310292_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: XRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f J L{ y Arrival Time: C ► Departure Time: fig County: Region:
Farm Name: j`& LkXC-- CC.AS NCJIR3G9_ta Owner Email:
Owner Name: —AawtS //11C Phone:
Mailing Address: P- d. �5CX 16 3 C-1114Z!! A J 1 -'�, 1VC 9 a S
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Cer�Or s
fecation Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Design Current
DaLZ Heifer
Farrow to Wean
D Cow
Non -Daily
Beef Stocker
Farrow to Feeder
Farrow to Finish
D . P,oul Ca ace Pio
Layers
Gilts
Non -La ers
Beef Feeder
1B__IrBroodCow
Boars
Pullets
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
t . 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 �4 No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes )] No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
Page l of 3 21412014 Continued

FacilityWacility Number: 1 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes �No [DNA ❑ 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: (-per
Spillway?:
Designed Freeboard (in): 9 S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1�0 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 �q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) JM
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
12. Crop Type(s): �� U�y '��} S jt�Qr W 4"- 7 Q-N S
13. Soil Type(s): F66- 0-5 i aK
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes '�! No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes k
No ❑ NA ❑ NE
the appropriate box.
QWUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes .0 No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q'Waste Analysis [] Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall ❑ Stocking 0 Crop Yield [] 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections Q Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Inspection: tl 1 y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�] No
0
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YeslNo
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA. ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
w.A .
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ow`f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: Compliance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance I
Reason for Visit: ),6-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: {j Departure Time: County: �Un/ Region:
Farm Name: `iJZJ�E �R ! VC�(ZSEQ lA Owner Email:
Owner Name: ajCeF-- * YEN—4jZtAS INC Phone: ! 10 —D 'Ia'
Mailing Address: ��� l�Gl(ZL�]C`l,Q ~ V (-�X1 1s£ ' >e ULAU I UL C /VC (9FSJ R
Physical Address:
Facility Contact:
Title:
Onsite Representative: .0 QAAAJ C)V 4CLY-EW
Certified Operator: f—_NQ't{ 6 . KL—(Z
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Ao / a�
ertification Number:
Certification Number:
Longitude:
16asa
Design Current
Design
Cu
gj Current
Swine GaPFEi"iiiiiii Pap.
Wet Poultry
Capacity
Pop.
Cattle NMC.apacity Pop.
Wean to Finish
a er
DairyCow
Wean to Feeder O Y� 1
on -La Non -Layer
H
EDairy
Da' Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr.
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )� No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility 1 Ember: _'� f - Date of Inspection: /
W:yste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
L4Gco n!
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes KNo ❑ 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 CropWindow ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _ ".yj—(6/V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes T�J No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 No ❑ NA ❑ NE
the appropriate box. 9q
QWUP ❑Checklists Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
Q Waste Application Q 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] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes /�� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: , - Date of Inspection:
24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No X 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? 0
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. 0
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes IY I No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) 7T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 4No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Jallo ❑ NA ❑ NE
Comments (refer to question ff): 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)."
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LAST �l;�a-
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
c-4,,I6, S
Phone:
Date:
21412011

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: �9 Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: $ y ]/ Arrival Time: Departure Time: County: Region:
Farm Name: RkAkE CC r4 / Y ` Owner Email:
Owner Name: �V1 NC Phone: 9 �d — la D6�13-
Mailing Address: p . V . VJOyC Cm /Xt A jR/jy__,e N(2 08—SQ 114
_
Physical Address:
Facility Contact:
Title:
Onsite Representative: AN001�1 VKF
Certified Operator:
Phone:
Integrator:
Certific` Lion Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
f olaSR
Design Current Design Current
op.
Swine Capacity Pop. Wet Poultry Capacity PUUS
Wean to Finish La er
Wean to Feeder Non -La er
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , F,oult , Ca aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharzes 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)?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes No
❑ Yes 9No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
A
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 9No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA600H
Spillway?:
Designed Freeboard (in):S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 10
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
tv
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
F(No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved
Area
12. Crop Type(s):-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
R
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
Pq No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes aj No
the appropriate box. PP��
Ej WUP QChecklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application Q Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ W/iste Transfers
0 Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
E] Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
J :t
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ 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 f
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
7�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [
No
❑ NA
❑ NE
- ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
7�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes KNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
M`
Use drawings of facilitv to better exalain situations fuse additional pages as necessarvl.
N
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-ro� � i4(�L2wo21L.
�Ze L,4ct ,LtC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
5
Phone: 9�d�3�
Date:
21412011

Type of Visit 1KCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
• )t�pu.V
Date of Visit: y (� Arrival Time: Departure Time: l� County: Region:
Farm Name: E CLLA L4 / 1�r(AZ'5E2 Vl Owner Email: �?
Owner Name: ��-� �g t` �9-MS INC Phone:
Mailing Address: r __�1QLi� / t� Q O S0
Physical Address:
Facility Contact: Title:
QR.tt_
Onsite Representative: 1` Q(zr-E?--
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 00 = 6 0 1 Longitude: = ° = 6
Design Current
Design
urientill
esign Current
Swine Capacity Population Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
Wean to Feeder gtoocl I I ILI Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Layers
[INon-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑Non -La Non -Layers
❑ Beef Feeder
❑ Gilts
❑ Pullets
❑ Boars
❑ Beef Brood Co
El Turkeys
it e 10 Turkey Poults
❑ Other ❑ Other
INumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )kNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑Yes No
❑NA
❑NE
El Yes No
❑NA
❑NE
❑ Yes No
❑ NA
❑ NE
❑ Yes kNo
❑ NA
❑ NE
12128104
Continued

Facility Number: —a
Date of Inspection Ib
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:-l�'CIsf
Spillway?: %-! c
Designed Freeboard (in): M.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Po ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes *o ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes �(J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes N No ❑ NA ❑ NE
l I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) W N �_ A T 'S f�, C_ 0T__&
13. Soil type(s) I-OQf-_Sryr---)/J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
.Comments (refer twquestion #): 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): .9= # "
UJ .
�" i NJSl o� i e✓�GL� t�11 iCvt! J��o9fj]e u6 lu E�t�$
•
a)r(Pj/o
NEED OR 93ii s - IFNOT 7+4t nr, TA" ',o ASAP E-4/05/og rp,kp,6s �+�w
1 r fn`51041 �' y
21V.Z�/O6x. oP `� 55 — *PFRr i9c,4i1v4T Ll"11 OF 3aoo�
81100lcq I .
"(4&wp okl Z)LkF
Reviewer/Inspector Name
/Y{�Jil�f} fjl/S(E.S Phone:
m
Reviewer/Inspector Signature:
Date: %0
Page 2 of 3 12128104 Continued

C
Facility Number: ! — oriot Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes YkNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 W­Up 0 Checklists Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑ Anal Certification
El Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rain Inspections [] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P No ❑ NA ❑ NE
❑ Yes �,No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes ❑ No
XNA
❑ NE
❑ Yes
'KNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: „_
gE G4ak F,.AL� o F ouOL Apptu /nr 4 w N 64V u�ou Cz &T TO Gwf*3 o F ?)aJ+/ p.t_L0wAW<c
Get "? y O F 110 t^' f Q.EcAGzD S. - CI-D a l ks O l C AC7 r v E
1
Page 3 of 3 12128104

Type of Visit 0,Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit J Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I L, I r 14JI651 Arrival Time: Departure Time: County: Region:
Farm Name: C�'A MASELOwner Email: -
Owner Name: _�4� E�� ll g �14211nS 1%YL' . IPhone: C310 -09g -o�d�
Mailing Address: �' IcO K I VI CPz66F JN . /Y :2, oQ(F5 Sa'
Physical Address:
Facility Contact: [� Title: Phone No:
(,�
Onsite Representative: '1 WN CVV e Integrator:
Certified Operator: F Q (�1 �}��G- 1 4 c i�— Operator Certification Number: 1609153
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
Longitude:
=c =' ❑„
Design C*urrent
Design
Current Design Current
Swine Capacity Population Wet Poultry
Capacity
Population C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder 00
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry PouttrY
❑ Layers
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
Turke Poults
FI:—]other
Number of Structures:
❑ 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 XNo ❑ NA ❑ NE
El Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
xNo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
Page I of 3
12128104 Continued

J
Facility Number: 31 —eMq Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Cl Yes �qNo ❑ 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): 9. 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �k`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 ANo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P 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 VjNo ❑ 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? 0
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop' Window ❑ Evidenceof WindDrift El Application Outside of Area
12.
�
Crop type(s) �(SC.C.I_E L? 1 S � coke[ k)4&a T
13.
Soil type(s) _ E2LESTtp1y
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
gkCt�>3poXF
"A10
8P4 lad 1 Lv
Reviewer/Inspector Name j —S I Phone: 9/0— -3
Reviewer/Inspector Signature: Date: LILILI a
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection yiy y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes K
o ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ yes t4 No ❑ NA ❑ NE
the appropirate box. El WUP 0 Checklists 0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VANo ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ j aste Transfers ❑/nnual Certification
El Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections El Monthly and l" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes]
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
4 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
Pq
❑ 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
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
0,Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit %) Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (& Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: t j a31 �� Arrival Time: Departure Time: County: Y��MpL-IN Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��Z-AIV�C�J1� �Fi�K C F--
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: 0 e ❑ c = « Longitude: ❑ ° ❑ d =
it
Design Current Design Current
Capacity, Population Wet Poultry Capacity Population
❑ La er
2(000 la ❑Non -La et
Other
❑ Other - - -
Dry Poultry
❑ Layers
❑ Non -La ers
❑ 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
❑ Daia Cow
❑ Daja Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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 M No ElNA ElNE
El Yes ❑No [I NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Pq No
❑ NA
❑ NE
12128104 Continued

.Facilitv, Number: 1 —� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
01 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: L.AC-iOOlS�
Spillway?:
q
Designed Freeboard (in): I .
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
C,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 ,K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 21SNo ❑ 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 W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
tNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
�] No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Co No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
G.E-r �� �� aQo�s �c_ acc p w� ru C o �o S
ON s oI L S AMPLz- �+P I Znj Ids Fs 910�
C9,959 to �L
Reviewerlinspector Name AA A '°" ' Phone:
Reviewer/Inspector Signature: QAin9� Date: 193)_08
12128104 Continued

Facility Number: I —= Date of Inspection ILOID97103k
R_ ectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ VAR ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:%No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;K No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RA
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D, 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
gNo
❑ 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
6 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Comments and/or
12128104

Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Foll6w up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: : f+0 /y) County: Region:
Farm Name: L/ kz= uN� Owner Email:
Owner Name•�S 6r Phone:
Mailing Address:
Physical Address:
Facility Contact: itle: / Phone No:
Onsite Representative: 2 ����� Integrator• �u�� - 419�iJ
Certified Operator: /!/ 242�, Operator Certification Number:
14'Z 5_
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = s 0is Longitude: = ° Q , = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
91 Wean to Feeder 12 &P19 Q
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pou Its
❑ 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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 ), No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ), No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Str9c9are 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AV
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 XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA [I NE
maintenance or improvement? ///
Waste Apotication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)S
13. Soil type(s) / n )
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�f{No El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
/YJ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
X No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
Xt
ElNE
1S. Is there a lack of properly operating waste application equipment?
[IYes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other cozments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
2) SAX Co�� �/,��� »�� C • �G,T��,,,� 7a
Reviewer/Inspector Name �� Phone:
Reviewer/Inspector Signature: Date: 51 O
Page 2 of 3 12128104 Continued

r
Facility Number: — Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists gn ❑ Maps
❑ Desi p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No ❑ NA
❑ NE
❑ Yes
❑ No ;?fNA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
ONo ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No 9NA
❑ NE
❑ Yes
0. No
El NA
El NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
FlNo
❑ NA
❑ NE
❑ Yes
�&
❑ NA
❑ NE
❑ Yes ZI No ❑ NA ❑ NE
lAdditional Comments and/or Drawings: ' [
/a Ae
K0 &,gs p4l)�0-19� 71
) A
12128104

05/08/2007 13:37 9102982078
r + . Y
PAGE 01
Ile
To • �lcst�r CD6,0
From;enr`1aC �ei
Date: -- g- 09 — Pages:
Comments:
Q

m
05/08/2007 13:37 9102982078 PAGE 02
IV.(.: Water Pollu�~ ' I S}trtrm Operators
Certifi ion
Henry G. Parker
A A - 14M
v o l.trr Ote rw rw�sr...ai.,ff l�,saG r. ramW bd .f
+1w G�u.a sin .f ro�ill r'�ed6K
Rent E. Rffwb �oo
C'� ab"tan

05/08/2007 13:37 9102982078 PAGE 03
Irrigation Equipmept Field Calibration Form
Location •At_znl4l'�-y
Date of Field Calibration: — 4
cnda+(rv)
Flow Meter Serial Number: 3_ O 2'C. J —
Equipment Number:
Measured ring size: 'inches
Is ring size wit 'n 0.01" of original manufactured size?
Yea or No. If not replace ring.
Pressure Gauge Readings At Pump: psi
At Traveler: _ „ f - C psi (if applicable)
At Sprinkler/Gun: —Pit
Expected Flow Rate (from manufacturers chart): 7- GPM
Measure Flow Rate (from flow meter): GPM
Flow rate variance greater th 10%
Yes No
Expected Wetted Diameter (from the wettable acres determination)
Measured Wetted Diameter: „ 1 r? 0 ft.
Wetted diameter variance grea
)or than 15% Wor measured flow variance greater than
104/6-, Yes No Yea, then contact a technical specialist or irrigation
dealer for assistance, enter work order number:
And/or explain findings: _--
Calibrator

V
Type of Visit G6 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: (f Q v Arriv�111e
l Time:;QD Departure Time: County: /n Region:
Farm Name: i � e Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: Q-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: Za�
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 S 0 « Longitude: = o = 4 = i,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder G 6'0 1 116V 1i
❑ Feeder to Finish
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Dumber 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 .TNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facillty Number: Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: G
Designed Freeboard (in): �I
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
S. 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 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s) f— p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,-No
[]NA
❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
Jallo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L3'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J:1-No
❑ NA
❑ NE
clr� 1-s /1,7 c_9 00
I
Reviewer/Inspector Name E Phone:
Reviewer/inspector Signature: /!!�_ Date:
12128104 Continued

r,
Facility Number: — pate of Inspection
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El 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 appropirate box.
❑ WUP El Checklists ❑Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑,Ro ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0'No
❑ NA
❑ NE
23.
If selected; did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
SNo
ZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
JONA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
E!fNA
❑ 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
❑ NA
Zf NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �ZNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes J!�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 0 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 P 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 /dNo ❑ NA ❑ NE
12128104

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit 1711outine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted ;%�i er tned © Conditionally Certified 0gis Retered
Farm Name: LLCt. fir' ✓ • _ ..
Time:
Date Last Operated or Above Threshold:
County:
Owner Name: _ .. ___ ... .. ... _... Phone No: ..
Marling Address:
Facility Contact: _ ........ Title: ... ._ _. Phone No:
Onsite Representative: �?#I����� �._ _M Integrator:
Certified Operator:. _ ... .. _ .. _ . _____ .. _ ... _ Operator Certification Number:_ ---
Location of Farm:
ne ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �u
Y` �'
Dugan Cn�nt Desegn $Current
Desrgn nrrent
C
sa
Svnneonl : '' / Cattle
ion mow: Po oa;
-^_Po tEon
_ _. a
- can to Feeder r` Layer Dairy
d
Feeder to Finish
Non -Layer ;; Non -Dairy
:.. -..
Farrow to Wean
Other71
Farrow to Feeder
Toa1 -
10 Farrow to FinishGuts
= q-icy,. F� tr9
Totat SSLW
Bows
Dischmes & Stream acts
1. Is any discharge observed from any part of the operation?
❑ Yes Jallo
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 teach 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 J2-'o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes-420o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes';Luo
Stru ure 1 Structure 2 Structure 3 _ - Structure 4 Structure 5 Structure 6
Identifier: �� _
Freeboard (inches):
12112103 Continued

Facility Number:-3— Date of Inspection p "
5. 7Kre there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ZfNo
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ YesZ6 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes eNo
8. Does any part of the waste management system other than waste structures require maintenancerunprovement?
❑ Yes ;'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes _.IQo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancef=provement?
❑ Yes 2fNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 'PWo
❑ Excessive Ponding ❑ PAN. ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �+ t
13. Do the receiving crops differ with those designated in the Certifi Animal Waste Management Plan (CAWMP)?
❑ Yek ZNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes Pwo
b) Does the facility need a wettable acre determination?
❑ Yes JNo
c) This facility is pended for a wettable acre determination?
❑ Yes . 2No
15. Does the receiving crop need improvement?
❑ Yes '.No
16. Is there a lack of adequate waste application equipment?
❑ Yes ❑ No
Odor Issues
,
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes �Wo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ErNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes J;Wo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes PTO
Air Quality representative immediately.
�C u'rCYS Cl/�P I%Cr� a�
ReviewerAk Spector Name
Reviewer/Inspector Signature:
Field Cony ❑ Final Notes
Date:
12112W Cowed

Facility Number: — Date of Inspection
• TT�r
r'
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss reviewImspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes P No
❑ Yes�,2No
❑ Yes ,gNo
❑ Yes A3No
❑ Yes , TNo
❑ Yes P26
❑ Yes U4o
❑ Yes
❑ Yes p.No
❑ Yes 0>0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 95 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Jr O Time: L L�
Facility Number 2
Not O erational 0 Below Threshold
Permitted 0 Certified [3 Conditionally CC fled ©Registered. Date Last Operated or Above Threshold:
Farm Name: L County: 04/0'�G
Owner Name: Phone No:
Mailing Address:
Facility Contact:] Title: Phanp No:
Onsilte Representative: _f� J� t} tJ E Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
O Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude �' �4
De iign Current
Design Current
Design @urrenIM
Swine7--
Ca achy P,o ulatiaWean&D0
❑ La er ❑ Dairy IEl
Feede
❑Non-La er ❑ Non-Dai❑
Farro❑
Farro❑
Farro
Total Design Capaci❑
Gilts
❑ Boars
Total SSMn-
SubsurfaceCattle
Drains Present ❑ Lagoon Area
❑ S ra Field Area
EH51di-n—ulP,Fn--dg/JS—olidiTirapsace
F
10 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:
Frecboard (inches):
05103101
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes )ZI No
Structure 6
Continued

Facility Number: — Z 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes No
-
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 A No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes )6 No
Waste Application
10. Are there any buffers that need maintenance/improvement? -
_,(
ElZ Yes No
11. Is there evidence of over applic yion? Excessive Pondingg ❑ PAN ❑ Hydraulic Overload
❑ Yes ZNo
12. Crop type ' f (r2 2 © 6� 5 W 04 E
B. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
t4. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
/"TINo
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes RJ No
16. Is there a lack of adequate waste application equipment?
❑ Yes 9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes VNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
ZNA/03
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes N
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 9No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes 9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes gNo V
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes JETNo
s`
24. Does facility require a follow-up visit by same agency?
0-Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes pr o
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Aftr fln other::comments.
pComments (refer to',gitestlont#) Eiplain any YE&ans►V rs andbr'any reeo&inendatil LA
Use,drflwings of facilityeto bettev'explam sitpahons: (use additional,piiges as�nec&sary) ;: '` ❑Field Copy
Se.
El Final Notes
'. -: i
I
/�
Tf ,' PACT�aN vNC f}us� uJn1ER S/}�p l }T 20 �p7 e,,,z Win!
� /��C
CAo A/ nJ �i'{ J�F Q. 10c- ,4✓ �ljf�%f ? ��c 'a.0 ae,C fi/✓� C%/� S� a2
p
(,(1= rh` /'�5 G� art//,�F�zNG �1-05� � %.�il�' �-ie� �Wi✓ '�
/�/%�'�'Z�/�'
10
&45
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: -29 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ;A No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNO
No
31. Do the animals feed storage bins fail to have appropriate cover? ElYes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes ❑ No
Additional Comments and/or Drawings:
17) ll\)r 4W#EAI?5
�
/g ���BD�9RrJC��tp5 /t%FI� v 6,1c
ZA515 CIA L�:!5 D/ve, 44V�_C-
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- F C-NREr-ui- Wt 2—ram [.�RStF It�$L��25, Lk5 -
�'IJN-q 5;r5 L'L� rrf
to N-S-r 1= APP�
g �r'_OOMJ t~+J!� 0
--roc- c0321JVoLZ5 P li ® RN7,cS F9 p, v-iv ua �O LAJ CAVPS.
CCLF7
CA".
O5103101

a5105/2003 08:26 2894035 k
Blue Clams
Date
I Lgn#
113/03
32
1/10/03
32
1 /17/03
33
1 /24/03
32
1 /31 /03
32
217/03
29
2/14103
28
2/21 /03
28
2/28103
26
3/7/03
25
3/14103
25
3/21/03
20
3/28/03
24
414/03
28
4/11/03
28
4/18/03
27
4/25/03
30
5/2/03
5/9/03
5/16/03
5123/03
5/30/03
616/03
6113103
6/20/03
6127/03
7/4103
7/11/03
7/18/03
7/25103
811 /03
8/8/03
8115/03
8/22103
8/29103
9/5/03
9/12/03
9/19103
9/26/03
10/3/03
10/10/03
10/17/03
10/24/03
10/31/03
11 /7103
11 /14/03
11/21/03
11 /28/03
1215103
12/12/03
12/19/03
12/26/03
L, I- 64"o"1
vk
.If11
T I
q 3,
PAGE 01
IV, 70 7#,
�- Ys�
G-i27zYV
= 0,ZSar-,
Page 1 1 Lg1s2003

qrw,005/05/2003 08:26 2894035 PAGE 02
Blue Cla►►
Date
Lqn#
I M102
30
1/11102
28
1/18/02
29
1/25/02
28
211102
27
218/02
25
2/15102
24
2/22102
22
3/1102
21
318102
29
3/15/02
28
3122/02
27
3129102
27
415/02
27
4/12/02
27
4/19102
29
4126/02
29
513/02
33
5/10/02
30
5/17/02
31
5124/02
34
5/31 /02
34
617102
35
6/14102
35
6121102
35
6/28102
34
715102
34
7/12102
36
7/19/02
36
7126102
37
8/2102
38
819102
39
40
39
35
N
35
36
39
9127102
40
40
41
40
K10/25/02
39
39
40
37
11/22/02
35
11/29/02
36
1216/02
35
12/13/02
35
12/20/02
33
12/27/02
30
33.1
(ram., AmP69
1;°(p/(,ot30
Page 1
L91s2002

I - _ _.
§)Dtvtstou of Water Quality
rs s f 7 Q Dh4ston of Soil and Water Conservation t_ s
Agency s�
Type of Visit 0 Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit §D Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
j
Facility Number
Z Z
Dateorvisit: 1 �l RZ
Tirne: % 3'r- Printed on: 7/21/2000
j /
I
---
O Not Operational O Below Threshold
Permitted .Cee�rttiIified
C3/Conditi(onnally Certified
❑ Registered Date Last Operated or Above Threshold:
....... .........
FarmName: 1. �
�(. �...1.
.....................................................
" Kars er
_ .i0k0 *L
Countv:._....._......................................................................
OwnerName: .... gAo.%. y .................................
4. / ie
....I........ Phone No .......................................................
Facility Contact:
Mailing A.ddiess:
................................... Title:
....................... Phone No:
Onsite Representative: _._,6VAO!.............................................................................. Integrator:..../!.`...
Certified Operator: ................................................... ..................... Operator Certification Number:
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��° Longitude �• �� Ors
Design Ctirrent
Design Current Design Current
Ca aci Population
Poultry
Capacity Population Cattle . Ca (tv`- >�'o ellatioze
'£
Wean to Feeder —Z60il
ME ayer
❑ Dairy
Feeder to Finish
❑ Non -Layer
I I JE1 Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
Total
UMIL`agobns , j Subsurface Drains Present Lague Area Spray Field Area
❑ No Le quid Waste Management S T
woltiFmgP tutlsl5olid;T. 9 g ystem r
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ Spray Field ElOther
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .....................................................................................
Freeboard (inches): 3 6 ��
5100
❑ Yes [K No
❑ Yes No
❑ Yes No
❑ Yes
h9 No
❑ Yes
allo
❑ Yes
f!!No
f
❑ Yes X] No
Structure 6
Continued on back

Facility Number: ly — �� Date of Inspection LLZ:U&j Printed can: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ISNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 6No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes allo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®.No
12. Crop type 00m S W►LPa.� �G 4e_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes allo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VI -No
b) Does the facility need a wettable acre determination? ❑ Yes [;-No
c) This facility is pended for a wettable acre determination? ❑ Yes S No
15.
Does the receiving crop need improvement?
❑ Yes
R No
16.
is there a lack of adequate waste application equipment?
❑ Yes
VLNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ELNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
03�No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
JXNo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[&No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
7[ Wo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[�]l No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
®.No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[allo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
allo
�'�i© vioiafiQns:ei- d�f cier<�c;es w ere noted dining this:�isit: You will receive Rio fujr 4r - . - . -
. •'Cor'res�dehce. about this visit -. -. • ... - . .
..
f'o ct4 — �rvVd 0e .
Frm d— AoeLrG i`+L Ga/G�Sk4�� —
Reviewer/Inspector Name �� x a
Reviewer/inspectorSignature: Date: //�Z//D�__ gmp

r
Facility Number: Date of Inspection Pr-hited on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E,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 $ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
AdditionaU.Comments an or rawt -
5100
J

f.
Dairy
Routine Q Com taint Q Follow-ue of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted � Certified [3 Conditionally Certified [3 Registered 1 Not O erational Date Last Operated:
1
• ......
FarmName:........................................................................ County:........ _..._....1.............._._._._.._.._._ .....................
OwnerName. ............................................... Phone No:.......................................................................................
Facility Contact: .............................................................................. Title: ........ Phone No:
Mailing Address: ...............................................................
Onsite Representative: ..... .......................................................... Integrator:..... . - `........................................._...........
Certified Operator:.................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
Latitude Longitude �• �� ���
Design ==:Current : DesignCurreat
$wine .., Capacity °Population PonlEry.' :Capacity Population Cattle
_-
Wean to Feeder
QQ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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 xNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Vlo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Freeboard (inches) : ..............�]....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 5(No
seepage, etc.)
3/23/99 Continued on back

' Facifl'ty Number: —/�,q� Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
);fNa
(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
b(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
WNo
elevation markings?
Waste Avylication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
P No
12. Croptype
13. Do the receiving crops differ with tholL designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
U(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?
XYes
❑ No
16. Is there'a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
IT. 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?
❑ Yes
`A No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O(No
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CKNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
co No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
EX No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O"No
24. Does facility require a follow-up visit by same agency?
❑ Yes
F%No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
TQ yiitatioiis;ot dgfciencie� rv�re itQted- d46hp! this.vtsit; - Yoit Will-teegiye iio t'ui-tltgr
ctirresuoridence: about this visit: ::.........:::...::::::::..::::
win of facility }to better eatplara srtaabons (use addrbonal pages as'rie essay
lj-,5) N('�
A,
A RY4'_� �V �Q_
Reviewer/Inspector Name `' 'I
Reviewer/Inspector Signature:
I
Date:

Fadi ty Number: 3 — Date of Inspection Qt7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below MfYes ❑ 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 V No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 �fNo
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 MNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes to No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes to No
-Additional._ omments an or_ .rarnn s: - --
_ g -� -- ;
r

. ;� Diivtsion of Soil:and'Water Conservation WOperation Review :.4
_ _ .
z ._�.Dtvision of Solt and Water Conservation ,Compliance Inspectron
4 Division of Water Quality .CompUance Lrspection
-... _ e
• - Othei-Agency..Opeistion
Routine
Follow-up of
of DSWC review O Other
Facility Number Date of Inspection `(`1
Time of Inspection E=24 hr. (hh:mm)
0 Permitted (Certified 0 Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
Farm Name: CP ......................
'� ounty: ...... ...��.`--�.............................
OwnerName:........................................................................................................................... Phone No:............................. -
Facility Contact:
..................................... Title:
Phone No: _....._..
Mailing Address: ...................................
............ ....................... .......... ................................................................ I.......... .......... I...............
Onsite Representative:..G.L""' k:!�........................................................................... Integrator:...... K
Certified Operator:
Location of Farm:
........................................................... Operator Certification Number:..........................................
r..............................................................................I---I---....................................................................................................................................................................................a -
Latitude �� �` �•� Longitude •
Design Current' °- Design Current. _ _Design Current
Swine _ Ca acity Population Poultry- ;`:Capacity Population Cattle Capacity Population '..
Wean to Feeder
Ud
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
r Total Design Capacity .0
Total SSLW
Number of Lagoons ID Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area -
161ding Ponds / Solid Traps- ❑ No Liquid Waste Management System --
Dischar_Zes '& 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. Dees 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): .......... ............ ................................... .................................... ................................... ................................... ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes
N No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes Mfio
❑ Yes tqNo
❑ Yes XNo
Structure 6
...............................
❑ Yes N No .
Continued on back

Facility Number:3 Date 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 evidencr of over application? [� Excessive Ponding ❑ PAN
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 readily available?
1,8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �Vo'Vioiatidris;or• deficiencies were noted during this'visit' • ;Y;oi} witl •receive d fui�thgr
correspondence. aborut. this .visit.. .. .. .... . .
Comments{refer:tq question #): 'Expfain any YES„answers and/or any reconmenrlatrons or, aiiyother comments:
-. _
Use Arawings of facility to better"ezplaiin situations : {qse additional pages as necessary} s
❑ Yes [XNo
❑ Yes XNo
❑ Yes 14 No
❑ Yes ONo
❑ Yes b(No
❑ Yes C�t No
❑ Yes XNo
❑ Yes Q�No
❑ Yes q No
❑ Yes 5d No
❑ Yes gNo
❑ Yes 5YNo
❑ Yes D'No
❑ Yes 9No
❑ Yes 0 No
❑ Yes ONo
❑ Yes ONo
❑ Yes W No
❑ Yes " No
❑ Yes ;i?No
❑ Yes [YNo
1
T_ s�
Reviewer/Inspector Name m ` ": tl _. Q 06R
Reviewer/Inspector Signature: ��� Date: O'_ R—M 1
3/23/99

} Facility Number: — Datc of Inspection
s
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[�<No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNo
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
t No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
0-Yes
❑ No
m It,on omnients an of .rawmgs:..
u
3123/99

- 13Division of Soil and Water Conservation [3Other Agency
® Division of Water Quality
Routine O Cum laint O Follow-up of DIV ins ection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
31
Time of Inspection 1 ``-10 24 hr. (hh:mm)
D Registered flCertified © Applied for Permit © Permitted 0 Not O crational Date Last Operated:..........
Farm Name: ..........
' {W.Xe....C: ......(1�umq............................................................... County: ......�t0irt. ...........................---• .......................
Owner Name: 1Sler,tlr................... Phone Vo:...�9l0�:..3�..
........... . ......1 ..............................................
Facility Contact: . Title: ................................................................ Phone No: ...................................................
Mailing Address:.. p. .QoX ...,�63............ ......... ..... ...... ...�hia�Uor{i�ta..(`!L.................................. �.............
` �......
OnsiteRepresentative ....... t('` ... aVA"y............................................................. Integrator:...................................................................
Certified Operator......................................................................................................... Operator Certification Number.j..&
Location of Farm:
c�.r Ix,.....lS....°r....yt. R ..lSiie...... z • ....milt 5......^!;?��c-...�.......................................................................... .
�As} yid ,_ a f
... .••.......... .
Latitude Longitude
Desi Current ...
gn '
i?esi Current s Des Current
Capacity Population'
sign
Poultry. "yCapactty .Population Cattle Capacity. Poptiiation
0
h � [&Wean to Feeder 7
,
Layer ❑Dairy
❑ Feeder to Finish
❑Non -Layer ❑Non -Dairy[
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other
❑ Farrow to Finish
r
Total Design Capacity ()7
❑ Gilts
' ❑Boars
t
=x Total SSLW `l % 01
Number of Lagoons f Holdrng`Ponds
�...
❑ Spray Field Area --
❑Subsurface Drains Present ❑Lagoon Area
,-
.. .
❑ No Liquid Waste Management System
y
(General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
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 CM No
5. Does any part of the waste management system (other than lagoonstholding ponds) require ❑ Yes F] No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes F No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes CA No
7/25/97 Continued on back

Facility Number: 3 -- L
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Q4 No
Structures (Lap_oon%JIoldina Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes k No
Structure 1 Structure ? Structure 3 Structure 4 Structure Structure 6
Identifier:
Freeboard (ft): ............ �.:. ............
.......................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes M No
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)
i
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 ......_.....�SLV ..................' D. 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?
1
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?
a
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?
❑ Yes
® No
❑ Yes
9 10
❑ Yes
No
❑ Yes
No
❑ Yes
CS No
❑ Yes
[R No
❑ Yes [% No
❑ Yes (; No
❑ Yes [?-a No
❑ Ycs R) No
[i Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
f
0 No.violations or deficiencies. were noted during this. visit.- .yo'U.W'i11 receive no ftirther
correspondence aiVout this. visit:•: •
Comtnents;(refer to question_#): Explain: -any YES"answers and/or anv recommendations.or any, other comments - ,
Use drawin s of facility to better'ex lain situations. (use additional a es as neeessarr
I; P P' g ) .
zZ +�^aw �cf�ra9 i1wv� �� (L 141 i %AI Fvtda av1ww, (••t��SCjCin "Z)y- skov -tOr. r., ��►_
l
I
7125/97
H,
Reviewer/inspectorName tG L.-. startAn
Reviewer/[nspector Signature: Date: L hi Lily

Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection
Faci€ity Number
Time of Inspection 3: 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Noty Operational Date Last Operated: _ .._ _ . _ _.. ._. .. . _........ r.... _ _.
Farm Name: ...... ----•..........
County: .....DVOC...... .. .... ..................... ..... I .........
._...._ .
Land Owner Name:... ............. _........ Phone No:
Facility Conctact:...-Al1w .... _-- ` .... ... Title: r...._.... _ Phone No: ... 61019— 25-t- -2.
Mailing Address: _�%� .. (p 7..---- ....................... _........... ..... . ..... ..... —AtEm.._......
Onsite Representatire:....�...�Jtc .................. Integrator: _.ldC�!(
Certified Operator: _ ly.. Operator Certification Number: 1.6 ,5
Location of Farm:
�...!� . .... .. . .........
.._.�.►n._..is........ ... ......... ......... .......... _....... ........ ._...... __....._..... .... _..�
Latitude ®' ®4 u Longitude 0 & Lc
Type of Operation and Design Capacity
y zs5 >g ��DeS�gn CLLerent 00 Desigh Current
Des n ;Current � h _n ,
S�nne 4 Po le , Ca it`P ulat�on :`
:. $ter-= � �' Ca act Po uiatiany Poultry. 0 Ca acE ulat�on Catt
= Wean to Feeder Qb ❑ La er ❑ Dairy I
Feeder to Finish;I❑ Non -La er =: ❑ Non -Dairy
Farrow to Wean F : i ..
��
�.
i
Farrow to Feeder -�4-. t�TotalgDeslgn, C' i achy
Farrow to Finish
❑ Other s.
y Number of Lagoogs 1 IlColdtngX01 R'1. e Drains Present
❑Lagoon Area ❑Spray Field Area
Genera
1. Are there any buffers that need maintenance/improvement? ❑ Yes E4 No
2. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Jfl No
c. If discharge is observed, what is the estimated flow in gal/min? N h&
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Q No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RINo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JQ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes $ No
4/30/97 maintenance/improvement?
Continued on back

i
i
Facility Number:...,(„
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?
Structures (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
3
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)
Structure 5
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.r14=..... ............... .... .._..... _................. ....... (YJN....................................
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?
❑ Yes 0 No
❑ Yes &No
❑ Yes K No
❑ Yes 9No
Structure 6
❑ YesNo
❑ Yes No
Yes ❑ No
❑ Yes EfNo
❑ Yes 19 No
❑ Yes
Df No
❑ Yes
70�f No
❑ Yes
Xf No
❑ Yes
$fNo
❑ Yes
R(No
❑ Yes
pi No
❑ Yes %No
❑ Yes 9No
Dd Yes ❑ No
Comments (refer to questioa#) Explain any YES answers and/or any recommendations or�any other comments
Use drawings,;of facility to better explain situations::{use additi&n fl agesls necessary)'
2�. t ve l ] v%u m6vm h S it hey 1-L- VJ3 1- kOUP GOYYGS PO4 L3 ti� kXStC� U( �r MAl ,on p
1
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a
cc: urviston of wafer vuatiry, water Vuattry aecuon, factory .9ssessrnent unit 4/JU/9 I

L'
•
Site Requires Immediate Attention:
Facility No. 3l
DIVISION OF ENVIRONMENTAL MANAGEMENT q
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD / c�
�r
Faun Name/Owner:
Mailing Address: ry
County:
Integrator.
DATE: ,2, 1995
n Time:
On Site Representative:
Physical Address/Location:
r
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 77° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon hav efficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e or No Actual Freeboard: Ft. Inches
Was any seepage observed from the la oon(s)? Yes orfNoJ Was any erosion observed? Yes ot0
Is adequate land available for spr y? e or No Is the cover crop adequate? es r No
Crop(s) being utilized: e to
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of e state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes o manure, land applied,
spray irrigated on specie acreage with cover1crop)? Yes or No
IX-M RZUSLt_Al�_
Inspector Name qgn�aturP
9
cc. Facility Assessment Unit e V q?5 -6_2 Use Attachments if Needed.