WD ESTAek.SS4
-rp C- JE <J SMT-6-S,
ueocrre Cthe `t xCLD fot2..^
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Facility,Number: 'JJ) —�3� Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�
QNo
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
UNo
❑ 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
--/
O'No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0<0
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
/NNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
��
QNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
U KI
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
U No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
E'1 es
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
—❑
1 1Vy
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L-7 N/
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
L--'J1l//`10
34.
Did the facility fail to calibrate waste application equipment?
❑ Y s
cl No
35.
Does record keeping fo DES required forms need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ Stocking Form Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number 1 2 3
0 Permitted ❑ Certified / t[3 Conditionally Certified ❑ Registered
Farm Name: _ Gq rr oll
Owner Name: GN r ret% J Ckj;O'er
Mailing Address:
Facility Contact: /1 Title:
OnsiteRepresentative: A/han raGA
Certified Operator:
Location of Farm:
Time: �1
Date Last Operated or Above Threshold: _
County J> V rO 1 t �
Phone No:
Phone No:
Integrator: ?Ye
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' =• = - Longitude =' 0• =
_ - -
"Swine
'Design
C8paeit"
Current
Po alation
:Design; -Current _ Design. Current �.
Poultry --, Ca acity 'Population Cattle -.., Capacity-pPo ulation
1' ❑ La et ❑ Da'ry
} ' ❑ Non -Layer I IE]Non-Dairy
S- ❑Other _ - _
Total -Design' Capacity,
m Tota1:SSLW.
❑ Wean to Feeder
❑ Feeder to Finish
❑Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons Di _AILl Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area I
-Holding:Ponds7Solid Traps m ❑ No Liquid Waste Management System - J
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes -ErNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ef 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 J 'Ko
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3 ti
05103101 Continued

-� Facility Number: 31
Date of Inspection 3D Z
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 �1 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 2rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes BNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ITNo
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes J:kNo
12. Crop type �er.-s ✓lln Nn .frrtctl/ t�Y'4:. Coi.1 Whe44 O ysS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management P(an (CAWMP)? ❑ Yes _L3No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Mo
b) Does the facility need a wettable acre determination? ❑ Yes _00N,.�o
c) This facility is pended for a wettable acre determination? El Yes �L No
15. Does the receiving crop need improvement? ❑ Yes '2rNo
16. Is there a lack of adequate waste application equipment? ❑ Yes -,ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Ja 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 ,2rNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes _jZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes LTNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _PNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J2Vo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 NO
24. Does facility require a follow-up visit by same agency? ❑ Yes -E1 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _;�`No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer topuestion M):: Explain any YES answers. and/or any rieommeadations.or any otherlcomments-�'
.Use drawings of facility_to better a thin situations" (use additional pages as necessary) ❑Field Copv ❑ Final Notes
;s lac l� i.J well r�;n-�oc,'�e� . Tl,e r�eeornlS ewe vcv y well
kefI Ti,e �jti"0OO,% qnd swine 1lottse Area ;t well m,gvj;c✓re4,
Dig✓till,-}1,te be•-�valc, aro� �s 9ot�d, j�lease OO✓I-�;rt✓e 1/ot.t.r
6e✓Pvta'a, Ih Ae boeL F;CId -F"+ i.✓as ,S�✓'%�cJ/tdC�gi7,'Gr
44;t �eqr rq.....(
Reviewer/Inspector Name 1 'J . C
Signature:
7 Dater 9 3D 02—
O5103101
Continued

Facility Number: 3 —z,V Date of inspection 3OQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below yes El 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 N0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,Z�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes -10�;No
30. were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or .1
or broken fan blade(s), inoperable shutters, etc.) ElYes 1U No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �Vo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments .and/or. Drawings: - - -
05103101

Diivrsion ofWaterQuality _ -
- O Division ofSoil and -Water Coniervatiou
,O Qther Agency. .
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X�Aoutine O Complaint O Follow up O Emergency Notification O Other 'r t� ❑ Denied Acce
Facility Number ss
Date of Visit: S 1 Q Time: I -rTS Printed on: 7/21/2000
3f 23
Q Not Operational O Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified Registered Date Last Operated or Above Threshold : .........................
ca,.r911 Vacks h Ycn!✓ti 1/v�o�i�+
FarmName: ............. .................................T....................................................................... Countv:..................................................................................
Owner Name.............................................ell�R�-. S C. .............................. Phone No:
Facility Contact:
bfailing Address:
Title:
Phone No:
Onsite Representative: ... lr`OGA�....................................................... Integrator:.t/f546"Ave
.......................................................................................................
Certified Operator: .............................. .................... .............................................. .............. Operator Certification Number:..........................................
Location of Farm:
Swine []Poultry []Cattle ❑ Horse Latitude =• 0` =11 Longitude =• =, 0`-
o
Design Current
Design Current Design _ Current
JrCapacity Population
Poultry
Capacity Population Cattle Ca' ai i _ Population
rra
eder
❑Layer
❑Dairy
inish S 2
❑ Non -Layer
❑Non -Dairy
Weaneeder
t
❑ Other
FinishTotal
Design Capacity
Total S$LW
JU Subsurface Drains Present �l0 Lagonn Area
s 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State" (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .........................................................................................................................................................................
Freeboard (inches): 3 I
S/00
❑ Yes eNo
❑ Yes �3`IVo
❑ Yes PNo
'h I A
❑ Yes,0_,/No
El Yes yJ No
❑ Yes ONO
❑ Yes 0 No
Structure 6
Continued on back

Facility Number. 3/ — 2,3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ YesZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )?fNo
(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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 1
elevation markings? El Yes VI No
Waste Application //��
10. Are there any buffers that need maintenance/improvement? ❑ YesXNo
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload []Yes -,RfNO
12. Crop type VerrwvGl0. N�Y,Srti�.'� I7rc�ih �n.y,t �1112�tf1Sa>?�gq(�fr fe-{i0>1
13. Do the receiving crops differ with tho4 designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yesllallo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 21'No
b) Does the facility need a wettable acre determination?
❑ Yes E�No
c) This facility is pended for a wettable acre determination?
[]Yes _�Ao
15. Does the receiving crop need improvement?
Oyes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes VNO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? -
❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes O'No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes;dNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes �7*No
J"
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ePINo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
❑ Yes/ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes,KNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ia'No
iVq•iriolatioris;oi•• dg& ncies were noted during 4bis;visiC - Yo will-febeipe iio; fui•thte. - : ;
-. - comes ondeiice: abeti( this visit: :::::::::: :
Comments (refer to question #): - Explain any YES answers and/or any recommendations or any other comments,
No-
Use drawings of facility to better explain (use: additional pages as neeessary): n . �..._. ��
(5. Need -to 4i e 9-4-tid 1ri 41r- fAy-(ac,cic Ftelal.
OVer^a(l1-4,e 4cc; t4, aKd reGDrdf nre well ke-ft.
Reviewer/Inspector Name /1?414 h;s
Reviewer/Inspector Signature:
Date:
5100

Facility Number: 3t — 23 Date of Inspection S Printed on: 7/21/2000
Odbr Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes /ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes PIRo
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_�ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑ No
5100

J%Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection ID-1 -7-n
Time of Inspection 1 3 D 24 hr.
Permitted I&Certified E3 Conditionally Certified 13 Registered 0 Not O erational Date Last Operated: ...,,_.. ..__
FarmName: �-�" r"I� )01_ 5��,# I Count „f_f 1:�\ .......................................................................................... Y:........................�........................................
Owner Name: ........... H.Phone No:.................................
.......................................................................................................
Facility Contact: ... ...dk:YY...!?................ J.2SG.._S�'.:�-.... Title: ............ VJ Vl�.�
................................................. Phone No:
Mailing Address: ................
........e...ra............................ .. ..........................
..I...........................................................((.................................................................
OnsiteRepresentative:...,,,,,,,`„P_�._._........,,�Y.°�:`......... Integrator,,,,,,,,,,,,,,,
J..........................................................
Certified Operator:........ .L, lr� y . ��.................... �.. _�.. .,
'�..........................A..O.................................. Operator Certification Number:...........
Location of Farm: -
Latitude =• =1 =11 Longitude =• =1 =11
Design, _Current- Design -_Current. :Design Current
Swine Pn Ca e _Ca acityo ulation
❑ Wean to Feeder ❑ Layer - ❑ Dairy
Feeder to Finish ,s'SZ ❑ Non -Layer ILI Non -Dairy
❑ Farrow to Wean
,. ;.
, ❑Farrow to Feeder J❑ Other
❑ Farrow to Finish Total Design Capacity
'' ❑ Gilts -
❑Boars joW'SSLW ?_
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps . ❑ No Liquid Waste Management System
viscnarges ar stream rmpaclS
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? No—
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 64 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �0 11
Freeboard(inches): .......................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N(No
seepage, etc.)
3/23/99 Continued on back

_t

Faciljty Number-7`i (— 13t i Date of Inspection I iD / >7 / q(% Printed on: 7/21/2000
- 5. Are there any immediate threats to the integrity of any of the structures observed? -(Tie_/ trees, severe erosion, ❑ Yes [(No
seepage, etc.) \\
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes -RNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
RNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
&No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? Excessive Ponding ❑PAN ❑Hydraulic Overload
❑Yes
VNo
ryry u❑
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
,py\No
b) Does the facility need a wettable acre determination?
❑ Yes
2' 40
c) This facility is pended for a wettable acre determination? -
❑ Yes
,<No
15. Does the receiving crop need improvement?
❑ Yes
TT/No
16. Is there a lack of adequate waste application equipment?
El Yes
E No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
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
0,No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yeso24.
jNo
Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[]Yes
ONO
�Vo yiolatiptis;oi dQticiencies -,,4re oo;etl• il(tt;itig this:visit; • Yojt will i ec¢ive lid tu�ther. :
comes olideitce. abotit: 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):
IGJ CRtkLe� W i� Ir 1 2� j. 2060. yvi�Gt%`m�
•
fc v w\-r - •�a.�l[_s�v—>
yr. v_ wttk-Al C.L',-e �as -+a %De,tiy sly}
ak�ur,•rs
.
Z1. Oil w e ab 0._L rtiS a..1,_ wP
. ^^' .
!� � G,Sw bWwi —{�In� S �av� ,�.te v,W i".t 1'V•g I�-�M Uw
4'9�4
/ .
15
Reviewer/Inspector Name B rea r (At V C
Reviewer/Inspector Signature:-. , A:::-- �,, c7T5
Date:

Facility Number: — (L Date of Inspection Ev / 2 r1-0 Printed on: 7/2I/2000
Odor Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes 0] 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 kNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Wo
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
To
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
j§No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
dNNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ENO
_kilditionall Uomments and/or
{�L Drawings:
ow r-S au^A0 -tbg
W� s ct nano- h L r� % S
5 4-20
5/00

4
Y
j
t.
r
.!
R

1 Division of Soil an&Witer:Conservation -Operation Review
: 3 Division of Soil 'and Water-Conseiiation Compliance Inspection
1?— ® Division of Water -- .Quality - Compliance Inspection
. 13Other Agency, -Operation Renew x,`
hb Routine O Comolaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number I Date of Inspection I X/ to/TI
Time of Inspection ©?A hr. (hh:mm)
B Permitted [3 Certified J_-] Conditionally Certified Q Registered Not O erational Date Last Operated: ..............
Farm Name: C4P�Ct. E.S...... .. 9f.M..\....................................... County: ... DY.t..!"A
Owner Name:
...... ...`..,.^��.!........�it./ .s�......................................................... Phone No:
..........................................................................
Facility Contact:
Title:
MailingAddress: .............................................p......................................................................
Onsite Representative: ..... AltaKrex'er.��.. .h........C. ....................................................
Certified Operator:, ..................................................
Location of Farm:
Phone No:
Integrator: .... .i'/'GS�i.(.o) e
... .............................................................
Operator Certification Number: ..........................................
Latitude Longitude
- Design
-Swine
Current :r '. Design - Current ;': Design Current
Poultry :Cattle Capacity . on
- ❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Tota].SSLW
❑ Wean to Feeder
.-.
IN Feeder to Finish
5 R Z a'%SQ
-;
❑ Farrow to Wean-
-'.
[j Farrow to Feeder
t
❑Farrow to Finish
❑ Gilts,
❑Boars
Number of Lagoons - ❑ Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area
- Holding.Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® 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 discharee is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DW ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gJ 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .........-. ............................................................................................................................................................ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes -F] No
seepage, etc.)
3/23/99 Continued on back

Facility Number: ­234 Date ofIaspeclion nigq�.
6. Are there,ytructures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
[]Yes E] No
® Yes ❑ No
❑ Yes 1Z No
❑ Yes ® No
❑ Yes J'No
11. Is there evidence of over application? ❑ ExcessivePondinng ❑ PAN ❑ Yes No
12. Crop type m h ) SG t C -1 w 0.SO t .0 ce r)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. d.. vatiot... deficiencies •were .... • dirritig this:visit: -You will ..... do further
. ' . coriesnotideitce: Airil : this :visit.:
Comments (refer to question #)t. Explain any YES answers and/or any recommendations or, any other comments
Use'drawings of facility to better explain situations. (useadditional -pages as necessary):: 2- -
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes No
[:]Yes 0 No
❑ Yes jo No
❑ Yes 19 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes 9 No
❑ Yes ® No
❑ Yes WNo
[]Yes ja No
7. M, IA)ooh walls 4e ee►h-*✓e wee4r'4 wooW(�/. ✓����a�;on.
hoe ;/"q 1✓t ia� Jor1 on bare 'rpe S A0 kle% eS144IisI, cPa.-< r;ov<r
e'n I A eke walls • ✓
Is. d9vHs 3A479 gerrtLdA He'yrtaed-r j.+tP�oreNtc't� Lveeds
.bo¢ti�r G,�gsses dar-t�n9%e-�';eld �ur�ehfl�./
— g0aPl y 1114e qs 1le7L,;rd4 i✓1 44c Fall,
Reviewer/Inspector Name [
Ae -I,
Reviewer/Inspector Signature:
Date:
3/23/99

m

Facility Number: 3/ -.7-3 Date of Inspection
Odor Issues.,
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes Jd 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 gNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes JgNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
`,,e,
El Yes A No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes A No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes 9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes gNo
3/23/99

3

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
of DSWC review
Date of Inspection Mlin
Facility Number !d�3 Time of Inspection �24 hr. (hh:mm)
0 Registered 13 Certified E3 Applied for Permit APermitted 1E3 Not Operational Date Last Operated: ..........................
C' +- I I � �Cc � I Count ��h
FarmName: ................................I.........�..........`...-............................................................ Y......{'.......................................n......................I........
Owner Name:........1: J.........`...................................................... Phone No:.......5.�— ("J 5—....{CO2
�To...
Facility Contact:
Mailing Address:
Onsite Represent
Certified Oueratt
Title:
Phone No:
Integrator:
Operator Certification Number: .........................................
Latitude =• =' =11 Longitude =• =` ="
•
Design
Swme�°Capacity
ean to Feeder
eder to Finish �a(J
to WeanOther
r[C]Farrow
4 Current ' llestgn--_ Garrent
Population 'Poultry Capacity Population "Cattle -
�: ❑ Layer ❑ Dairy
❑Non -Layer ❑Non-Dairyrzow
Design Current ,-
Capacity Popuhition
to Feeder
rrow to Finish
, - -Total Design Capacity
❑ Gilts
El Boars
Total SS LW','
Number "of Holding
On ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
r �Lagoons'!
,..
; ; ❑ No Liquid Waste Management System
,� ,,
_
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
k No
2. Is any discharge observed from any part of the operation?
❑ Yes
M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
XNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
NNo
c. If discharge is observed, what is the estimated Flow in gal/min?
A
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
Q No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
JQ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
t4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes'0
No
7/25/97

Facility Number: 3� `0�3 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(Laeoons.Holdin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
...................................
Freeboard (ft):........ 3,......................
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes ANo
❑ Yes .� No
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 markets?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......Ie_ ..i.....................................................................................................................................................
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 then: 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.violationsor deficiencies were noteddoring this.visit. Yodv ll recei.ve no hiriher:
................................................
correspbtideitce atiouf Phis;visit: ' ::: ; ' ; •.::::::: ::::: : :::: ; ::
la� Cam( � v f2 f As
C
❑ Yes C�No
❑ Yes 0 No
,Yes ❑ No
❑ Yes , 15N0
❑ Yes ONo
❑ Yes qNo
❑ Yes qNo
❑ Yes 0 No
❑ Yes KrNo
El Yes ,[�,&No
El Yes 16t No
XYes ❑ No
❑ Yes VNo
❑ Yes 0 No
❑ Yes V�No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: '\§_�_( Date:

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
IQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection V Id
Facility Number e!�
i Time of Inspection '' 24 hr. (hh:mm)
E3 Registered C3 Certified 0 Applied for Permit ® Permitted
Date Last Operated:
r
Farm Name :....Co- tK.-..Q...1.. 1.._> O-.[.. tS-a..v.�....TA.:.>r:. a....4}... �.............. County: .... 1%y..�...L.l_�.............................. W.,..t.6
Owner Name: ......0 4 n�ra..�_I................... ................................. Phone No:....C.f.t....L)....... �T s.. .._�. .�. ...........
Facility Contact:
Title:
Phone No:
Mailing Address: ..... �1. Dr ...F..�.eL.L. t,� �............................Z3.3313.
OnsiteRepresentative:..A.1� 9. .tn....... .rC..C................................................. Integrator.......r..-?--d.. il..>..__..............
..............
.........
Certified Operator:.................................................. ............_..........._............................._... Operator Certification Numberi.�..71.7... ................
Location of Farm:
Latitude =• =' =41 Longitude =• =' ="
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish 2_v
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity;. Population
❑ Layer I Dairy
❑ Non -Layer El Non -Dairy
❑ Other
Total Design Capacity Zp
Total SSLW
General
I. Are there any buffers that need maintenance/improvement?❑ Yes Q No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes R No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
iR No
c. If discharge is observed, what is the estimated flow in gallmi0
IA JA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
92 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
El No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
EtNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
® Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
A(No
7/25/97
Continued on back

racility Numbe -
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
J;jTNo
Structures fLasoons Holding Ponds, Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Nt No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: .._ ............................... ..........................................................................................................
......................................................................
Freeboard(ft): ............. ....................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
W No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
IIR Yes
❑ No
12.
Do any of the structures need maintenance/improvement'?
X Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
XNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
ELNo
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ...�.en.rev. tr..................... ..... .... .................... :...................... ... SY.x^s_1A....,6p.itL!......... ....................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [LNo
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.violatitins or deficiencies were noted during this.visit. You.will receive no further.
correspondence ahout this. visit.
® Yes ❑ No
0 Yes ❑ No
❑ Yes RNo
® Yes ❑ No
❑ Yes $1 No
❑ Yes 9No
■ �
❑ Yes 9 No
❑ Yes lj No
Use Arawmgs of tactuty to netter exptam stmanons. Luse aaamonat pages ,as necessary):z
.-t j WC-o rf w ws to-"t-S 'I n t—.P ^r S P
bJ o r o . r t-W (4 10 w.,�c. I a-�.-e.,..--s a-� t �,q, o o . wall c+-. 4 c.e c
yvb S o v. o r t-tLs o- l 1 L`°^�`t- "`Q-t-e'd t M 3 0) c-. r .-e�c. E s'h, r.�+�t u�
I.U-.,,.1 lax, �W-e2,.. Ce•-q o * V. kw t)r " , P l e,a 3 it u , t-vL-t E W a LT
I.I. Of r to r 1•.o S b • Z q a. t v�S o sp +-�--� E-i'LI d-S i,n L. i4 f i tAL f 1 cv.... t'1-a. a, v t
a r cR-s t LL Fo 1pb v w f; S S v.a ] t o L to
t•'t,- i r-a L �t�� `�i S a� !. _ Tr 3 t4,c t, • 14 C, I {fe r ka..v ( +.via .r gt•t to:.. {a P v
it. W o r K o H t.a r re-c fi v.F-e ?44%T Sr t-" fi a t}-S W twre. uva.t2S�tcw., �J 7/25/97
klh4-itr_ hI be;[t t.I`✓-L-4 will a.e_ de"t -"r 16_0- h1 apemen t _e_ <e� aG.Q-a+M
p" ).
Reviewer/Inspector Name ? _A,*�:�
Reviewer/Inspector Signature:
Date:

0

Site Requires Immediate AttentiSkir
Facility No. 4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: L , 1995
,, Time: � V, O
Farm
Mailh
Count
Integr
On Site xepresentanve:
Physical Address/Location:
Type of Operation: Swine �� Poultry Cattle
Design Capacity: rt5 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' �' �" Longitude:'" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) P or No Actual Freeboard: �KFt. Inches
. Was any seepage observed from the lagoon(s)? Yes oqo Was any erosion observe ? e or No
Is adequate land available for rsspray? es r N/ o Is the ver crop adequate? s o
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?( or No
100 Feet from Wells?6)s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes ol?9
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ord9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes 9r No
Additional Comments:
R
WAM
cc: Facility Assessment Unit
Use Attachments if Needed.