310268_INSPECTIONS_20171231

NUH I H CAROLIN —
Department of Environmental Qual

Type of Visit: QMomptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 18i Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: l y yfJ I Departure Time: County: Region:
Farm Name: n!I �� / L�,�lc 41 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: e j_AeJ e5 ►iy cc,�(� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean [o Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow[o Wean
Farrow to Feeder
Farrow to Finish
D . P,oult ,+
La ers
Design
Ga aci
Current
P,o P.
Da Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 [39No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes
❑ No
❑ Yes
Ep No
❑ Yes
q No
® NA ❑ NE
NA ❑ NE
U NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412015 Continued

Facffl Number: IDate of Ins ection: Z
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
q NA
❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i 1
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 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
4 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, 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
n❑
12. Crop Type(s): i V__
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E7 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[r3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[p No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
[� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[B No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
n NE
Page 2 of
21412015 Continued

Facility Number: 7 jDate of Inspection: 1 7_!
i
24. Did the facility fail to calibrate waste application equipment as required by the permit?
/ ❑ Yes
g No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P 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
Q No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
U NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
E� 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
m 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
[k] 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
4 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EP No
❑ NA
❑ NE
Comments (refer to question #): Explain any,'YES answers and/or any additional recommendations or'any other :comrnents:: - "
Use drawings of facility to better explain situations (use additional pages as necessary).
WIC .7 t-S'IQ = o'aS
41 �S`k-7 = 1.30
l/: s�>
1_�Dkow
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:lb 2 %341
Date: 1
2 4/2015

type or visit: t_icompuance inspection l.J uperatton mevrew V 3rructure mvamauun lJ recumcat nssrsrauce I
Reason for Visit: fd Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / Departure Time: County: 20-en.
Farm Name: (, ff { Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: `�� Integrator: %Hj
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: CCVI'4!;�
Design C•unrent
Swine Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
eeder
Non -La er
Da Calf
Finish
Dai Heifer
Wean
ffWeantoinish
Feeder
Finish
I) . P�oult ,
La ers
Design
Ca aci
P.o ,
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
11 Other
Turkeys
Turke 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 [2% ❑ NA ❑ NE
[—]Yes ❑"No
❑ Yes ;3 No
❑ Yes
�No
[—]Yes
Ea'No
❑ Yes
I;aNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: Date of Inspection:
Waste Collectiog & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _O'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure 1
Identifier: I
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes r,�No ❑ NA ❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,lIo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,{ rvo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes —I ,Ingo ❑ NA ❑ NE
maintenance or improvement? %
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P,,Ko ❑ 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?
Reouired Records & Documents
❑ Yes�No ❑ NA ❑ NE
❑ Yes [,2Gb ❑ NA ❑ NE
❑ Yes r_JNo ❑ NA ❑ NE
❑ Yes nb4o
❑ Yes [] o
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 12 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�o ❑ 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 Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Flo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C3'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C3 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[2'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
[;�Ko
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes [;�/No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes k] No ❑ NA ❑ NE
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes
[2'No
TO
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Comments (referto. 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).
/JBf Sa jop& on M 3 CC_ �o s ez l Zr1 1et� I
l i co (re C_�. W d _L.l. I•w� a' s kn''Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-P v VV f I '-'� o'
Phone: ATj(e
Date: ..'2(!
1/ 015

Type of Visit: (D Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: /a& a4, Region: C-,
Farm Name: li/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: �22,16
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
7
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
D , P,ouI
Layers
Design
Ga aci
Current
P,o ,
Da Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
01 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 fZNo ❑ NA ❑ NE
❑ Yes r'No
❑ Yes [�r`No
❑ Yes No
❑ Yes No
❑ Yes �?No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
,,��0,//////''No
�No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
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?
iiiiii
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
XNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�6o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
�o
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement? 0�,,(
11. there evidence of incorrect land application? If yes, check the appropriate b elow.
❑Yes
�Iqo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground vy Metals
(Cu, Zn, et
.)
❑ 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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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
jZfNo
❑ 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
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ jNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number; Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
ZNo
[:]NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ NA ❑ NE
the appropriate box(es) below.
.0'No
❑ 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
O No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
9`10
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ,[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ETNo
❑ 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 O/ 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 ff No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
*"
❑ Yes eNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes ❑,Go
❑ 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).
Neeg 4e o'ac Sod 0-r1.-,
we e CA i \mae. \Q . -
�f�31�5"`fct pta.c.e5 new wo--(?-j
keoz-i & S k h
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _()-Woutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0, /Denied Access
Date of Visit: Arrival Time: ,.,Departure Time: County: � �U Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ( {�Q/-�� "rr(clr
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
I
Current
Pop.
urrent
Design Chd
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 J' No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
[:]Yes EfNo ❑ NA ❑ NE
❑ Yes ff No
❑ Yes jZfNo
❑ Yes �Vo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: jDate of inspection: Z /
Waste Collection &Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZNo
❑ 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
6 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
PNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.❑'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EjNo
❑ 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
U�4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J2�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes PNo [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 22
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,fNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check y V Yes �No
the appropriate box(es) below. - I/"
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
[2"Ro
❑ NA
❑ NE
[:]Yes
[�J­No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[—]Yes rNo ❑ NA ❑ NE
❑ Yes E]-No ❑ NA ❑ NE
❑ Yes 0 No
❑ NA
❑ NE
[:]Yes 2 No
❑ NA
❑ NE
❑ Yes E] No
❑ NA
❑ NE
❑ Yes E� 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).
ti c�6'� au� sc �U�-
-1 l y 1, l� drdn
l
r_a1-ecorc)�s %
OAl-_
Reviewer/InspectorName: 4L)fi �
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -
Date: Z
211120111

of Visit: ro Compliance Inspection
for Visit: J!J Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ( 1 Arrival Time: Departure Time: Countyt7) RegiontU///L
Farm Name: Y IU � Us AL/t - ri/C -/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: i —
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: '0�n r
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity P.op.
to Finish
WetPoultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
1HWean
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul
Layers
Design
C•_a aci
Current
P,o P.
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other 1 1=4Other
Turkeys
—TurkeyPouets
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 E!fNo [_]NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes fNo
❑ Yes ZN
[:]Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

1
Facility Number. 3 Date of Inspection.,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes f� 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
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.)
/Z5
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ZNo
❑ 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 KNo
❑ 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 Auplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ETNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )�JNo
❑ 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 C�J'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 7JNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EJ�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes jrNo
❑ 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 JZJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [—]Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes F No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

1
Facili ' Number: - Date of Ins ection:
14. Did the facility fail to calibrate waste application equipment as required by the permit/ ❑ Yes �Zf No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes gNo
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?
(refer to question
Ps of facility to be
o.�0,
o. 6C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any Y @S answers anmor any
situations (use additional ME
& jwe
T
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 16 No ❑ NA ❑ NE
❑ Yes �� No ❑ NA ❑ NE
[:]Yes LLl No ❑ NA ❑ NE
r�d11,
ire
Ci+'Ci' S (oa/C 3voo" .
Phone:
Date:
2/4/2 Il

Type of Visit: 9womptiance 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: I Arrival Time:�eparture Time: County:qID65joL Region:Ud6
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: � s Lc+cl�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator: 4Uzn
JI
Certification Number:
Certification Number:
Latitude: Longitude:
4
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry -Capacity
Layer
Design
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. � $oult .
I Layers
Design
Ca act r
Current
Pi ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
NJ Other
I IOther
Turkeys
Turk— Poults
id
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 No ❑ NA ❑ NE
❑ Yes Eno ❑ NA ❑ NE
❑ Yes ;2Tlo ❑ NA ❑ NE
[-]Yes ;'No ❑ NA ❑ NE
❑ Yes e4o ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. to storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZrNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes P?rNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
'.L;jNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes EfNo
❑ 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 �, o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes j;�i,Io
❑ 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?
r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,,rf No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .[;�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .EfrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 2-No
❑ NA
❑ NE
acres determination?
j^
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 [DNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _L2'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,e'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4ETNo ❑ 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 eEfj" No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes 2r�o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3i- Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the pernt?
❑ Yes
;;rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo
❑ 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
ryNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Eno
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ve 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
�ZrNo
❑ 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
[ZNo
❑ 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
2rNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
r'No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E?�lo
❑ 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).
slime sal/-4 -ZD & (. 76
level. P6A fte6
l .
'Arrn �- ie'ee�rvrely
Reviewer/Inspector Name:
Reviewer/Inspector Signature: L
Page 3 of 3
Phone:
Date: S'
/4/2011

Type of Visit ,J�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: County:. Region:
Farm Name: r±:!, 6-Off:.L L7-0 Y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 1-e:-!eXA Cecl
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certi [cation Number:
Back-up Certification Number:
Latitude: =o =' = Longitude: [�U
Design Current
opulation
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Populatioean
to Finish
❑ La er
❑Dai Cow
ean to Feeder
❑Non -La er
❑Dai Calfeder
to Finish
rEl
❑Dai Heifer
rrow to Wean
to Feeder
to Finish
Poulrrow
ersrrow
on-DairyLa
❑Beef Stocker
❑ Non -La ers❑ PulletsBeef
El Turkeys
lts
ars
Feeder
ElBeef Brood Co
Other
III❑ Other
Number of Structures:
El Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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
ErNo
❑ Yes N ElNA ElNE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;�INo ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 12/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PKo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes Ca No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes eNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes I[J No
❑ NA
❑ NE
Comments (refer.to question #): Explain any YES answers and/or any recommendations or an y *other comments
Use drawings of facility to better 'explain situations (use ailditional pages as neeessary)
.,. .s _..,.. .-:._:,��x,,., •max....,
Reviewer/InspectorName v—Phone:
Reviewer/Inspector Signature: Date:
�...._ o _1 o 12 R/04 Confinued
0 - 1

Facility Number: — Date of Inspection
Reauiied Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PrNo
❑ 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
PKo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P-I�o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El 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
/
U No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
-�`
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
11 i`o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ao
❑ NA
❑ NE
Additional Comments and/or Drawings: - ..
yid ti s�
Zit lGf�e/
Xe-AoU y/as-/lo d/- letelf a� iv�.cc�-
"�CGIcJe Co/z Ix'Z.,e Ai �jsr IlG,fr— //�Z/�rcJ
/� i 6e fC/re 26 0
�/�o�/� �� 3 • �ivr2�./�Carc�l �ct�.
y�4 /<a
Page 3 of 3 12,128104

�� �vision.of Water Quality
Facility Number r-sod-l--� r-'«�I 0 Division of Soil and Water Conservation
����ood�� 0 Other Agency !11
\`
IType of Visit compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit..�outine o Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Vz
Farm Name: —A
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Arrival Time: � Departure Time: County:
Title:
Owner Email:
Phone:
Phone No:
if ` Integrator: /7 L"5eN
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = =„ Longitude: = o = , = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
HLayer
Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,P'No ❑ NA ❑ NE
s
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�?No
❑ NA
❑ NE
❑ Yes
Fe o
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[;;�,No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VNo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E?No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E;rNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
((((((
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[;?No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�Ko
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
z No
[I NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
4 Q©Oe P
IReviewer/Inspector Name I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

I
Facility Number: I— Date of Inspection 2 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
[]Yes
4No
❑NA
❑NE
❑ Yes
❑Ao
❑ NA
❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
9No
❑ 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
VNo
❑ 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
[;?No
❑ 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
9'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes W 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
Vf 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
,�('
LI 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
VrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IG No
❑ NA
❑ NE
Additional Comments and/or Drawings: "- -- - --
........ .. ...
/ v
-
(v MAX
-y line G.7i
y/a ty �°• ��
Page 3 of 3 12/28/04

(}-Division. of Water Quality, , /`
Facility Number 2 (p 8 0 Division of Soil and Water Conservation 10e
0' Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access Q
Date of Visit: ,�D O Arrival Time: i e11parture Time: ' County: Region: �'/t
Farm Name: iQ� f ��/ /iDr ram/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: .&A11U_ F0li ,Allilv,_)
Certified Operator:
Back-up Operator:
Location of Farm:
ter
Other
Latitude:
-Current -
Dry Poultry
Phone No: Q
Integrator: i%%C/i�, �l t�DGc%.✓
Operator Certification Number:
Back-up Certification Number:
o = 0. Longitude: [�o =, =„
;n . Current - ``Design
city Population Cattle Capacity
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 ONo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ Yes /No
❑ NA
❑ NE
12128104
Continued

i
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes yfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VfNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window, ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
�
Do the receiving crops differ from those designated in the CAWMP?
rzfffff
El Yes PNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes Z No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
to
❑ Yes XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes V(No
❑ NA
❑ NE
Comments (refer to question 1/): 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 Ir © I Phone:(f 7Y("-732
Reviewer/Inspector Signature: Date: 6713014916
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )zNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ 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
)zNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
ElNA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
—
❑ NA
El 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
WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rrr���,,,SSS'''
�e `Vo
❑ NA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Ad 7!% G . 0
Page 3 of 3 12128104

e�I H ok(od
IType of Visit Gf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Fl T1 Iz-as Arrival Time: 6IS Departure Time: County: 01//LTd Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: A CA G hzt
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: Q o = ' Longitude: = o =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder .2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =I
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 O No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12128104 Continued

f�
Facility NumbDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? -]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6,va j
Spillway?:
Designed Freeboard (in): s�
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L,J 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 ffNo ❑ 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 allo ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0"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
�
E No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2-9-o
❑ NA ❑ NE
maintenance/improvement?
�
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
elNo
❑ 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 Drill [:]Application Outside of Area
12.
Crop type(s) t3 (-a1UA,.)QA (G-) S V
13.
Soil type(s) tj( )1 N//6' 4
14.
Do the receiving crops differ from those designated in the CAWMP? Ely s
EKo
❑ NA ElNE
15.
Does the receiving crop and/or land application site need improvement? Yes
U�W�o
El NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![ --]yes
[D-No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
L—J,
El NA NE
18.
Is there a lack of properly operating waste application equipment? Yes
❑
,`
L-1 o
❑ NA ❑ NE
JS) 3S "V r.16CoS SEE��t1F of SOU,
pvwteW,= of (3c-.a-nn,rW%(r) ov2x�k:. 5r .- DCT t-JE.Ebs To 96 i2,D(SFe
TD S S o (Z.0 (-o"5. ":� r✓00 Vj AP LZCATM4,j L► J U f- 31.
P,1,) ,,.,,)s r =PSP e C T a T--rECL- t' � "L tOF Aa rV Pl\jo yvr rrAt--
Reviewer/Inspector Name I �Ar-J Q2P.J,E,CA, I Phone:Q/O79h—
Reviewer/Inspector Signature: Date:

u
Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes r No❑ NA El NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check El Yes EX61❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑ Maps ❑ Other /
21.
Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA
❑ NE
[:]Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ So—�il AA�nalysis [:]Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Ea -monthly and V
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�❑
[3 o
❑ 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
Es StvA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
U*A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E❑
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑. K
❑ 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
❑410 ❑ 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
UU ❑ 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
r, ��
E1 ivo ❑ 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
/
El
NNoo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 o ❑ NA
❑ NE
jAt d tiona[ Comments. and/or Drawings:. + kt._ ..' "•,_ .n w :x .�
12128104

Facility Number 3 ZG Date of Visit: z Time:
Not Operational 0 Below Threshold
O Permitted 0 CCertified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: e!2a lts A,.-e _ �Z County: lh.01th
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: _ 6dh P✓
Title:
Phone No:
Integrator:
Certified Operator: Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =o =I =- Longitude =' =' =-
- '� Design _ Current
Swine ;Ca aci ropulation
`
- Design Cun�ent Design Current
Poultry "io-apacit Ro ulation.. Cattle Ca achy P,o ulation
❑ Wean to Feeder
❑ La er
❑Dai
❑ Feeder to Finish
< ❑Non -La er
❑Non-Dai
❑ Farrow to Wean-
"
❑Other
Total Design Capacity
Total SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑Subsurface Drains Present ❑ 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 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 ❑ 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): 2q
05103101 Continued

Facility Number: 3j— ZG
Date of Inspection E71-10121
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
lie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Z'Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0No
❑ Yes ❑ No
❑ Yes ❑ No
J V No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
gapm v.cwq}ovca,c, caP,uw,axwuuom.,unc nuumuuu, Pngw an UVUcnl
aV U Field Copy U Final Notes
IS. 74 S n SfacJ:oti WQJ pee" Co' I q AoA%WU� i� Covjv�C{inv will,
V;�ccn�SI°b`s%4i'sf wid1� i7SWG. Mr, fi7cock rlee�is {o
CoIis.V14 w;-)11 NIeeS"gt A 4e11 4L,aY­i Lt;J f:-e-ld alas Uyef sailsw;(L
fl.,et,, *ems 40 D✓ vie-1-44e sv✓lace. Ne neei(5 N k 6 5 #a gvin(/o�
W- 4 e . I t"c c o .,.,,. e N d :� c / a(o .Fn 4 4 ,' J -F; r, (d 40 ✓ 41,e. WA F4 c
ahcl l-ik./e 4zi f Grob /9v4 ;n -qLte +-✓as4e pIgnr A rR 9,• 4cock
r7ee�(S -1a A,,.te G wcJ/es4q%1rS�ed croe ;vi a1 cLoi�ai^G¢ (co&l4i,. eA%
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
l'
Date:
Continued

. a
Facility Number: .3/ -2 ,6 Date of Inspection OO
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
IS L,v;71,-1,eT1qi�.T7.;s ;J ;,, refcre»ee fo qLc P-lo( ajo�
-J>1e r)'D" SIlie or -Ike '(R-L, e13 y01'1 Oi.Pe 4✓-etvel(,,nc,�o-/Vwu �I
-il-te 1
-t6 l,ovS6 . J4 Seewlr -% ,4 -Fell Lve MG � be qvl AJpI ro�✓lq�e
c rop �'a✓ � L,c le.!'e,r¢t-,rtd "F; Ala( _
/y7--A7oevi +NIa7 be'IGle 4'0 con-;i.1ve wI`-I1, 6err,✓4O\
in 41,e -Iwo gelds oh 4L e 16' s;c{e 0-/" 4Lte P,14L.. h)oweve✓)
411e be.--,vdA gS4-er4 NeeAf -,o be ;—,plvvfd ;n 41,e.re
reltls -lo have 4 well e54,f (skeA sand ek7-44ese
M.-. )I yCOCK 11SO deeds do �erfo✓� r'ou-/,'-� e'"la,�-lenq✓Ife
o-1 A �r W 4z5 keeja �L,cvti i,r pvoloev cap de�;o .far
lethd off,rli rafiaL,, -rie,-hel1d: mpleaj, AA,d �acEed ��om
-41e 44cre qrcl %ole5 er i�,e %e(ol dve
1G1;�1ds should 6e /ou-J;ne1y geYA4C'O err,.{ ��e'd
.1e �rev2ny InRrd �Ah �orMq�ia+� gvlG�/n/IerirllRrh rrorer Satl
S>lordi wR�e� and q/law -f4"en-) ci lG,c reC2i,/i'-q
Crop,
Tn S/rry qr , me deeds 4P no PIS v
Gq✓6e?or^,iJ� �o de4eem ne fpro✓JC✓ CPCei✓inq G✓aPS �o/ 1?,S
Gropf h4Bpf 4, be wr14erl /oio Ij,JG wl 1c�IRn
/e 4f SCi/( �,tRi/�trK;rf✓ R vl;lro ct1 dei;c,i �o✓ e �urM
M✓. A; 6,&k heeds -1e, e4svre 4keif he hers e) well eS=lRblisbled
s/r,H4 "'r _/he �eqV;.-ed cfOp,,and -/tie Ce'ar e,nd ./';&Id needs
-Fes bC Wasje AfP'1iel4`Io)q elnd nv4rien�
U llke a"rd l'2mo1/gI • =h/clv eat ;n 1kiJ 1-5 41,e ,Teed -1O
qhd jeePel;.n:nq}�� rs^ (J17QeSire Veq�l9�lort ,
O5103101 ✓

Facility Number r 31 26g Date of Visit: 4/11/2002 Time: 1pm
10 Not Operational O Below Threshold
Permitted ®Certified ❑ Conditionally Certified E3Registered Date Last Operated or Above Threshold:
FarmName: Charles.Aycork#..I....................................................................................... County: Ruplin............................................... ..IRQ.........
OwnerName: Charles ................................... Aycock ....................................................... Phone No: 2.10.:28S4263..........................................................
Mailing Address: 1.024_Cypress-CreekRd. ................................................................... WaUace..N.0 .......................................................... 289.66 .............
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative:.Qwmtr............................................................................................ Integrator: Murphy.Family.Yarms .....................................
Certified Operator: Charlea.................................. Ay ark............................................. Operator Certification Number:.1Z1S8.............................
Location of Farm:
Vorthwest of Cypress Creek. On Southwest side of SR 1828 approx. 1.8 miles Northwest of SR 1827. Shares access road with
U-310 (Herbert Aycock).
® Swine [I Poultry ❑ Cattle ❑ Horse Latitude 34 • 45 1 30 Longitude 77 • 44 ° 00
® Wean to Feeder 1 2640 ❑Layer ❑Dairy
ElFeeder to Finish s ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
ElFa1Tow to Feeder ❑Other
❑ Farrow to Finish I
1 : ❑ Subsurface Drains Present I❑ Lagoon Area I❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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 D WQ) ❑ 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 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [R' No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................1....................................................................................................................................................................................................
Freeboard(inches): ...............3.5...............................................................................................................................................................................................

Facility Number: 31-268 Date of Inspection 4/11/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8..Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any structures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes 0 No
❑ Yes M No
❑ Yes N No
❑ Yes Z No
❑ Yes Z No
❑ Yes H No
❑ Yes Z No
12. Crop type Coastal Bermuda (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Z No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment? '
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, 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/mspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
Need to work on the weed problem in fields. Needle grass is overcoming the bermuda.
The rest of the defeciencies listed in last inspection have been satisfied.
Reviewer/inspector Name tale Stmberg
Reviewer/Inspector Signature: Date:

05/03/01.. Continued
'•t
Facility Number: 31-268 Date of Inspection 4/11/2002
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
Yes
M No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property) .
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
R 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.)
Q Yes
0 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
OR No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary covet?
❑ Yes
® No

Division of Water Qila�ty
Q Division of Soil mull -Water Conservation -
.-
(Type of Visit 6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1 Z, Date of Visit: I I 0d1 'rime: �Printed on: 7/21/2000
Q Not Operational Q Below Threshold
❑ Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ..........._............
�� H4GoGL
FarmName:......._C_...`._Q.......e_�..........1/................C�../................................................... Countv:._� ... ....................................................................
Owner Name: ............. l'�:`.y.:..�, 6.S A... !; OP 4..................... ~. Phone No:
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: .... {<<'J /i GP4.............................................. Integrator: ... MJ
Certified Operator: ............................................... ... .................................................... ........ Operator Certification Number:
..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• 0` =« Longitude =• =° 0.,
Design Current Design Current Design Current
Swine _Capadity.Population Poultry Capacity Population Cattle Capacity.:'Po iilation
Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer 10 Non -Dairy
Farrow to Wean
- Farrow to Feeder 10 Other
Farrow to Finish Total Design Capacity
Gilts
a Boars
Total SSLW
I J �3 Subsurface Drains Present p Lague Area J❑ Spray
;.; ❑ No Liquid Waste Management System -
urscaarees & btream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan 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): 33
5100
❑ Yes ONo
❑ Yes )�o
❑ Yes ZTNo
rt f Q
❑ Yes XNo
❑ Yes JL21%
❑ Yes.0No
❑ Yes JNo
Structure 6
Continued on back

Facility Number: 3 1— Z 6 Date of Inspection I Z •
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes [YNo
(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 jzfNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;j'No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes 7�(No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes 10 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ONo
12.
Crop type a+rV-'Vefq Co­-4�o1 Craw, s— all 6r4iN
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑'S'es ❑ No
16.
Is there a lack of adequate waste application equipment?
/❑ Yes JYNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes gNo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
�cs ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes )d]No
21.
Did the facility fail to have a actively certified operator in charge?
❑ YesXNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes QYNo
JONo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
!ll
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
X��� No
❑ Yes
; 1Q yio1 (iglis;eF deficiencie$ wgre jlpCetl diR iitg thjs;vlsjt; Yoii wiii•i eegiye Iici fuitii$r -; • ;
6firisu6ridence:ab46tthis visit:
1-5./Vee6i 4e, 4kjorl� /'•Mc QGGOrL�^� 40 SOlI feS� reGDMMc'ooi44innS)pt, 14o>y/
QEn re o4h.os r:&,44 *t,^] ;iebd N- work fo iw..rprove ber.hvh( i'h IOLJ
grea5 anD( e!/wti t ofl�e� 5�gsses. 4ver�11 i ke 6erMv�'a crop ls9a�tP..
1�•Aeed to be svre 4o useq twos4e a"l ylrs del4e4 w;1L,days of
6t fr j O a.}reh eV6n}J en -�Ge zRt2-2 r S . Nerve �rec bep d reoo�atS
Oojcola6te -Foy jnsPec�,nH,
Reviewer/InspectorName _S�h,6Ct/A Il-'/'�IR��tr-rry�• =
Reviewer/Inspector Signature: ty t__ � Date: I t / Z-1-41 5100

Facility Number: 3/ — 4 g Date of Inspection I1 Q
Ddoi• 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 Plo
28. Is there any evidence of wind'drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or _
or broken fan blade(s), inoperable shutters, etc.) ElYesATNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or,Drawings:: —< --
14. Ttic I'V44ble GGver rVUtP SGtowj SO siO��hF�e✓`J; T1�GeGl< se'yJ
-(k4rf 4kere core en1 4D c.t Ale flew. ml-. Ayco&k needf-{O
Ge✓tsu/'f w;4/N ' -leA,7 chl sppec%'a1 i sF 4o k� Ake w�odt c do►
Such -��tf 1-0 has �'Ns ermt,4a)A ta61e acres anul a Wad71C r"qh
4o acveJ jrtw"ld 6e �:v ded iw%o Zo.tPS W ;Gtl
Yh� A cnc.)< wail sera/ ateGor,4'7 �o g"d ree0,-ds s5ARM0 6e kefi
J

,- - O(Division of Water Quality
O Division of Soil and Water Conservation
- O Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Dale of Visit Time: ® Printed on: 7/21/2000
Facility Number
Q Not Operational O Below Threshold
(] Permitted Certif-ie-d`/I] Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .....1...5-�-� �t'^'�:.'..^.�._�1 County:..._ V\)
....................................................................................... .............................................................
OwnerName: ................................................... ........................................................................ Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ..................................................................................................................... ................................�...(........................................ ......... ..........................
Onsite Representative._Q1!.Q,V.............................................................................. Integrator: ..._L`aY...:.........
.....................
........
..........
..
Certified Operator: ................................................... ............................................................. Operator Certification
"N}unjjjlber:..........................................
Location of Farm:
❑ Swine []Poultry ❑ Cattle ❑ Horse Latitude =• =' =- Longitude =• =' =11
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Ca aci Population
Wean to Feeder QO ❑Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder I[] Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present IL La=Area
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 dischar�,c is observed. what is the estimated Ilow in gal/min?
d. Does discharge bypass a lagoon system" (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Sit ucture 2 Structure 3 Structure 4 Structure 5
Identifier: ............................................................................................................................................................................
Freeboard (inches): '31
5100
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes b�No
❑ Yes XNo
Structure 6
Continued on back

Yacility4 umber: 3 — g6,g 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, ❑ Yes j<No
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 XNO
(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
9No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
kfNo
Waste Application
10.
Are there any buffers that need maintenancerimprovement?
❑ Yes
kfNo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
kNo
12.
Crop type (2 1 S�1
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
&rNo
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
C<No
15.
Does the receiving crop need improvement?
MYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
&No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes P�rNo
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 VNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes DINo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes VNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? - ❑ Yes ONO
aqd yi6latiotis'o, t. deficiencies -were hbted. dilti.hg this:visit. Yoit will -receive tie: further
curies olideilce: Aouf 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):
` �' �� �\1L\sS3- ��S S10✓l� Q S' S2S� �
os
awe Y-� 5� lbw e�� ,
Gyre 4 - 6�, L,, rt I � _�ZLIQ
Reviewer/InspectorName �� lAr-�FY1Q �Q�` S 3�Gb X22-6
IReviewer/Inspector Signature: _ _ Date: 1\ 9.-CJO 5100

FaciliS Number: � Date of Inspection Go Printed on: 7/21/2000
Odor Issues - -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 1Jor below ❑ Yes �J No
liquid level of lagoon or storage pond with no agitation? 6�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'N No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 O(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or ,,,yyy
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 41 No
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes No
5100

P
E3 Division of Soil and -Water Con-servati6n Operation Review
!:. Q Division of Soiland Watei•�Conservation.Cpropliance Inspection
Division of Water Quality Compliance Inspection =
�-.- 0 Other Agency -_Operation- evrew,,
JJE Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Facility Number 1 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
❑ Permitted Certified Q Conditionally Certified 0 Registered Not O erational Date Last Operated
Farm Name: 5..._F4.`CG0.C,1 ..... #$.....t................... County:.... 1�C,.D.l-r..l... h.............
Owner Name:.5....... ../N.`"f.C-C.C-L................................... Phone No:... 1_Q.. ..2.�.5.... Z.rb..e.........
Facility Contact:
Title:
Phone No:
Bailing Address: .L.Q. ......0 ` .C�..I7— SS....0 t7 �..--
...........\ t2.f4.s
Onsite Represent••alive:... .k�c. ?..-1..r s......_Integrator.,.,..Y...I!N„1u1.,L�-,,:j3..{:,k..`. ..........................
Certified Operator: ................................................... .................................................. .......... Operator Certification Number: ..1�....k.S.e.............
Location of Farm:
Latitude Longitude
Design Current
-Swine - Capacity Population -
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Hol
/ Solid Traps
sDesignCurrent
C'anarity PnnuNtinn Cattle
❑ Other
Total Design Capacity [
Total SSLW [
❑ Subsurface Drains Present ❑ Lagoon Area
`_ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 _ Structure 5
Identifier:
�t
Freeboard(inches): ........ZI............................................................................................................................ ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes i%No
❑ Yes D(No
❑ Yes $No
❑ Yes XNo
❑ Yes 9No
[]Yes No
❑ Yes ❑ No
Structure 6
[]Yes ANo
Continued on back
3/23/99

Facility NumDate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes KNo
❑ Yes 'qNo
❑ Yes XNo
❑ Yes %No
❑ Yes �<No
❑ Yes KNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
)kNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
`�No
c) This facility is pended for a wettable acre determination?
Yes
❑ No
15.
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Wo
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
RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I(No
21 "
Did the facility fail to have a actively certified operator in charge?
❑ Yes
15KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes )<No
24. Does facility, require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
dVti yibl'atitiiis;oi•• deficiencies •were noted• doing Yhis;visit: You will i ecQipe �i6 fui Ill • ; • ;
" corres ondeitce: ahonit his visit
Comments (refer to_question #): -Explain any YES'answers and/or anyyrecommeridations or any other comments
'Use drawings of facilityto better explain situations (use additional pages as necessa -y)_-
s
l2 r "h—�C O't^�t mot^ 4 C1 l7 l'WL t�
v7t•'Ac7 5cAs lT—C-HIG-
-t O U G�-0,-, V"b A l
Reviewer/Inspector Name
-
Reviewer/Inspector Signature: n ,� r i ^ _ ��� A ^ ,�, Date: I 1 . A O C�_
3/23/99

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

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
review
Date of Inspection
Facility Number I Z g
Time of Inspection
0 Registered 0 Certified E3 Applied for Permit E3 Permitted Not Operational
24 hr. (hh:mm)
Date Last Operated:
FarmName: ... ........... 1....Lif..t7: S.......... it.C.¢.S.f ......Ak_.1...........................................
County: ......
Uir......................................................... ....
(
Owner Name: .......................)Cxli.S...... ....!Q
1,
..ct! L............. ................................
Phone No: .....LjLli).ZFS
! -42,0
.........................................................
FacilityContact: ................................... 1 ..........................................
Title:.................................................................
Phone No:...................................................
Mailing Address: ...��..V.1.......Q ��y?.
g (! 1 l.. �i'..........V
C�p4 D� ................
I.M.Ii...•..:1: Y[A.......................
kstn I^'O
..... .R�A.tlA..T.'...............
N<............................................ "494
..........................
/1�(t�'M
OnsiteRepresentative: .......... 4a�A�Y ..S.::.......�...t.1Cti
....................................
Integrator: .....
1
MV.Yt1..............................................................
Certified Operator:...............................................................................................................
Operator Certification) Number .........................................
Location of Farm:
r.......� ..........s� .?...:©.:......SR . �... %....2..:.....rn..i. s...... S...s7........ 5 J.'a.]............................................................................................ �
....................................................................:.....................................................................................................................................................................................................
Latitude L J' 0 Longitude 0.
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? - ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 9'No
c. If discharge is observed, what is the estimated flow in ;aVmin? J /}
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes VNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes', P3 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? _ ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97
Continued on back

Facility Number: 31 - Z4X
. 8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(Laeoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Stmctme 2 Structure 3 Structure 4
Identifier:
.......................................................................................................................................
Freeboard (fty z
.........................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrit)' of any of the structures observed'?
❑ Yes P No
❑ Yes P No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) -
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) -
15. Crop type 6C.Li..t.........................................................................................................................................,
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
0 No.violatiom or deficiencies were noted during this. visit. Youmill receive no further
correspondence about this.visit.-:
and/or
❑ Yes 1A No
❑Yes [Z[No
fZl Yes ❑ No
❑ Yes O No
❑ Yes [XNo
❑ Yes P No
PYes ❑ No
❑ Yes [%No
❑ Yes No
❑ Yes P; No
;Yes ❑ No
❑ Yes No
❑ Yes J No
❑ Yes No
1t2_ E,"n�o-% c4 on,\ %Vivuxr /c {tr ML 0tI,J(S sltwlt) to CY14d '/ re5/e1erlrcl _ TYrrz S�tcvtd
I.R KA'+�6�'Fa '�Y6�- NV vi�J- W41� Ca h'tG.e'I' Dt� C-t" Sci t `1- Lok+ r to v_ 0.SS�SiArtc� J-
Ig.rfscve rt— �rel� S gilt) toe a�seeJet) �ctlt `9g, Pk Wc,�
S�mr�tl- Gr01 i� gp�ytefr]s. WUp shavlt) 6a urwa.,.�eJ (-F t,s is �ona
2z. 1r�t9ai3ov Sys �4tovte� be co (i1xe, t� . d -(L V~pt' al
7.0 nlir � w- tsoi ea.s S6,)ja b� recler_acr) :h spray rrt�ras � r e_" fofrl covt -5e .o,F flue
t-,c(d, Ca4wtt- Id 4E� ('I^{ �;Sir'�ct ti6otlt vc�y(ti Z•t"e_ d- coP[1cv rr sulfa SOT( fc1'i'.
1 J 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Dale:

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
j
Facility Number 3 �. !
Farm Status: ❑ Registered ❑ Applied for Permit
R Certified ❑ Permitted
[I Not Operational I/Date Last Operated: ....__..... ............... ...... _.....__.....__...._— ..... _....... ...... _....__....__....._._.......... _......
Farm Name: . ,.... _... �....— ..... �..__..___.... County: --•• AIL1..____.._�.
Land Owner Name:
�_.C-. Y.t�K.AAS..._ I ....---.._..__....W.... ....__....._...... Phone No: S�00.��__{.�iH.�__.....W....._.....__.....__.
Facility Conctact:... LAIN[lP�... .L9Stt_.....—....�n...�—.. Title: _....12I�1]Lf.._....__.....__ Phone No:..._1 !1�1.2 � � �?g .......
Mailing Address: _..102 �G . _....__....__............ bZki�M�y ....� G .... �...._ ....�....�.... _ y ��.....
Onsite Representative:....'L �(JY ......A ........ _..... _.....
__...._._....._...._. Integrator.. %,!�41Y 1 .—........_........._.....__......_.....__.
Certified Operator: Operator ....__....�._. .. Operator Certification( Number:
Location of Farm:
Latitude ®�®� �� Longitude r O ®• ®�• � St SIVe (.fie
Type of Operation and Design Capacity
Desrgn Current - `' Des Carent F=4 `g' ? ` Desigo Current ,
Swore Poultryr Ca acq 'Po "ulahon r Cattle PCa Yaci "' Poiulahon
u Ca ace 1'o ulafion3
Wean to Feeder ❑ La er'- 803
Da'
e; ❑Feeder to Finish to I❑ Non La er ,� ❑ Non Dairy
Farrow to Wean d
Farrow to Feeder Total Destgn Capacity 5 lVE1
Farrow to Fm�sh
Nu ber of Lagoons / Hotdmg Ponds ❑ Subsurface Drams Present
M 'MISOr
a ❑Lagoon Area To Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes KNo
❑ Yes 1M No
❑ Yes
V] No
0,
❑ Yes
EP No
❑ Yes
&dNo
❑ Yes CKNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancelimprovement?
❑ Yes [d No
Continued on back

acility Number:..3
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
44ructures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I
Structure 2 Structure 3 Structure 4 Structure 5
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Croptype ....��Via._...._..�....r....__..__.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
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Reviewer/Inspector Name
Reviewer/InspectorSignature: A..--
❑ Yes IZNo
❑ Yes eNo
❑ Yes No
❑ Yes No
Structure 6
❑ Yes (&No
❑ Yes No
Id Yes ❑ No
❑ Yes IR No
❑ Yes ® No
❑ Yes CTIo
❑ Yes IR No
9 Yes ❑ No
❑ Yes [&No
❑ Yes p,NO
❑ Yes &No
❑ Yes ®'No
r ■
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an
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Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. I _ 2 (o
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: S-b
Farm Name/Owns
Mailing Address:
County:�u 0 L4
Integrator. 1 4,1, Phone:
t
On Site Representative: Ci�4�-fi7 1��r,�� Phone: 9-A-!�_ -42.(o.&�—
Physical Address/Location:
Type of Operation: Swine v1_ Poultry _ Cattle
Design Capacity: _"OD Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:° '41 Longitude: -77 ° "�Y� ' "_" 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) or No Actual Freeboard: �_Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes ot:�g Was any erosion observed? Yes or
Is adequate land available for spray? s or No Is the cover crop adequate? �Por No
Crop(s) being utilized: 4-40e D fg Lo oe rS.E C' o
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?6 or No
100 Feet from Wells? V or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or ko
11
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 10
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ors 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 orO
Additional Comments: look) S cvno�
6)�
Inspector Name
Signatuie
cc: Facility Assessment Unit
Use Attachments if Needed.