310314_INSPECTIONS_20171231

NUH I H CAHULINA
Department of Environmental Qual

Type of Visit: 0 Compli ce Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 outme 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1
Date of Visit: Arrival Time: Departure Time: ® County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M' rj``! Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
16Y 7`0
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pog.
La er Dairy Cow
W an to Feeder
I
INon-Layer
Dairy Calf
Z.feeder
to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=Wsign Current Dry Cow
D . P,oult . Ca aCi P,o P. Non -Dairy
I Layers I 113eef Stocker
Gilts
Non -La er
I I Beef Feeder
Boars
Pullets Beef Brood Cow
Turke s
Turke Poults
Other
Qther
Other
Discharp,es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [DNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ 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 I of 3 21412015 Continued

Facility Number: - Date of Inspection:
W-iste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes 0-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 7
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
E
❑ 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
MNo
❑ 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
G3'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectioVX/0
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
Page 2 of 3 . 21412015 Continued

A
Facility IN umber: _ / Date of Inspection:
24 yDid 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
❑ YesFj_`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
io ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No &NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
DINo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes
[DIZ-
❑ NA
❑ NE
[:]Yes
O'No
❑ NA
❑ NE
❑ Yes
J�o
❑ 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 napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector SignatuT
Page 3 of 3
Phone: 110 i96 %3o Y
Date: ( 117
21412015

Type of Visit: p CC pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint p Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Lb Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
l
Onsite Representative: aljAcTPANt M-tUk-fz Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: i$ 1 q-��
Certification Number:
Longitude:
Design Current
Design
Cbu rent
Design
Current
Swine
Capacity
P.,op,
W.et Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
x,
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Drs Poultr,
C•.a acity
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
FlOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA 0 NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes �No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

]Facility Number: '' 1- Date of Inspection -
Waste Collection & Treatment
<y. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? �cs YNo
o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (..l &D� J LAGm j 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No DNA ❑ 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 L 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 EJNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [j] 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 Q 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 CZ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
o
❑ NA
❑ NE
El Yes
WNo
❑ NA
❑ NE
[:]Yes
0"'No
❑ NA
❑ NE
❑ Yes []/No
❑ Yes [/] No
❑ Yes ❑ No
❑ Yes E2/No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑X4:) ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E?N/o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: - 1 Date of Ins ection: u
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes 2f� o ❑ NA [_]NE
A
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
�2No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
NA ❑ NE
Other Issues
N
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[�❑ 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
21/XO ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E], o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
<0 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
['No ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any'other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
?OR
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L10 11 b -•1->0
Date: 14 La, 6
21412015

(Type of Visit: ff CoEppliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up (:) Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: © County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: UOtU
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: 1 n
Certification Number: IV ! q3
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design C►urrent
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Design
Dr. P.oultr. C•_a aci
Layers
Current
P,o P.
I
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to finish
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
a What is the estimated volume that reached waters of the State {gallons)?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
D NE
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 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:—
Waste Collection & Treatment
4. Is iitorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J Z U
1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[J 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
i 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 environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 en 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 EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
r] Yes V1110
o
❑ Yes
❑ Yes ✓[No
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
❑ Yes FdN o ❑ NA ❑ NE
ZYes �Zo
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: I- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes YNo ❑ 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 0
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 5No 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z�Nq❑ NA ❑ NE
VNo
❑ NA ❑ NE
❑ NA ❑ NE
Comtmnts (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 necessarv).
Reviewer/Inspector Name:
M
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 '214A015

(Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: &Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: ® Departure Time: d County: l7 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: 'jG11j yg Integrator: II b p�
Certified Operator: Certification Number: 1 a7 "T -3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
ILayer
Design
C*apacity
Current
Pop.
Design Current
Cat#te Capacity Pop.
Daig Cow
Wean to FeederEINon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , Pooult .
Layers
Design
Ca aci_
_fff e
P.o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Twke s
Twkey Poults
Other
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Date of Ins ection: l t l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
`I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
0 Yes
r] No [DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7"Fo
hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes Yo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes [Z/No
0 NA
0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ NA
0 NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements [:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FZ /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste 'Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections/
nspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: j
24e•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �b
'45. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Vo
❑ NA
❑ NE
�No
❑ NA
❑ NE
No
NA
NE
❑
❑
❑ NA
❑ NE
VZ`N�
❑NA
❑NE
No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone(
Date: li
2/4 Ol4

(Type of Visit: Q 7RPoutine
liance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Malting Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: Q NA-M AI MZuJ&ri- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 101 3
Certification Number:
Longitude:
Capacity Pop.ultry
Design jEfE]
Wean to Finish
DesiSwine
Capacity Pop.
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
er
Dai Calf
Feeder to Finish a4�
U
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,ou1tE. Ca aci Pio ,
Layers
D Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ONE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No [DNA ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes YN
❑ Yes �(No
❑ NA ❑ NE
[DNA ONE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility number: - Date of inspection:
Wade Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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: t_A[MOO UA GtaU
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes dNo ❑ 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 environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes YNo
o ❑NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ 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 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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?
2/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E/No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L_l '�
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LI No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: ) 3
24. id the facilityfail to calibrate waste application equipment as re required b the permit? Yes N NA NE
PPq Y P ❑ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Lad'1V0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes C21flo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes eNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
z
❑ No
❑'I o
6/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer.to question #E): Explain any YES answers and/or any additional recommendations or any other comments.
useYdrawings of facility to better explain situations (use additional pages as necessary).
6.) LZA&C MEWC-p
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1� 3
Date:
21412011

1
Type of Visit: U Co fiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other "0 Denied Access
Date of Visit: 1� q Arrival Time: Departure Time: County: �LtPtI q�� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: mz_� a-,
Certified Operator:
Back-up Operator:
Location of Farm:
[$7,71 TM ix iM A
Phone:
Phone:
Integrator: 4
Certification Number: t' U r714-j
Certification Number:
Latitude: Longitude:
Design Gur•rent
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop0,
Layer
E]
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
'Dairy
Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
lt > Ca aci. P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
r7ILayers
ers
Beef Feeder
Boars
Beef Brood Cowher
Other
oults
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ 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 ❑ o
❑ NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �o
❑ 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 I of 3 21412011 Continued

Facitity Number: 31-31 q Date of Ins ection: t 2.9
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: ( Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WNo
❑ 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 ❑ 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E ❑ 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 WN [DNA ❑ NE
maintenance or improvement?
Waste Application
Zl�b
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
l3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 1yNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNodvol
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes TT Na ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Cacility Number: 3121 j+ Date of inspection: 1 17zn I I E
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes FZINO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 540/
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:]Yes No ❑ NA ❑ NE
❑ Yes D440 ❑ NA ❑ NE
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
o
❑NA
❑NE
'No
En
❑ NA
❑ NE
zfo
❑ NA
❑ NE
Io
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othervomments.:::: < I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:C.L L PhoneA 67 13 &f
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

a
Type of Visit: t) 7Routine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up „0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ]Li?,o Departure Time: , County: Qup (_Ml Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: . a M A11♦ A*.) M. S1.t&ft Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design @urrent Design Current �Desigo Current
Swine Capacity Pop. Wet Poultry Capacity Pap. Cattlepacity Pop.
Wean to Finish La er Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
U
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C*urrent
Di, Psoulte. Ca aci P,o
La ers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Imoacts
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 nNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
L.a o
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number; - Date of Inspection: ti
Waste Collection & Treatment
.' 4. Is;storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes
dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
LA&cMN k LAGvay Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes F, No ❑ NA ❑ NE
❑ Yes [!f/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Ed�lo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes 6No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2 f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [iiyes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ZrNo ❑ NA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
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 eNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes Qr To ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes >N ❑ 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: 'j 1 - 1 Date of Ins ection: l Lit-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0"No
❑ NA ❑ NE
25. Ig the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0-16
❑ 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
Rio
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑4o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
aKo
❑ 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
E:J�o
❑ 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
[2No
❑ 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
dNo
❑ 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
r
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ 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).::;;n
tb':) L.ZMC O(Ie CD. ?UASE KEEP T�CKki, r�IbTXC`e DWO 0tt4- 00AX
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t-'N iZ.JI)k.LA 1 Phone: llb) I
Date: l
21412011

0
� �� :Dwtsioii of Water Qua
Facility Nltmber O 1)ivis
type of Visit
Cory{pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
teason for Visit
OJRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: __D", Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: fttat - Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= n F--I I =is Longitude: = o
Desig
] Wean to Finish
] Wean to Feeder
Feeder to Finish
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish
] Gilts
] Boars
itli r =,
F
„Citrrent�
Population N µWet-P ultry Cap
Dry Poultry
yCurrent ,,.,;x ti
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
LJ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer.
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
Number
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
ElNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Vocility Number: 3k —3 19
Date of Inspection It 13
Waste Collection & Treatment
4. "Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L#,C� LJ 1 U4 Gmn 0 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7�4o
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 QNo ❑ 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 e No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
<Comments(refer to question #): -Explain any YES answers•andlor any4ecomm6idati6ns or any other comments
Y-
Use drawings of facility to better explain situations. (use addttioual pages as necessary):, ,.
_.
2(:5; L�vs Nt=Erp uLoAC . K Ef
Reviewerllnspector Name j�}( ''M Phone.
Reviewer/Inspector Signature: Date: t 16
Page 2 of 3 12/2VO4 ' Continued

Facility Number: 3 1 —3j Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E I N'o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ElYes E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ 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?
ElYes
ff/ NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
00
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
r 1 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ 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
J �,/
L/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
u 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
IJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D o
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3 12128104

Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Cj IV 1 hA L) M -L4-- —
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: E—_1 o =, [_-1 u
Design Current Deslgn Current Design Current
Swine C++specify Population Wet Poultry Capacity Population C*at#le Capacity Population
❑ Wean to Finish 10 Layer ❑ Dairy Cow
❑ Wean to Feeder 10 Non -Layer ❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
El Pullets
❑ Beef Brood C-Al
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page l of 3 12128104 Continued

Fecility Number: — Date of Inspection17
Waste Collection & Treatment
/,,;o❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:)��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z5
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,�,/
DIN. ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 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
environmentalZo
t, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�fo ElNA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
L—JZ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
ZNo ❑ 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 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
U. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dN ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
igs`:of facility ao tiet#er esj
Reviewer/Inspector Name d.-:jY./ C; e;.� Phone: (916 ) Fly
Reviewer/Inspector Signature: t Date: ! 7�

"acility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ YVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [ No ❑ NA ❑ NE
❑ Yes M/No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
b No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ 'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
CNo
❑ NA
❑ NE
❑ Yes'
[INA
❑ NE
❑ Yes
No
❑ NA
❑ NE
1217&104

3l H 31 y
Type of Visit Tompliance Inspection O Operation Review O Structure Evaluation Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 20ther ❑ Denied Access
Date of Visit: i t lt. a Arrival Time: 300 Departure Time: County: L_L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [= I Longitude: E__1 ° 1--] 0
Design Current Design Current
Swine Capacity Papulation Wet Poultry Capacity Population
Cattle
Design C*nrrent
Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -La ers❑
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
Beef Feeder
Gilts
Pullets
PoBoars
❑ Beef Brood Covi
Number of Structures:
Other
❑ Turkeys
❑ TurkeyPoults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
[I Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
[I NE
❑ Yes
VNo.
❑ NA
❑ NE
12128104 Continued

- F'icility Number: Date of Inspection u lt+
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: [ &&0-a•.1 I LACY -off 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ►$ 1-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ?5NE
(ie/ large trees, severe erosion, seepage, etc.)
r,(
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
[Dyes
�No ❑ NA ❑ NE
maintenance/improvement?
l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[5(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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
&N ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
L No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E( No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No ❑ NA
❑ NE
Commerits_(i efer to question #) Explain any YES answers and/or any:recommendatrons or any�othef comments.
��.
Use drawings of facility to better explain situations. (use addthonal'pages as necessary)
li� i'ivTrJ(�clt �-A ,1 6� �FtLr boarv( rk-Vr� 1.oVf4 OK` t4 M50or'T 5 iJ � ^*,
31 J i1�ffa_rrd , `_V)1 rgL5 001-c'e. ✓Df- �W�+ P 1.'& of CA_ jf)s U
�.i 01ff Wt ii 6--- rssuea� yr, �. p� ss vV- �OA46 ( UYV% 4 -
Reviewer/Inspector Name `j„ jrrk.PE a4,Phone: (flo) 719-
Reviewer/inspector Signature: L- a�a Date: !I 6
12128104 Continued

Facility plumber: —310 Date of Inspection
Mnuired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
CNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
EI'NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If es check the appropriate box below.
P g P Y
❑ Yes
❑ No
❑ NA
,�
IJ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
E� E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
iNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
El NA
VNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
E)/NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
6rN//E
and report the mortality rates that were higher than normal?
WNE
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
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
❑ E
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?
El
❑ No
❑ NA
[2/NE
Additional Con ents rand/.or Drawin
12/28/04

Type of Visit 6 Co pliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit U Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: CUD Departure Time: County: A/f rt Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: d� HF� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm -
Back -up Certification Number: _
Latitude: o = . = Longitude: = o
WIm
Aesig M Design Current Design
Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity
Axopulation
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Da' Calf
Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean Dr.-Q Poultry El Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Layers
❑ Farrow to FinishEl Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars ❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
❑ Other I ❑ Other I Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑/ o❑ NA
❑ NE
❑ Yes
[:]Yes
❑ NA
❑ NE
[]Yes [ZNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — l Date of Inspection �o C
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: AJ �(� [ ►) 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
a3 �
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 YNo ❑ 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 [ Vo ❑ 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
L✓I No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O NNo [INA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes
C No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN ❑ NA
❑ NE
,Comments={refer�to gnesi►on�#) Explain any YES answers gnd/or auy recommendations or any other comments.
��[Tse drawings�of}}facetlty,�to�6etter�egplain situations ,{use;additional pages as necessary):
�pp^' - 6 ,✓"�'i h. K rya +n y + -
p�
Reviewer/Inspector Name p FA_rZ__Jx'Lk- ... Phone: ,03 �(
Reviewer/Inspector Signature: Date: O 6
rage z of .s % Ursurluea

Y
-� Facility Number: 3 Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes fo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3] 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 E1 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
-0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
[I NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
oo
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
B
Ej o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
M40
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
ETNo
❑ 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
��
.L� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately �,
31. Did the facility fail to notify the regional office of emergency situations as required by El Yes 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 Z No ElNA [INE
33. Does facility require a follow-up visit by same agency? ❑ Yes BNNoo ❑ NA ❑ NE
Additi6nal'Commeats and/or Drawmgs: .._
Page 3 of 3 12128104

Facility Number
Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
r
f Visit ��C,,oLLmpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 0 outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� 3 D Departure Time: County: O� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: `� 'Title:
Onsite Representative: ��VA)V!g +� �aJ(
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
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ t Longitude: ❑ ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
- - ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CmNi
Number of Structures: =1
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?
sal
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
�`No ❑ NA
❑ NE
❑ Yes
t ❑ NA
❑ NE
12/28/04 Continued

Facility Number: --'� Date of Inspection 1
Waste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: th �� l � 601"L!
Spillway?:
Designed Freeboard (in): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6. 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 dNo ❑ 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 environ ental 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 two ❑ 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 ElYes 0'N' o ❑ NA ❑ NE
maintenance or improvement?
Waste Application —/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ 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
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Yes
[I�
T"'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2"No
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
ld 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):
AA ery 16A f.1z.
L.A 0AA/,r QjVp
Reviewer/] nspecto r Name I L.7tf#/V ELL I Phone: `M9 7 d'
Reviewer/Inspector Signature: Date:
Page 2 of 12128104 Continued

L'
Facility Number: 3 — ?j 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
lyd'No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Doe record keeping need improvement? If yes, check the appropriate box below.
LTJ Yes
❑ No
El NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ON-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EW
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,2
Ld o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, _,
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Ll'Ko
.lam 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
P-<o
❑ 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 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
0J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
12128104

�� -V Division of Water Quality
,
F
cility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: Title:
Onsite Representative:'
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine: , r ,��-Capacity; � Population
10 Wean to Finish �I
❑ Wean to Feeder
eeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Email:
Phone:
Phone No:
Integrator: I !�//,l 7
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 1 = " Longitude: = ° = , E_—] "
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ 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?
Design Current',..,
Cattle Capacity, Population;—
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures: F
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: _ — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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
Cl 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
❑ 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
F'� 4
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments e
Use drawings of facility to better explain situations. (use additional pages as necessary)c
C �� t s fl?2Q O •
�l��aQn s ar`e ex
V Xa-
_ _ w
Reviewer/Inspector Name G Phone: 6Z'7- �t
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

'Facility Number: — Date of Inspection 97
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 CAWMF readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need i vement? If yes, check the appropriate box below. ElYes ElNo [INA ❑ NE
❑ Waste Applicatio ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfal ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
yllqlo & d-
3-�
1 S G /o� %Te��� JrP�CIy
eed
*1'a �C I'al47 a
/1'1Q '5F J-�GCi✓y S sl��G
T
Page 3 of 3 12,128104

i
F
f Visit Coppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technicat Assistancen for Visit 0 Koutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: OS Arrival Time: % a0 Departure Time- County: 00r IW Region:
Farm Name: - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G&J-6 a-XW ID�
Certified Operator: i4Fon6(7- i-ALzR-
Back-up Operator:
Phone:
Phone No:
Integrator: CnU(z Yty
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ; = 1{ Longitude: 0 0 = & =
Design Current- Design CuCiCnt Design'" 111 Fnt
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder -Layet ❑ Dairy Calf
Feeder to Finish Z 41 1 1.,LWO
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish El Layers
❑ Gilts ❑Non -La Non -Layers
❑ Pullets
❑ Boars El Turkeys
Other ❑ Turkey Poults
❑ Dairy Heifei
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocket
❑ Beef Feeder
ElBeef Brood Cowl i
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
iNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
d o
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
20
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

t
i - R
Facility Number: 3 Date of Inspection
Waste Collection & Treatment ,_,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LOCI 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: G F I % Fr 7-
Spillway?:
Designed Freeboard (in): 11 1 °I
Observed Freeboard (in): 'ZZ Z-o
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
4No ❑ 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
I!I No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
WNo ❑ 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 I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) gm1 not 0g) Fes co E W S C-;r{i
13. SoiI type(s) f- a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
"o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
7No
❑ 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
YNo
❑ NA
❑ NE
3E1�a�"�F:s�:.3,r. s :.4 �.; 1� : x sr;• k�.� av�,
ra YEEP t'. eY oANA `L,-T W=
Reviewer/Inspector Name e~,. Phone: NO) 3g-� .- 3�OD 1a3
Reviewer/Inspector Signature: Date: Z b
I2128104 Continued

t
` Facility Number: — 3 Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? LJ Yes Zo
El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check El Yes ❑ NA ❑ NE
the appropiiate box. ❑ W­Up ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
A
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[�/NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LdNo
❑ 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
E2<o
❑ 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
LJ 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
d
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
u No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

1.
"Y
Type of Visit i0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit WRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: iL Time:
rO 3/
Not Operational 0 Below Threshold
Permitted Q Certified [3 Conditionally Certified 0 Registered Date Last Operated or,bove Threshold:
FarmName: 'V e- K / t ✓A r County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: /Phone No:/
Onsite Representative: C/ 0 Integrator-
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° u Longitude ' & OK
Swine
Design Current, Design Current Design Current
Ca acity PD ulation .;I?oultryL Ca acitt P,o ulation .: Cattle Ca acity P,o ulation
❑ La er ❑ Da'
1254W❑ Non La er iry
❑ Other
Total Design Capacity
Total SSLW
INHWoldilePonds
mber of Lagoons Q ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
- -- - -- —
1 Sofid Traps j ❑ No Liquid Waste Management System
❑
Wean to Feeder
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑Gilts
❑
Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f �
Freeboard (inches):
OS/03/OI
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

1 w,
Facility Number: Date of Inspection / C
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Poonnding/ ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type �t5C4 i_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW`N4P)? [I Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15, Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
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?
❑Yes
❑ No
(ie% discharge, freeboard problems. over application)
23.
Did Reviewer,7nspector fail to discuss review/inspection u7th on -site representative?
❑ Yes
❑ No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
!© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit_
Coinments;(refei= to gaestioa: Eiplsrn:any YE$ sos�eei s s�d/ar,.attty t�eeommeudat=ons or.snv outer wmmea#s7
Use drawings of facility to better explain situations. (nse addEtronial pages. as netessarv) ' _
a Field Ga Final Notes
=max . = ,6 • :_. ? z� � '� _a °� ._�- «_ - , -- •-� -.,. �. r., ffi ;k.
il�l5 Z41" tC Ah 74e /.4*1
- 4 7�P ?l#l- /-*114Oh 0�,e ✓ r/0 14AVA war-h X Wlv,"
-t&o rA dr / 4i��i'! �O�T ��o -� /i 5 �i�r .� /� .�fi�s�r x-���►�+07
lef
Reviewer/Inspector Name
Reviewer/Inspector Signature: rXe Date: Z
05103101 Continued

Facility Number: 31 3il,C Date of Inspection z/
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i_e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or at p'ermanent/temporary cover?
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [-]No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Type of Visit O Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 314 Date of Visit: Tune;
4/25/2002 9:20am
rO Not Operational O Below Threshold
Permitted 0 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ............
Farm Name:GvQjrgUarriQrA1&2................................................................................. County: D.Uplin ............................................... W...IRQ.........
OwnerName: George .................................... Farriar....................................................... Phone No: 9.10:19 A1.7.5.....-.---------.---- ..........................................................
Mailing Address: 457T..am1Etlllale..RoAd............................................... ....... Kenansville..W.................................................. 2,8349.............
Facility Contact:.............................................................................. Title:.................................................... Phone No:
...............................................................
Onsite Representative: .Geno-Ken edy............................................................................ Integrator: 3kltlxplty..lFaunily.kax.....................................
Certified Operator: Gg.QrgA ....................................]rs.[dair......... ......... ,........................... Operator Certification Number:,167..4.3..............................
Location of Farm:
East of Kenansville. West side of SR 1959 approx. 1 mile North of sharp curve or 0.5 mile South of SR 1730.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' S6 36 u Longitude 77 ' S5 12 u
❑ Wean to Feeder
® Feeder to Finish
2448
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
© Yes ❑ No
[] Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Z No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. I ................. ................. 2................. ................................... ....................................
Freeboard (inches): ...............2.6.............................. 2,2...............

a ,lhIy Number: 31-314
Date of Inspection 1 4/25/2002
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bennuda (Graze) Fescue (Graze) Small Grain Overseed
❑ Yes ® No
❑ Yes 0 No
❑ Yes W No
❑ Yes ®No
❑ Yes N No
❑ Yes 0 No
❑ Yes 9 No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
l4. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facilityfail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?.
X Yes ❑ No
❑ Yes 19 No
❑ Yes N No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes N No
❑ Yes ONO
❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IN No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
14b . The facility needs a wettable acre determination.
15 - Field # I needs to have the winter small grain crop cut and removed to stop damage from happening to the Bermuda.
- Field #2 needs a 1.1 T lime application in accordance to the latest soil sample results.
- Fields need work The farmer plans on switching from fescue to bermuda but it is getting late in the spring to get this done.
Because it is getting late, the bermuda will need allot of care to get it to take.
Reviewer/Inspector Name G
Reviewer/Inspector Signature:
Date:

Type of Visit ACompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit *Routine Q Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
Permitted 13 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 5�.�.... IF ±-+rtalr................................................................ County:....j,��' �''�.................................... ....
_..
OwnerName: ................................................... ........................................................................ Phone No: ......................................... ........................................ _....
Facility Contact:
Title:
Phone No: ........... . ....
MailingAddress:..............................••--...............................(........1`............................................................ ..................................................................................... ..........................
Onsite Representative: ' {.. ..k:........ ......•.•........ Integrator: •..................................... ............ ..
Certified Operator: ................................................... ................•---......................................... Operator Certification Number: ...... ............ ---.. .. ..
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' �« Longitude �• �� �44
:. Design_ Current
ine .C9naeity Pnnnlatinn
❑ Wean to Feeder
Feeder to Finish
= ❑ Farrow to Wean
Farrow to Feeder
_
Farrow to Finish
Gilts
Boars
Design . Current- . - .. Design _ Cnrreat::
Poultry CipaMy Population Cattle _..
-Capacity—
El Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
T061.Design Capacity _.
Total SSLW
Number of Lagoons ❑Subsurface Drains Present IIJLagoonArea ❑ Spray Field Area
Hol ' Ponds ! Solid-Tra .- ding ps .., .', ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JyNo
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 ORNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................................................................................................_......................................................._.........................................
Freeboard (inches): 3 l
5100 Continued on back

't
'eY Number:`31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
RNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
[kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate pubUc 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
Wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
,KNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
9No
11. Is the ev'den of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
,KNo
12. Crop type, T, v�
13. Do the receiving crops differ with those designated in the Certified Animal Vhste Management Plan (CAWMP)?
❑ Yes
qNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
34No
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?
9Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
hdNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
t!(No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J'No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fi�No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
WT10
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
'J No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J"o
24. Does facility require a follow-up visit by same agency?
❑ Yes
qNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
-yiofatioris'oi deficiencies were not0- d{rrift �his•visiC - YoR Wd-teeeive do f'ui•ther
�tiri-esj oy ideitee: aYwuti this visit: - . -
Comments {refer 16 question #). =Expiatii any YES answers and/or any. t ecomaiendr3tioa4 o`r_any other comments. `
--
Use,dravrings of facility to;betterexplautsiations. (use.additional pages
?,�--
Reviewer/Inspector Name - �� " t
Reviewer/Inspector Signature: Date: S/pQ

T Fa�'li ity Numbertt31 — (y Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below VYes [INo
liquid level of lagoon or storage pond with no agitation? IN
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 1 to
❑ Yes �_'�No
❑ Yes 1
No
❑ Yes No
❑ Yes No
❑ Yes )&NO
Comments an or ;;ngs:
\Additional
ID
�—'4 Gk—
1 `�d�`�. • �-Qa2.C� �C ��3` �� �� G� Y�J-�c.� �/' 65s',u i'►Z
5100

F— Facility Number
Permitted 0 Certified © Conditionally Certified 13 Registered
FarmName: ..�.. c!r......................................................
Owner Name
Facility Contact: ..
Title:
MailingAddress:..................................................................................
Onsite Representative: wt--ems,,,,,,,,,,,,,,,,,
Certified Operator:
Location of Farm:
Date of Inspection
Time of Inspection L--� 24 hr. (hh:mm)
0 Not O erational Date Last Operated: ..............
County:.......... ....................................
Phone No :..........................................
Phone No:
Integrator :...... 1. r ............
Operator Certification Number:......,,,,,
Latitude Longitude =0 =° =11
Design Current .. DesignlL-uJJrrent r Design Current
Swine Ga ace Po elation . Poult
ty: = zT Ga 'city_ Po 6hition Cattle .Ca ci ,°, Po lation
W ❑ Wean to Feeder ❑ Layer ❑ Dairy m
C07eeder to Finis ❑ Non -Layer ❑Non -Dairy h
❑ Farrow to Wean
[] Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design Cabaidty
❑ Gilts
❑ Boars
TotaYSSLW� _.
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?. ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [;�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ^/
Freeboard (inches): ........... � d� ............................
.........................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N(No
seepage, etc.)
3123/99 Continued on back

jFacilfty 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?
❑Yes
ANo
(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
XNo
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes
hNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
b
elevation markings?
No
Waste Apelication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
birNo
11. Is there evidence of over applica 'on? ❑ Excessive Ponding ❑ PAN
❑ Yes
kNo
12. Crop type
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
t'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
❑ No
16, Is there -a lack of adequate waste application equipment?
❑ Yes
)'No
Reauired Records & Documents
IT.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
MNo
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
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Iq No
20:
Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [XNo
24, Does facility require a follow-up visit by same agency? ❑ Yes b�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes OKNo
�'vo yiQla ign�s;© iigfeiend" •vv re itQte �ltrt`ing this' visit. Yoit will ceeeiye ti fu th�r ;
corresjondeike: abouti this visit_
JAQ_
Reviewer/Inspector Name r t z r r11*8
? r ` �'x� t ys a OVZ���
Reviewer/Inspector Signature: �1n Date: IY 19 —QQ

:.� Fadility Number: -31y I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 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 V No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes yNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Cl Yes >(No
Additional'Comments and/or -rawtngsc r
3/23/99

Lagoon Dike Inspection Report
Name of Farm/Facility /
Location ofFarm/Facility
Owner's Name, Address fs T �� OI !" 4Ud _ _�)At,;CM
and Telephone Number
Date of Inspection Q 4 Names of Inspectors R.(-
Structural Height, Feet r Freeboard, Feet S
Lagoon Surface Area, Acres Top Width, Feet (�
Upstream Slope,xH:1V Downstream Slope, xH:1V 3� 1
.Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes ----No
(Check One, Describe if Yes)
Erosion? Yes ---'No
(Check One, Describe if Yes)
Condition of _ 6 �5 Q
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes `-No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes `-�_No
r -
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dann Safety Law of 1967? Yes `t-�No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility 602(9e— —TA
Location of Farm/Facility �2 J—I`75`7
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
2P1 2. 4—$! ���� b�—
'1ej C z &3? U
Names of Inspectors
r rr
Ir7 _ Freeboard, Feet
3 � Top Width, Feet r�
_ 31. Downstream Slope, xH:1V
Yes --� No
Seepage? Yes —'�_ No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes ✓ No
3A k
Yes ---"'No If Yes, Depth of Overtopping, Feet
Yes No
Yes / No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes �No
f --

Lagoon Dike Inspection Report
Name of Farm/Facility / L - 3 1
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
66f?�S 2L6W. 4(_o
Names of Inspectors
Freeboard, Feet
'f Top Width, Feet
3 ' Downstream Slope, xH: I V
Yes -- No
Yes `�No
Yes --No
Did Dike Overtop? Yes "-No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes '`----No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes ` -�No
Other Comments

C25
Lagoon Dike Inspection Report
Name of Farm/Facility Jt� 0 „K�
Location ofFarm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Embankment SIiding?
(Check One, Describe if Yes)
beoa y- :F4Pl{22 (-Sr) 7-,AvL--Cn -bA{k:—g.L�
_(1�rrPt 941=j , 4 C z `P 310
917-919,1 Names of Inspectors k (`(,
[� Freeboard, Feet
-
3 -C Top Width, Feet Z
Downstream Slope, xH:IV
Yes No
Seepage? Yes _�-' No
(Check One, Describe if Yes)
Erosion? Yes ✓ No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes -"No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes /-" No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes -No

[:Divt§ion of Soil and Watetr;Conservat,on Qperation Review a w
xf
D:I)�vision of Soil and.Water Conservation'- Compliance Inspection '� i
tlDiv�ion of Water Quality Compliance Inspection
Oilier Agency,= Operation Review, a
m
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number I)ate of Inspection
Time of Inspection O 24 hr. (hh:mm)
Permitted
0 Certified 0 Conditionally Certified [3 Registered
10 Not O erational
Date Last Operated:
Farm Name:
.......`G—.......................
Count y ..................f!.
��I 1........................
Owner Name: ................. ............. Phone No
FacilityContact: ..... ..................................... •--...-----............... Title:................................................................ Phone No:........................------.....................
MailingAddress:........................................................................................................................... ........... ...............
.....
Onsite Representative: W ►'. 6� Integrator: rator (,_ � ._. Y..............I.............
...................... g ...... I
Certified Operator................................................................................................................. Operator Certification Number:.....................
Location of Farm:
...........................................................................................................................................................................................................................................................................t r
Latitude �• �` �•� Longitude �• �� �«
'''Design Current : -. Design Current Design Current -,
Swine - -Capacity Population Poultry Ca aeity Po elation Cattle Capacity Population ;
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish - Total Design Capacity
,F
❑ Gilts
❑Boars "- Total SSLW
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 than -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
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
[:]Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M No
❑ Yes UKNo
❑ Yes KNo
Structure 6
Identifier: ��]]
Freeboard(inches): ........... c?..�.............. .............................................................................................I.............................. ..................
5_ Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [] Yes C(No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of luspection
r~ 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of ov r application? []Excessive Ponding ❑ PAN
12. Crop type b Ip , Z.. S q
No
❑ Yes
9Yes
. ❑ No
❑ Yes
KNo
❑ Yes
No
❑ Yes
No
❑ Yes
D'No
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)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. -Were any additional problems noted which cause noncompliance of the Certified AWMP?
::.. yi. . . . r. . .... eiert... mere ... . ilirrt .. t. ..v... You witi �eceiye p.... * .
rorresporide'& abati>k this visit: . . . ................... ............
❑ Yes 4 No
❑ Yes ❑ No
W Yes ❑ No
❑ Yes []No
(Yes ❑ No
❑ Yes C4 No
❑ Yes 9 No
❑ Yes % No
❑ Yes C[ No
❑ Yes N'No
❑ Yes gNo
❑ Yes XNo
❑ Yes 91 No
❑ Yes Pd No
❑ Yes f rNo
_ w.
Comments (refer t©squeshon #) :Explain any'Y^ES answers andlot:any recommendattons.or any:other corriments'm
Use drawtogs of facility to better explain-sitnaions (use additional pages as necessary)
t r ,—
A.
cA
%► s ,+- L'sz
uCl tke s�e.c{ es , G,, �,� -�=,.5 R Q� os .sd�-, ems- pasty � le.. • �y
01 1e tune✓. Ke h� 1,.�"[� t V% vew,e., 4s
'PCs �.� w, $ost -�2.$ ire r� • �t w2 txr -t`t 1-' + ✓ 14 .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: e-1 C7 9
3/23/99

Facility Number: — 3 Date of inspection
Odor.Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes M"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes WINO
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 FrNo
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 9No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0N0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes VNo
Additional omments.an orDrawings:
IL
O
3/23199

`13 Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
r Facility Number Date of Inspection
II
Time of Inspection 0 24 hr. (hh:mm)
Registered 7" Certified— E3 Applied for Permit E3 Permitted E3 Not Operational Date Last Operated:
FarmName: ....... &OY.t�L.... .YA:Y.Y.aaf........�.l....'k...*.z............................................... County: ..... hu�it......................................... .......................
OwnerName: ...... ��L{l ...��......&a.tBx......................................................................... Phone No: ... ..0. O.r7S...........................................
FacilityContact:......... 4?SAY.wt.....&fnol ............................. Title................................................................... Phone No:...................................................
Mailing Address: .... �itZ.....Ithul....fil)....�a�t.......RC�.......................................................� tra iyil..�Cy....1`ii:......................................4.3!�i°i........
Onsite Representative: .... 6Cay......k(,ty:yw.y............................................................ Integrator:....
Certified Operator................................................................................................................. Operator Certification Number;..Jf..7..43 ..................
Location of Farm:
Latitude ©•© 36 Longitude ©• �°
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any pan 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?
I
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any pan 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 certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes (� No
❑ Yes ® No
❑ Yes
No
❑ Yes
No
Yes
❑ No
❑ Yes
)] No
❑ Yes
No
Continued on back

<� `"ility Number. --
r
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lai oons,lloldine Fonds, Flush Pils, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes No
Yes ❑ No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......�................... ......... .........
Freeboard (ft): ...........}r..L..... .................. ............ ...........
10. Is seepage obsen•ed from any of the structures? ❑ Yes No
11. IS erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12.1 Do any of the structures need maintenance/improvement? W Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DIVQ)
r
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
09 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
J& o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type ............ �il!mv.a.t&...................................�k►' ' ��...�ft3t1+............ ....... ............. lNif a :.....................................................'...........................-
16.. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)'?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
O No
18, Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
;1 No
20. Does facility require afollow-up visit by same agency?
Yes
® No
21. Did Reviewer/[nspector fail to discuss reviewlinspection with on -site representative?
r
❑ Yes
® No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
91 No
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
El No
0 No.violations or deficiencies were -noted during this -visit.- You.will receive no further
correspondence about this visit:
x
Comments (iefer'to question #): Explain any YES answers and/or any recommendations.or any other comtnenis. .
Use drawings of facility to better explain situations: (use additional pages'as necessary)
ei Z-a inso t ci &Joeory `lcv+ 5IVuld he 16Wtlrt�l r �`Lg10Yi�LWt�
t+►1a�riwa!
f 2 ++
Ou'tZt� otN -�. [r�O+OL't� `� � t � � e l�"S t�G� tf�. �S+Uri dr. iY►ru.r' � 1 iGt Wc.�� `i vwclt � � C-
`� � � 4n
I BPr n vr)c, cyan 5L1� b + m ►ratr�� ; r �p)A'`�
2,2. S rm trt(,9cj--. 5�t)lo be 4 f b,1 6se{ 1pvll yw-,16 tr a J �;GW rivm6t,T W itk � (wvc�, aauje.
�aS S3 S�t� �e �{�], 7/25/97
Reviewer/inspector Name
Re viewer/Inspector Signature: Date:

Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection 7
Facility Number
Time of Inspection 5'-J 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit
(ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted
or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:....
_ .... ...... _... ...... .. _..........
Farm Name: ...� .�t�cti�... ...�. Z
r.........
.... _ ... .... County:.... Lk4N1 i ..... W........... ... _......_.
Land Owner Name: _ .._....., _�f�[.1�.��..........----..,
................_...._ Phone Na:...LqL�.�(a-.--�.7�-......................._.....
Facility Conctact:... �?tft�....it ....
Title:......4L2!1� ._.. Phone No:..%��
Address:_.Z Yti.E].D�_�.... ....
i... 2$ ` ..Mailing
. .1L1
Onsite Representative:.._ �R. '�.'SOU.:t�.............._.._..._..................................
Integrator:
Int tor: .. ..........._._.............. ......_.
Certified Operator: .. ....._� ...... .._._ ............ ..... ..... .......... Operator Certification Number:
Location of Farm:
Latitude ° 3{� " Longitude • f -c7) ` l {i
Type of Operation and Design Capacity
- Desrgtt Current'�Destgn Current ` ' f '24;'; Design`u Current
Swine Ca act :. ,pi elation . I'ouliry: .. Ca "ae :�.Pa �"ulation f` Cattle ::`Ca act Po 'ulat�on
❑ Wean to Feeder ❑ D
Feeder to Finish ❑ Non -Layer ❑ Non Da
Farrow to Wean n�
W.
Farrow to Feeder TotalDestgn Capacity 1 ,
to vcM
Farrow Finish.'
m_ ry . r a 'Total: zibU 330l
�,'`
Number pf Lagoons! Hpldeng Pouds Z _ ❑ Subsurface Drains Present
�`� �,.��, � ��� � � � ��� �� < � ❑Lagoon Area 'f�. ❑Spray Field Area „
General
L 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)
e. If discharge is observed, what is the estimated flow in gaUmin?
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 J2 No
❑ Yes C No
❑ Yes tff No
❑ Yes C9 No
N
❑ Yes No
❑ Yes Pj No
❑ Yes )a No
❑ Yes ja No
Continued on back

Facility Number:.... .(..„.�.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures tLaagoons and/or Holding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (fl): Structure I Structure 2 Structure 3 Structure 4
2• L
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
❑ Yes
f No
❑ Yes
@:No
❑ Yes
Q No
❑ Yes
JM No
Structure 5 Structure 6
❑ Yes No
Yes ❑ No
Yes ❑ No
❑ Yes gNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DrWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes JRNo
❑ Yes ONO
52 Yes ❑ No
❑ Yes [$No
5dYes ❑ No
❑ Yes ® No
❑ Yes JR No
❑ Yes No
® Yes ❑ No
Comments (refer to,quest�on Explain ariy YES answers'and/or any recommendattonsor any other comments ;.
Use drawings, of facility to better expiam situations: (use additional pages as necessary)
IVIz., t5vosl6, Gins th 4t,., 1 Pur- wall of lot- (a airs _},oJJ be A-11tj 0144, d" arvj
4
re-�tAtA' 1\.L )her tall 6� ' o k 1ojaon's Sltovl {) be- tnt3wrd . ?AM �bTS sllatl�� 41G
rtseatd.
19' CoaSlaj mx 1h N1& -*I w' -#3 56vid bt. IMPOVeJ.
L4 . S n reu rt's s 6o)J - 6e, l t. + )),j �VJ ntlr`t6ar W riser-* 11 um6 a t^ torn t, �c
ic\5oo;, �nrvv wait( � waz�_ k)Ai �` mrfj,
a
Reviewer/Inspector Name
F .<;
7.
ReviewerlInspectorSignature:
Date:�Q
27
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97