310294_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

I
Type of Visit: Wompliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 9 �' - Departure Time: ® County: Region:
Farm Name: l;�-'q_ l� Owner Email:
Owner Name: ;-L ( S Phone: (�
Mailing Address: �]�/ysa�✓ililL+����i�S� ZVC cd�]
Physical Address:
Facility Contact: Title:
Onsite Representative: S bN T)'))'1_Q
P S
Certified Operator: N45oH F PH 1 LL { Ps
Phone:
Intrator:
ol 95900
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C►urreat
Wet Poultry Capacity Pop.
La er
F=]
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
La Non-er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr P,©uIt . Ca acity Pao .
ILavers
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes �q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

lFacility'Number: - jDate of Inspection: `L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �6 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I a 3
Spillway?: S.
Designed Freeboard (in): 7 S
Observed Freeboard (in): s -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. 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
V 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
1No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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): V� S G L_� IAA f S I>
13. Soil Type(s): Atts�U1c-cx 6��oLIL f��UGl/J 6�NCC&R-6
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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[] WUP ❑Checklists [] Design 0 Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No
0 Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[] Rainfall []Stocking E] Crop Yield ❑ 120 Minute Inspections Q 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
❑NA ❑NE
❑ NA ❑ NE
0 Weather Code
[] Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facilitv Number: 'Z I - 4.1 I IDate of Inspection: PQ 7q lizi
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 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. A
❑ 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 -fA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air. Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) 7`
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YcejsNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).. M
<:� �. O 51AQ u":"
CAC'aM-f)-►wva01
5-L) 1.9q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 916 19 (�i�3Z
Date: / /l��
21412014

Division of Water Qiality
Facility Number ®- O Division of Soil and Water Conservation
0+ Other Agency
Type of Visit: QMompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - - j ; Arrival Time: I T 4 5 Departure Time: I 10 -'LVA*l County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: _ n�/�i F,
Back-up Operator:
Phone:
Integrator: n 1�
Certification Number: '�` p�• �� T
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design C►urrent
Swine Caparity Pop.
Wet Poultry
Capacity
Pop.
Cattle C**opacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
it
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
to
a. Was the conveyance man-made?
❑ Yes
[;3 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
['No
❑ NA
❑ NE
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)
❑ Yes
(.—,3"No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
offNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. �L_Q1 �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .31.
�-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;no ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ,6No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 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 4 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RTNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VjNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
XrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
KNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /0 No
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t6No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes R(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

( h
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CZ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YJ 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? -
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes V�j No 0 NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
❑ Yes ;a No
❑ Yes'. No
❑ Yes L2"No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any`YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone: j '01-6c�
Reviewer/Inspector Signature: r� Date:
Page 3 of 3 J 21412011

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 0 Emergency 0 Other 0 Denied Access
Date of Visit: (p / Arrival Time: Departure Time: County: Lilt/ Region:
Farm Name: . N4a-sE(- -4 r - Owner Email:
,, ! q 10-Q93- 39 so (U)
Owner Name:
Sd/�[/Lt� S Phone: q10 ` o%O' GI�BLwZ
Mailing Address: C
Physical Address:
Facility Contact:
Onsite Representative: ,a SQV 'P14 l L LU S
Certified Operator: �N r'ASo. `- I-jLk_1 ps
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
C9o/a
Certification Number:
Certification Number:
Longitude:
Design Current
SwineMEC­apacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
Dai Cow
Design Current
Capacity Pop.
Wean to Feeder
OO
Sd0
Non -La er
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oult .
Layers
Design
@a aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
RLOther
D_ischarses 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 I X! No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Nu :ber _ _ " 3 j - Date of Inspection:qj1jP7-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freehoard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: — I -
Spillway?: p
Designed Freeboard (in): l�.S , 5 1. S
Observed Freeboard (in): f' 95
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?
Structure 5
Zo [j NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �kNo ❑ 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
S. 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
0
❑ 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
{�
S Q � FsCjZ >C9)
12. Crop Type(s): -�
13. Soil Type(s): ngAm6F (3LaLc) l�tiR U lilt-�-� ' OKF<Y� I r ! l4wLl/J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YestNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
❑ 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 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Q Soil Analysis
❑ Waste Transfers
Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q 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 Nuer: _ `3 j - Dq L4 I Date of Ins ection: Ki 71& VZZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. T�
❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (FLAT) certification? ❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
1ANA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes A No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
�T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #f): 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).`
CflLy ��nanr�c�G cola
V� •1 ` - � iJ� ✓
1•y
�.LJ �.S 1.S
sl► 31�� 1.� _C3 a.0
1Ci' r R
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
co/W
Phone:
Date:
214/1011

Div`i"sion of Water Quality
Facility NUm Soil and Water Conservation
O Other Agency
Type of Visit: 30 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: `� `�' (,��$ �3 Owner Email:
Owner Name: F W cu tpS Phone: "4J6 -bra-OI S $
Mailing Address: Q'+ I '\,C)41now y c. n[ i r -2'-�Lj I
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Cj. Y141LU Integrator:
Certified Operator: 3A-sov F Nje_ct Q S CmfOti u Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current Design
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle Capacity
Wean to Finish I JI-ayer Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D . P,oult . C•_a aci_ P,o , Non -Dairy
I iLayers Beef Stocker
Gilts
Non -Layers
Beef Feeder
EEJ
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes rNo
o
Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment �(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes kX I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �,! -
Spillway?:
Designed Freeboard (in): �� '1,t Is �S
Observed Freeboard (in): - � egLl
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I V I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r<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? 19
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, et .
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): % (i2'e �) re SC, c 6?�
13. SoilType(s): �(ZAA(j,fr u" AtnigUUILLe PYAeal- !'ULU
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
[3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the'facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Re[ uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists 0Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes , No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ W/ste Trans rs ❑ vdeather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections E] 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: 979(p
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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
!�[
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[3NA
❑ 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 x �. , ;
Use drawings of facility to better explain situations (use additional pages as necessary). }'
�
Ac,l6(1PJCW ),,.c d31
3
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ���-T'/ig-439�
Date: L l i
21412011

Facility Number Dnisron of S and Water Conservation -
Q Other,Agency,
v
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (k Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �\ , rArrival Time: �� Departure Time: County: L1 N Region:
Farm Name: � J I`t A-S F-9-LA# Owner Email:
��3SdN � � l910-a93-3ti8otN
Owner Name: pS Phone: l�GllO-'i9�-
Mailing Address: � � l/yS;ON (- 4LAW_4_YZd W�i"LA3 / —1 �3 IE_749 )
Physical Address:
Facility Contact: Title:
Onsite Representative: _�'4_5aq P���trlp5
Certified Operator: -�A5 Y Pala—ij?
Back-up Operator:
Location of Farm:
Design'
Swine Capacity
❑ Wean to Finish
Wean to Feeder $aD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
s`' ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
031C__)� aSgo�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 1 Longitude: = o=' 0
urrent .,.a W
oulation Wet Poultrvl
Non-
DrypP„oultry„�
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy kleifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
)No
❑ NA
❑ NE
12128104 Continued

Faciliiy Number: -3 J — Date of Inspection d /
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) " 1
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes gNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
jq No
ElNA
ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
�No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
El NA
El NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ElNA El NE
El Excessive Ponding Hydraulic Overload Frozen Ground Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
VIPOL c
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
_X
❑ Yes tKNo
❑ 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 o
❑ NA
❑ NE
Comments (refer to question#): ' Explain any YES answers andlor any'rec6m endations or any'otlier com""meats `
Ilse drawings of facility to better explain situations. (use additionalvages as.necessary)
-A a 3
11125hq r.y f.q
Reviewer/inspector Name f N G 5� ,� ;� Phone:
ReviewerlInspector Signature: - - Date:
Page 2 of 3 12128104 Continued

Facility Number: 3) —jy Date of inspection /b
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 )kNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ Xaste Transfers ❑ Y'lual Certification
[] Rainfall ❑ Stocking El Crop Yield ❑ 120 Minute Inspections El Monthly and I" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes W1 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 'J(jNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes �No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Y,N,o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
)kNA
❑ NE
Other Issues
�t
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
��,,,((
❑ Yes J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
11
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ONo
❑ NA
❑ NE
Additional Comments -and/or s. Drawing
k .
G,ftL46aAT10N �jur CA-3--i10
Page 3 of 3 12128104

I Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
yl Reason for Visit $-Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: yy ll Arrival Time: Departure Time: County: Region:
Farm Name: t"l ! Y i�Q S�_� Owner Email:,
Owner Name: � A sc-w `FA ��-1/ Z�-! s 1 / r Phone:
Mailing Address: oQ_ I �X7i4N�%� CAUQCf) RCA � Z C OR S58 -7-_'y
Physical Address:
Facility Contact: \,� Title: Phone No:
Onsite Representative: yHno'xj Ly p5 Integrator:
Certified Operator: F—• 7-�jf I LrL I l` S Operator Certification Number: r" S
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = u Longitude:
Design Current
Design Current
Design Current
Swine C*apacity PopulationrEONon-Laver
et Poultry Capacity Population
Cattle C+apacity Population
❑ Wean to Finish
Layer
❑ DairyCow
Wean to Feeder
(]�
QU
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ ers
❑ Beef Stocker
❑ Gilts
N
❑ Non -La ers
❑Pullets
❑ Turkeys
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
Othe
❑ Other
10 Turkey Poults
❑ Other
Number of Structures: F
Discharges & Stream Imoacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
Page 1 of 3 12128104 Condnued

Facility N mber: —cQ9q I 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. 1f 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): 1 9 . t _ _ 19.5 19 . S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ElNE
(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
'QSJ
3
through a waste management or closure plan?
4
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes �No []NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes 0 No
❑ Yes �No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA ❑ NE
❑NA ❑NE
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑EEvidence of Wind Drift
❑ Application Outside of Area
12. Crop type(s) 5G aecz-(n1 PSSCLJ'&'
�T')
13. Soil type(s) 0.46e ?>ktZ4 f t 4 rRAA of t_L(r= / aGLPcx_K
/V1 Aaa usN*
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
Reviewer/Inspector Name I _ �f: S J Phone:' "f S rol
Reviewer/Inspector Signature: Date: Date:
Page 2 of 3 121,28104 Continued

Itsacility umber: 3 jy Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists [] Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No El NA El NE
El Waste Application 0 Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑/aste Transfers
✓✓✓✓ ❑/nual Certification
D Rainfall 0 Stocking 0 Crap Yield ❑ 120 Minute Inspections 0 Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
`P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FINo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,S..No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�&
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number ( 4
0 Division of Water Quality
0. Division of Soil and Water Conservation
0 Other Agency 5
Type of Visit '0 Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: y 3 Arrival Time: �0 Departure Time: County: U /V Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: p Title: Phone No:
Onsite Representative: ascy-! _ _ 1 i' C��- ! SIntegrator: 6
Certified Operator: _ _$ SnAl � � Lt'! S Operator Certification Number: C75 /ocQ
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I = u Longitude: = o =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder �QO Soo
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -La ei
Dry Poultry
Pullets
u
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�LNo
❑ NA
❑ NE
12128104 Continued

r
F`3cility-Number: — y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 SSSyytructurnee 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ 34 � 1 tt+S d Hffw' GEs
Spillway?: Q
Designed Freeboard (in):
Observed Freeboard (in): 3 & �g 3
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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
T No
❑ NA ❑ NE
maintenance/improvement?
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 1 o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
VNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
RfNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
JWNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
VNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
['K-'No
❑ NA ❑ NE
Comments (refer to question #f): 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):
eeLoq-'�> PAJLS NA cc&7 FeO 5�Gt.4 Flee ON CAP�►GL�
p oaf- cA613CW T)Es JC, IV IX 66
Reviewer/Inspector Name ( N�S Phone:49
Reviewer/Inspector Signature: Date: yfa
12128104 Continued

Facility Number: 3 — y I 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 [;dI No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
" No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tqNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
UNo
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
A No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative inunediatety
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
4No
❑ 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
E�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
b�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number 2�
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other _❑I ,Denied Access
Date of Visit: Ar 'vaI Time:ET Q eparture Time: ounty: uPG Region:
Farm Name: `T 'J Owner Email:
Owner Name: i l�,Sfl� LGz Phone:
G
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No: //��
Integrator• — `&C044i
Operator Certification Number:
Back-up Certification Number:
is iw
Latitude: ❑ o = 4 = « Longitude: ❑ ° = C =
g.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
oQ I JE1 Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Cattle
Design Current
Capacity :.Population '-
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: EN
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 ,PlNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes )3"No
❑ NA
❑ NE
❑ YeNo
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes ElNA ElNE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �i
Spillway?: No A)n p
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes,XNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 )?fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes No ❑ NA ❑ NE
maintenance/improvement? i
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil R
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl
❑ Application Outside of Area �J
12. Croptype(s) _/Z/%lu G Zf �• (>`, f/df�25EF4 / /�`�U� (J`� 2f
13. Soil type(s) O 4 /1/p
/ 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ElNE
d
15. Does the receiving crop and/or land application site need improvement? El Ye pl,
oElNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes gNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes /91No ❑ NA ❑ NE
19. is there a lack of properly operating waste application equipment? ❑ Yes [2rNo ❑ 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):
sr /U-44-1-V �G-
L
Reviewer/inspector Name Phone: C1110) q'70-- �3Z
T--
Reviewerfinspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection / 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes g/ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other 'e
21. Does record keeping need improvement? If yes, check the appropriate box below. gYes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield )21 120 Minute Inspections
22. Did the facility fail to install and maintain a rain gauge?
❑ Monthly and V Rain Inspections{ Weather Code
ElYes ff No ❑ NA ❑ NE
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 CAW -MP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
I�(NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
ElNA
❑ NE
❑ Yes
'V!No
PINo
ElNA
❑ NE
ElYes
❑ No
PrNA
❑ NE
❑ Yes
o
/�&
ElNA
❑ NE
El Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
['To
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
Additional Comments and/or Drawings:
2 ! /�fL�02Q G��4�rfE2 ao� �Na.sLc
% zasJ S
O/Z del 0 -5.
7'LP
1212&04

Facility Number 2
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
IType of Visit ,Off Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit grRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0�Q Arrival Time: Departure Time: r County:
cl�s�.-GZ
Farm Name: Owner Email:
Owner Name: 5 Ci Phone:
Mailing Address:
Physical Address:
Facility Contact: Titll
Onsite Representative:
Certified Operator: fit/
Back-up Operator:
Location of Farm:
Phone No:
Integrator• IW`16
Operator Certification Number:
Back-up Certification Number:
Region: 4(_1'',<20
Latitude: [ c [ [= Longitude: [= ° [= 6
Design Current Design Current Design Current;
Swtne. Capacity. Population Wet Poultry Capacity Population Cattle�Capacity F1Populaho
,
❑ Wean to Finish
to Feeder
�a
'f�
Feeder to Finish
[Ell Farrow to Wean
''IWean
Farrow to Feeder
=, [] Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -Layer. -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures `-C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
[I NA
El NE
❑ Yes
r❑1No
[--]Yes ,mil No
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
12128104 Continued

4
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? [IYes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 4
Designed Freeboard (in):
Observed Freeboard (in): �_ j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? !!
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
jo Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
`l 4,44 4^/T A L.�opr% �i 5 f�i� Lf-�C' 6,0 VFf
Reviewer/Inspector Name E F W8 I Phone: f32'7-
Reviewer/Inspector Signature: Date: & Z4
Page 2 of 3 12128104 Continued

-
Facility Number: —Zrj Date of inspection `J`�"
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 CA WMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
udNo
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
!!!!!❑ No
0A
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
Ff.
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
El 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
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
&* 2 ,
�F_ -Tf.� `�i �� /�i✓�✓uiSRL /T t/i4..s�A�.�`'
��i✓� ,
�•9 5 F
Page 3 of 3 12/2&04

(Type of Visit ,(?f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
� " I
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:.
Mailing Address:
Physical Address:
Arrival Time: rr Departure Time: County:
Facility Contact: 1 Title:
Onsite Representative: ,SO ✓1
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator: Ui
Operator Certification ber:
Back-up Certification Number:
Region: yyl16D
Latitude: = o ❑ i �" Longitude: ❑ ° ❑ , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other - - -- - - ---- - - - -- J
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poul
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
CTDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
QNo
❑ NA
❑ NE
❑ Yes
,allo
❑ NA
❑ NE
12128104 Continued

Fcility Number: Date of Inspection /d U
j
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: t'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j Q
❑ Yes D-no ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 21No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes x] 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 O No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P�Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J::'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O/ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 .E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0"Ro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
3 No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
ElYes
,E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Use drawings "off facility to better explain stttiahons: {use additronal pagesaps necessar},):
�'Q l 2 e /�I �✓� S /� ' l
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128/0 Continued

Facility Number: _3 -;�;R 7 Date of Inspection j0 yr D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,Q-No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .E] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes -El-No
r
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes ❑ No .ErNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ETNo
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
,E lIA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ,Eallo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NAr.❑'NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes L2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes QNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes L2'RTo
❑ 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 )2 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 /ZNo
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes eo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit _"Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j2rRoutine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 % Date of Visit:
erinitted �rtified © onditionally Certified 1
3 Registered
666666���Farm Name:
Owner Name: --
Mailing Address:..—
Z51 Time: or
Not Operational O Below Threshold
Date -Last Operated or Above Threshold:
County: !:L
Phone No:.
Facility Contact: . ___ _. ---Title: Phone No:
Onsite Representative: ✓ 1111k?� _. _. _ . Integrator- ----- _ f
Certified Operator: — Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� Du
:p
Design t Desag�►� ,Current , - _ ,, x Desxgin Caai�ut
_
`S_ wine 'tianrp9rPoT "on, Cattle non "
can to Feeder ,Fp Layer 1 Dairy
Feeder to Finish
i Non -Layer Non-Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Totstl Deign Capat:etY
4 :_.
Q -
Gilts
W
Boars.�'S.ST+�.i
Nnnnber?!o�
A
x,
OSChmes & Stream Imincts
1. Is any discharge observed from any part of the operation? ❑ Yes __0"No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes 'a.No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ,ETI(io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �3.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

1"'acility Number: Date of Inspection
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes _QNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes O'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 Z'No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;,21'No
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenauceJimprovement? ❑ Yes ❑'No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yes ❑.No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc N
12. Crop type (/- ,,7J22. _ 5,, V : Ls��?.= s) ?✓ 9�1r �i� Sly �f)i st'rs 'y���
-
l ,�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNT)?
,�
[I Yes
,O'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
i3'140
b) Does the facility need a wettable acre determination?
❑ Yes
©No
c) This facility is pended for a wettable acre determination?
❑ Yes
. M-No
15. Does the receiving crop need improvement?
❑ Yes
J2 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
M•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
0,woo
liquid level of lagoon or storage pond with no agitation?
'
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[I -No
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes
El -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ yes
❑•No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
.�. L4 flit s Ac �G-on / i-q / 6v- e-eclsl 14 -5pl9
71C/ek/g
—f1&-C2Se 117,r164
�� 1 00,4'? .3
Reviewer/Inspector Name y
Reviewer/Inspector Signature:
Date: ` /c 3 IC V
7'f I 11 An TP

Facility Number: oil Date of Inspection
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?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection 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?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. 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 Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes f0'No
[:]Yes ,17•No
❑ Yes ❑-No
❑ Yes ❑•No
❑ Yes 0 No
❑ Yes ..01No
❑ Yes •Q-No
❑ Yes Q No
❑ Yes IaRo
❑ Yes,.,eNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Facility Number �!'� Date of Visit:�N&0
nal Below Threshold
® Permitted ® Certified D Conditionally Certified 0 Registered Date Last Operated Above Threshold:
Farm Name: /i !Q krse�� e5 z d'3 County: n `—
y�y T.--� 1 1
Owner Name: _ �1G5�K _ N_�_�`/t�S Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: L�&e z-
Certified Operator:
Location of Farm:
Phone/No:
Integrator: & � h
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� lJ" Longitude �• �� �u
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Imp -acts
1. Is any discharge observed from any part of the operation?
❑ Yes 4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes EgNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes (9No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: Z 3
Freeboard (inches):
05103101 Continued

Facility Number: 31 — $3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 01 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes F] No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes C.NO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes EgNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [S No
12. Crop type (6✓n __'26V AV4OQ7A- L 3�,*7vxC J '5*4// Wm4eeA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes El No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
El No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
❑ Yes
4K] No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Q No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KI No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
E� No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
A5 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
91 No
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
El No
(ie/ discharge, freeboard problems, over application)
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
N No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� .-a£ -.ux a._•. i s.' a _�a �; tr �•
Comments (refer;to question'##) a XiplauE ny Y,ES;answersa,ndlor aec ny#rommendations or'4awnny o;'thertcdtnments g m
Use thaw gs10f4facdity to;bettet�eiiplain situations: (use addittonai pages as necessary) �' ; ; ;
❑ Field Copy ❑ Final Notes
F _
/V e NeQ� 7 D A4 1A_fX,'JL PeeeINY ✓i CDC Lci � DDoI Z'd ✓P A'.
s( /s
i
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z
0510310I Continued

Facility Number: 3E — 3z Date of Iuspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 P3 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JK1 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 ,M 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 8 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P9 No
5100

Division of Water t2tt -
- ality
Q Division of.Soii.and Water Conservation
Q _Other "Agency,
Type of Visit ,G'Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit-ADrRoutineO Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
31 ZG)
Permitted [3 Certified 0 Conditionally Certified 13 Registered
Farm Name � c� N u >r Se+�
.....Z
...................................
Owner Name: i�S
Facility Contact:
Mailing Address:
Title:
�] O Time: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .......................
County: ... I)��1 I,)
Phone No:
Phone No:
Onsite Representative:... �x4 ...•...T.b.,._..... y Integrator: y�, ... ,';`��
............................................. !..'!.
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �" Longitude �• �� ���
Design 'Current
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Curlrent .
Poultry Ca aci ci Population Cattle _'Ci a _. Po elation
❑ Layer Eoo
Dairy
Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total Ssm
rdni
jrpijpp Z Subsurface Drains Present ❑ Lag+w►n Area ❑Spray Field Area
H-Pnnds / SolidTiaps- ❑ 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. li' 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
Identificr: ................ ................................Z.........................................................................................................................
Freeboard (inches): 2-9
5100
❑ Yes ' 'No
❑ Yes ❑ No
❑ Yes�No
❑ Yes No
❑ Yes ,�}1No
❑ Yes//❑,110
❑ Yes 9�To
Structure b
Continued on back

Facility ijumber: -7 —Z Date of l6spection 1 Printed on: 1/9/2001
5. ,Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes -O'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type o Co r t�
_''1 �. � �, � of T:�� +1 GG ,.,..,10
rm t d --, Na `a , :5 - `(11 bra
13. Do the receiving crops differ with those designate in n the Certified Animal Waste
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
❑ Yes')z(No
❑ Yes j2No
❑ YesZfNo
❑ Yes�No
❑ Yes 'Q'No
Plan (CAWMPV ❑ Yes o
❑ Yes No
❑ Yes No
�dNo
❑ Yes
❑ Yes No
❑ Yes �ZNO
17, Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes
'1_0No
I8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes YNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes )dNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes /ZfNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ""No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes E�No
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 'VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes QNo
0:.i'. Q•viQiatioiis.oi Oi fi:cie:acies w' q're pgte0. di0fi this:vjisit: You wi�i ieceiye uo' u tier r : .
correspondence. about thi's :visit~
Comments (re_ ter to question #):, Explain ady YFS answers and/or any, rec-ommendati6mi or`anyiither c-o
iise+ vviregs affacitity to, better explain.situations. (uise.additioi al Fags as ae�eessier9) wr
ra c 0�4�J
Reviewer/Inspector Namej�etJUrri
Reviewer/Inspector Signature. r_ -_ W Date. 5/00 .

Facility Number: 3r —Z1 Date of Inspection I��/ 'l/(Jf � Printed on: 7/21/2000
Odnr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes,,ITNo
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 ZZINo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

4• � .t
- - DiVii II of Water Qualrty
Div
x � �
0 rston of Soel and Water Conseryatron
3 t Other Agency,
%`a:L
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: O 30 Q Time: , � Primed on: 7/2112000
Facility Number
0 Not Operational 0 Below Threshold
Permitted [3 Certified © Conditionally Certified © Registered ' Date Last Operated or Above Threshold: ..................
Farm Name:... a`....1.1a l-.�'.� f.............�.. .. ... County:........ 1.irk.............................................
l
J` Q 6 q
Owner Name: ... TA..SO.Y...�1......................... L..•1C.h1.1.. 1.................................... Phone No:..........i.1. ...�.. ZJ... ..�... .Ss .. ..
Facility Contact: .............................................................................. Title:................................ Phone No
Mailing Address: ... ........ jo.C?y, .......K�!.: .......N.C....................
Onsite Representative: .................................... Integrator:.............. RVY.ph.
Certified Operator:......... i4san........._.. .�>.................. ...... Operator Certification Number:.. a�7c
Location of Farm:
swine []Poultry []Cattle []Horse Latitude �' �° ��� Longitude
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder Q ❑ Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity Z
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag,wn Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes *No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance than -made? El Yes No
h. 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)
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?
Structure I Structure
''2Structure
Identifier..............✓..1.......... .................. �.....f................_........---.--......
Freeboard (inches):
S/00
❑ Spillway
Structure 4 Structure 5
❑ Yes o
❑ Yes T10
❑ Yes *No
❑ Yes $,No
Structure 6
Continued on back

10 -30 - 00
Facility Number: — q Date of Inspection Printed on: 7/2112000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes [No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [4No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [VNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [-]Yes � No
12. Crop type ,1 WrM Jn S-Ld , f -r)r,I - %A L & . Snr/Ln, I SIMAJI 01424 l LO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes U'No
b) Does the facility need a wettable acre determination? ❑ Yes O(No
c) This facility is pended for a wettable acre determination? ❑ Yes t_514Qo
15. Does the receiving crop need improvement? ❑ Yes zjqVo
16. Is there a lack of adequate waste application equipment? ❑ Yes ANo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes r
18. Does the facility fait to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc-) 4 ❑ Yes 110
19. Does record keeping need improvement? (ie/ irrigation, reeboard, ste analysis & soil sample reports) IYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑``Yes Wo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _12441F
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes �o
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 o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Zo
�; N+o iol'atioris:o�- deficiencies -were n6 ed ding i. s.vjsjt.'• Y:o4 will i eeeiye Rio: #'urther
comes oridezrce: about: this visit. - : - : - : :::::::::::::::::::
Comments (refer to.question #): Explain any YES answers and/or any recommendations or any -other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f q . 4e-.p gre_t, boat rc cord it, d :�, c,e . `
0 5 4IXVt'se-OL
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q O C� 5100

1~acility Number: — Date of Iwspection Q - () Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond.or lagoon fail to discharge Wor below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation., asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 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 QJ No
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes No
5100

r [3 Division of Soil and' Water'Conservation -Operation Review
0 Division of Soil and Water Conservaboif Compliance,]*s tion
R Division of Water Quality--Compli"ize Inspection
_3 Other Agency Operation Review;.
10 Routine 0 Complaint 0 Follow --up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 14 tjQ
Time of Inspection 3 24 hr. (hh:mm)
Permitted � Certified 0 Conditionally Certified [3 Registered 0 Not Operational Date Last O erated-
FarmName: ....... ....."L--%Ii............................................................... Lounty:.....D....Lt..................................................
Owner Name:
Facility Contact: ...............................................
Mailing Address: ........................................................
Onsite Representative: ,. 5...........,
Certified Operator: ...................................................
Location,of Faxm; , I f
Phone No:
........... Title:..:............................................................. Phone No:
................................................................................. .......................................... ............ ..........................
.................................................. Integrator: ...... K...........
.................................................. Operator Certification Number:..........................................
vv�T.ai....!`v�.1!...,.....�v`...c...-�J'.....1�...1.......!....'-.�...Iri1R.....J..l.
...� ....�.. ...� .�.. ................................................................................................................................................................. —............... ..--..I............�
Latitude �' �� �• Longitude �• �� ���
" Design Current Design:-, Current Design Carient ;
Swine Capacity Po ulation. „Poultry .-.-Capacity Population .:'Cattle Capacity Population
Wean to Feeder
Ot5
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�T.
Humber of Lagoons - ®- ❑ Subsurface Drains Present ❑ Lagoon Area
rt ..
_Holding:Ponds / SaIid Traps ❑ No Liquid Waste Management System
❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
[% No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
cirNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
��nn
Freeboard(inches): ................................. ......................
.................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
3123/99
Continued on back

Facility Number: 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 maintenancehinprovement?
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AUplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type G[ La
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?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
21 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?
N,6 yio�a>fions:oT deficiencies were itufea dining phis;visit; You will ieeeive Rio ui-ther • ;
correspondence. a��it this visit. . . . . . . . . . . . . .
Comments (refer..04uestion #); _ Explain afiy YES answers and
Use drawings of facility to better explain situations (use adi itk
Eft-►-a—
vet%
�Cchvr—cam � t—� cc�s
❑ Yes 9No
❑ Yes allo
❑ Yes PNo
❑ Yes P�No
❑ Yes 91 No
❑ Yes [g No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes RJ No
❑ Yes f � No
❑ Yes PQ No
❑ Yes ONO
❑ Yes ONO
❑ Yes J�No
❑ Yes VNo
❑ Yes 9No
❑ Yes ® No
❑ Yes (1NNo
No
❑ Yes
❑ Yes 19 No
/or'anyrecommendatio- s 6r "y other comments:
. k
;nal pages.as necessary)
rc"A ,.
AL
Reviewer/Inspector Name — 7 -- - - - - t o 3S 3qC� - ar7
Reviewer/Inspector Signature: e �� Date:
3/23/99

.J Facility Number: 3 —1T Date of Inspection d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below kYes ❑ 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 XNo
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 KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or C` \\
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? �(es ❑ No
dc(Vttoaa bmments and/or rawtngs
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
[4p Routine O Complaint O Follow-uP of DWQ inspection O Follow-up of DSWC review O Other
i nr r irr
Facility Number 3 q Date of inspection
Time of inspection Mn24 hr. (hh:mm}
© Registered j& Certified © Applied for Permit © Permitted JE3 Not Operational Date Last Operated: ._...._.... ,
°� 1J'f�R ..... .......�... y:... - ...:...
Farm Name: ............ ...N. i �-..... Count �........................... .............................
Owner Name: .......... N .. ...W �� P. f.' { ��t��f�?-' :.''.a.........................1....I.............
. .......................... k.. }. �......,.�...r............................ Phone 1'0• .....
Facility Contact: ........................................................... .. Title: .. Phone No:
Mailing Address:... Z ................ . k.. Q..............I....
OnsiteRepresentative:1.......r.5,!�.lti .. tl{1111�hi-
..................................................... Integrator:........ .. K.I ...........................................................
Certified Operator:............................................................................................................... Operator Certification Number :.........................................
Location of Farm:
M...... rs..... .....Sod.........` `!u...... .:..... n ... ltv.7...tUc...
... ak.... SKJAPk........................................................................
----- .... ........................................ ....
Latitude • 4 " Longitude • 4 "
Design Gurrent Design Current Destgn (i
Capacetyµ Population `' Popltry .r Capacity =Population -Cattle„ Capacity: °pop
Wean to Feeder
5U6
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEE
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certifted operator in responsible charge?
7125/97
❑ Yes [P No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes tO No
❑ Yes W No
❑ Yes ® No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: — 2-14
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Itold inu Ponds, Flush Pits, ete.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ?
Identifier: 1 Z
Freeboard (ft):..........2'........................... Z'3......
10. Is seepage observed from any of the structures?
❑ Yes ;N No
❑ Yes `® No
Structure 3 Structure 4 Structure 5 Structure 6
I 1 _ Is erosion, or any other- threats to the integrity of any of the structures observed'?
........................................
❑ Yes C$No
❑ Yes ® No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public r health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes [,No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes No
(If in excess of WIMP, or runoff entering waters of the Sta1te. notify DWQ) _
15. Crop type ._....._...:'<?.Q:UaQ.......................................... jlfh0��l..IA+Yh....... .............................................................. .................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes �A No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes Ej No
18. Does the receiving crop need improvement? tAYes Pj No
r -
19. Is there a lack of available waste application equipment? ❑ Yes bO No
20. Does facility require a follow-up visit by same agency? Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'' ❑ Yes 16 No
22. Does record keeping need improvement? Yes ❑ No
For Certi€led or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available`' Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes No
0 No violations or'deficiencies were note'd,during this visit. You.W'ill receive no further
correspondence about this'. visit'.
COrmneno-,(eefer to question #)::Explain any YES answers and/or'any recgmmeridations:or any other comments r : m
y
Use.,draw nes of facility to better`ezplain situations, (use additional pages as necessary):
`� ff
6+k `G�,QtiRS S . jh(h, t
it. w� SkWO c.vJ O-S Spy is-s nc" Lb if) Ptwtu*
ZZ' f 5rtcof6s LACK 4,t>at
6rj JCL <
y
7/25/97
Reviewer/Inspector Name " ` �" '
F ,' .�
Reviewer/Inspector Signature:
Date:
I

�CRoutine 0 Com taint 0 Follow-up of DW2 inspection 0 Follow-up of DSNVC review 0 Other
Date of Inspection
Facility Number 9
Time of Inspection I 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ AppIied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ...._ ..... _......
_ .. _ .. ......._._ .....
Farm Name: �-i .$... h� rS. i._�_.....�.... _....-�....._ County: _Z1L..p.Lj_ks......... ....._.......
_......f
Land Owner Name: Ala. x...r.,............. .....� .�. .a �. t. �!r ._ _ .... _._..._ Phone Nw .-L.9j.Q.a ZR ...: �.. .
Facility Conctact:... _...._............................ ....... _.... Title: ........ Phone No:
Mai f in. Address: , -' � + +�+ G" +rc- i^ LA. C—
Onsite Representative: k n► .sr rs�...a y..� i S. T±r.A......._........_...._. Integrator:
Certified Operator:...a3bn �".!��l.5 ._.... _... Operator Certification Number: >�f�S�.
Location of Farm:
.S?.n_..s<.c.aa�la.ea.S: _.S.a...�....n�..... ... l.lt... n...�t.�..x-a.�.�..,�.�.. �..........D:...Z.�.....r�a.�.. .,S �al........a ....._........ 4
....R..l.`�..�7.............. .._............. _........ , ...._....... .......... ..... ........ ,._...... .......... ........ .... ...... ...._ ._ _ ty
Latitude ' 1 ���� p5i u Longitude
Type of Operation and Design Capacity
�� Design Cuarreat �, s best o Cu ent Design, Current t W.. £. g ',
Swine, Point Cattle"
P,o ulation -. i7'' � _ : @a "acrtrr.=:Po nlatian � aD r Ca AC Po tilatiott
® Wean to Feederfr `.
❑ Feeder to Finish ❑Non -Layer a s ❑Non -Da
Farrow to WeanNE,
ar
Farrow to Feeders �Total9 DeS1gII Capaely (b
'F
3 Farrow toFtntsh S ��y'
❑ Other
Number ofLagoons J Holding
Ponds ❑Subsurface Drains Present _
❑ Lagoon Area T'.❑ Spray Field Area7
,
01,r
n rat
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes JR No
❑ Yes ®No
❑ Yes ® No
❑ Yes ER No
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
Continued
an back

Facility Number:......
6. • Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ff No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes KNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes BNo
Structures (I,aggons and/or Holding PogAg
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.�z.:. 5 _..... .. ......_....
10. Is seepage observed from any of the structures? ❑ Yes 19 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes CR No
12. Do any of the structures need maintenance/improvement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
C,No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ka. .uan u. ..............1...... ..... ........... ....... _..................... ........ .................._........ ..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP).
❑ Yes
0No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[allo
18.
Does the receiving crop need improvement?
❑ Yes
§� No
19.
Is there a lack of available waste application equipment?
❑ Yes
8 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
.® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
FK[No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JR) No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24.
Does record keeping need improvement?
E) Yes
❑ No
Comments (refer toMgneshon #} Explain any YES answers' and/or.any recommendations'or any other conrnents
Use ticawingsof facility to bettei explain srtuattons".(use additional pages as necessa) " r
ry
1z. Maw v eta i�v. ov. inr,� i oo>.� w0.t1..
'i - M w k e Y e �0 4 i S f ► e t t� ► �J L �.rrx +-V-tL. t- t vi u w" b c r S j 5 F cf a
PV�IL 5r ,,es tr4 juvNr lrv-i )C . g r �+•� p (e S f a.e.r,L v
8
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: _
cc: Division of Water Quality. Water Quality Section. Facilitv Assessmen Unit 4130/97

® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DS*VC review 0 Other
Date of Inspection 11 `i
Facility Number
Time of Inspection =io 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 1<5 min)) Spent on Review
to Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: _.. _ .. .... ......
Farm Name:. i 4. .. d ?^� }... ..... __._ ......._...... County:.. al ....._....._....... ....., W..Lt.i]
Land Owner Name:... ���.rr j.icst�.� �.5.iC...._ .... ...... Phone No:...1. Z 4 3 y0 q..
Facility Contact: . Title: _......._..... .......... —.— Phone No: .... _...... _ ....._....._ ....................
Mailing Address: -.r'7..,,2,...%TD. _.... .........Y.l�aary�sA,,-,....�.�_.. Z�.��..
Onsite Representative:.... Jtr. k�k..� a. s .. aC ..... Integrator:..i ...l:m x. p. ...-__... _......... ...._ .
Certified Operator: ..... jrsan.,..... .�. ..... �l t.�. 5..... ......... .._....... Operator Certification Number: _... ���L.. _ .....�.
Location of Farm:
Latitude 3®' S'$' ©K Longitude ®• ®
Type of Operation and Design Capacity
w .!, s ,F,
�. Design�rrent Destgri Curirent Destgn Currents..
Setae" Cattle
Ca act F.1?o ulatibn� k oul#ry` w Ca achy . Po ' ul$tton -. Ca act z� N, ` dathe V
A Wean to Feeder op �❑ La P� ❑ Dair
❑ Feeder to Finish ❑ Non -Layer j ❑ Non -Dairy
EM
Farrow to WeanUP
y
Farrow to Feeder�Total De5lgn,Capa�ty Z, on� N
Finish Farrow to Ftn
.. otal SSLW� i� 0 a
A
❑Other
� '" h
Number ofLagoonv/ Holding Poads
Subsurface Drains Present m ...
�`4�.,,,
Lagoon Area Spray Fiel
❑d Area
7
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/9 7 maintenance/improvement?
❑ Yes ®No
■
❑ Yes
ff No
❑ Yes
91 No
�j 1,4
❑ Yes
Ca No
❑ Yes
K No
❑ Yes
IN No
❑ Yes
91 No
Continued
on back

Facility Number ..3i...—.,`�,,�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
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
... ........................ _......
_........._
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes JR No
❑ Yes (9 No
❑ Yes 0 No
Structure 5 Structure 6
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 �a.c.si �..........�,.,.,ra,� .l �...q.t .t ^..... ........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
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?
Immpilf
slain R
12 . MF� W V .. L a o vt -.. 6 ri. y H ,•► P r- lA 0 0 r. ram! q
M a Kt S f t 1713 t i 14 E La ►•. v b P'V-'S
C, t"J, 1 z a �, e b X-� o "j i r r, q ICL r e C-o v-cL� .
Kee4 r �}
❑ Yes O No
❑ Yes E!j No
19 Yes ❑ No
❑ Yes ,R No
❑ Yes JKNo
❑ Yes JK No
❑ Yes 0 No
❑ Yes IR No
❑ Yes ® No
❑ Yes H1 No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
® Yes ❑ No
Reviewer/Inspector Name _ A
Reviewer/Inspector Signature: 6[ r Date:
i�u.ru r nn � -n■ i.
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farris Name/Own(
Mailing Address:
County:
Integrator. IM,j 14 9 Phone:
On Site Representative: .. Phone: 5 s
Physical Address/Location: l 10 % �/70 x , 7 i� ( z
Type of Operation: Swine Poultry Cattle U-4
Design Capacity: Number of Animals on Site: Q6
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:'3 Longitude: -7R' 0a Elevation:' Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) &r No Actual Freeboard: I_Ft. _C_ Inches
Was any seepage observed from the lagoon(s)? Yes o Was any erosion observed? Yes ott
Is adequate Iand available for spray? e or No Is the cover crop adequate? es or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? P or No
100 Feet from Wells? (§ or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 1 0)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or [`da If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes oea o
Additional Comments:
In pector Name
Signa e
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
' Facility No.}
DIVISION OF ENVIRONMENTAL MANAGEMENT `
. ANflv1AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Own(
Mailing Address:
County: _ NA"t i ► �. _ _ _
Integrator. On- _ �c l ti► rL Phone: On Site Representative: j�Y4 r_f W R vl[ i qPhone: &L.2�ca
Physical Address/Location: 5 i j Q7 a aQ , 7 n_� - V-1
Type of Operation: Swine t/ Poultry Cattle I Y wt .S-e C1
Design Capacity: Z. (F Q( Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3Y°_' ��" Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or� Was any erosion observed? Yes r o
Is adequate Iand available for spray? Yes or No Is the cover crop adequate? is r No
Crop(s) being utilized: 69 040 �`� '- ra E-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings' R or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes QO
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o* If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Addi'tignal Comments: g' , Q G
Inspector Name Sign e
cc: Facility Assessment Unit Use Attachments if Needed.