310332_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

(Type of Visit: U Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1
Date of Visit: Arrival Time: Departure Time: 3 Q County: }J �j'f•�
Farm Name: Y we '-N Owner Email:
Owner Name: Pj0Z Vl Ntye-^Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: W ri
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design C►urrent
Fettle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Design Current
Dr. P,oult , Ca aci Pao
Layers
Farrow to Finish
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Teske s
Turke Poults
10ther
Dischareesand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ -I o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[—]Yes
F5-No
❑ Yes
fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: ja ita.
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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El"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 <o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes R3"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
Cg-N-b_/
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�
[9'10
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
❑ 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
Lid""'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I `_T 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
[lff<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El yes
2'1Vo►
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
Cg o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MN ❑ 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 InspectionsSludge 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 21412015 Continued

11
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CDNV— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!3'110 ❑ 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 i[TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ��A ❑ 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 the 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?
0 Yes ❑ No ❑ NA �
❑ Yes Ej<o ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes 6]�Wo ❑ NA ❑ NE
❑ Yes �o ❑ NA
❑ Yes C <o ❑ NA
❑ Yes Fio ❑ NA
❑ NE
❑ NE
❑ 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}.
r rV 1,66 r V
Reviewer/Inspector Name: [� �j r`—� Phone: g10'I R 4 -- % ! -
Reviewer/Inspector Signature: �V Date: f 2, �/ Ifs _
Page 3 of 3 21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: _D e/1s1 Region:_
Farm Name: y-ou x Z- Owner Email:
Owner Name: Phone: ;
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &Ijr4, AJor1_,nn&n Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder I
&W e-0 Poultry
Layer
INon-Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Dairy Calf
Design •urrent
Capacity Pop.
Feeder to Finish
Dairy Heifer
Farrow to Wean
D . l;oult ,
Layers
Design
Ca aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ 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 1 of 3 21412015 Continued

Facili Number: - Z Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes, No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 'ffNo
❑ 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 allo
❑ 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,4;-rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes LJ 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 ,❑i'To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;3 Ro ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:fNo ❑ 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 allo ❑ NA ❑ NE
❑ Yes -nNo ❑ NA ❑ NE
❑ Yes _[R'No ❑ NA ❑ NE
❑ Yes J "No ❑ NA ❑ NE
❑ Yes -Ef'-No ❑ NA ❑ NE
❑ Yes ;:3.No ❑ NA ❑ NE
[:]Yes ❑'No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:; '
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [2-N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: jDate of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
M
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: (Dibmpliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Grroutine Q Complaint Q Follow-up O Referral O Emergency O Other p Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region: i�j
Farm Name: F \ ff [Mari Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: &� pr j-M t
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: M I off)
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C+apacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cable
Design Current
Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
iry Calf
Feeder to Finish
00
Design C•u Tent
ult . Ca tacit P,o ,
Layers
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
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?
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 �INo ❑ NA ❑ NE
❑ Yes
52 No
❑ NA
❑ NE
❑ Yes
[;�No
❑ NA
❑ NE
[—]Yes ,E5 No
❑ Yes WrNo
❑ Yes [(No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acili ` Number: - Date of Ins ection:
Waste Collection & Treatment
~4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i❑/'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes C2"Ro ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -�-�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �, o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 7
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J;11�o ❑ 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 jNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L�"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 F,:�rNo ❑ 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? 'P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JL3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2-No ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;],No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
En —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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [:]Yes fNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

�1
hacili umber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �].No ❑ NA [3 NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 J:3 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �>o ❑ 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 P
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes n No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes [�_No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsor:any other comments:. ..
Use drawingsof facility to better ez lain situations use additional "a' es as necessary).'
tY p ( pages -
3 oo Cam\ b �� ►, s
ce, r
VrA f r_X
I
col/� a►1q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2 /2014

Pr
Type of Visit: PLC-a'ihpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outinc 0 Complaint O Follow-up 0 Referral ( Emergency O Other O Denied Access
Date of Visit: Q y Arrival Time: eparture Time: County: Region:
Farm Name: � Z . / �,�i�fz-� Owner Email: ��—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: �(�� �jl%%j�� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
C+opacity Pop.
I
Design Current
Wet Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design
Capacity
C*urrent
Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult . Ca aci_ P.o ,
ILayers
Dg Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
I
113eef Feeder
113eef Brood Cow
Boars
Pullets
Ot
Other
Turke s
urkey Poults
ther
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No ❑ 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 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)
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
❑ NA ❑ NE
Page I of 3 21412014 Continued

acili -Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;21,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes O'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 oNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes /6No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ,-n No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes )2fr-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 �3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 4�:FNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes eNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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 12rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes /❑'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
[:]Yes �jNo ❑ NA ❑ NE
❑ Yes ff:TNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PkNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[J-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

F'keili Number: 3 - Date of Inspection:
A Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes PrNo
❑ NA ❑ NE
the appropriate box(es) below.
T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ETNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes .fNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ErNo
❑ 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 Oo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVVW?
❑ Yes )2No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes )7,�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ NA ❑ NE
Comments refer to question # . Explain an YES answers and/or any additional:recommendations or -an' -other:comments::x�
Use drawings of facility to better explain situations (use additional pages as necessary),
_
as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C/ a
Date: J��Z,7
4/2014

Facili Number: - Date of Inspection: a
24. Did the fa`ci� fail to calibrate waste application equipment as required by the permit. ❑ Yes ONo ❑ NA ❑ NE
25.. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No ] NA ❑ NE
the appropriate box(es) below. j"—
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes/ f No ❑ NA ❑ NE
❑ Yes 1 No ❑ NA ❑ NE
[:]Yes ONo ❑ NA ❑ NE
❑ Yes Z:rNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes ,-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �❑ NA ❑ NE
�rNo34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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 Faces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:1-
a12014

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

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denled Access
Date of Visit: d l% Arrival Time: Departure Time: County: Regiot/ AJ�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /.�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= 6 0 Longitude: 00
= 1
e g
Design "Current" Des!gn, Current_;;.;
...�., PSwe c„-Population MCa aci
: o ulatton
�- ..
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
❑Feeder to Finish `� e-. "�'• "`
T,
❑ Farrow to Wean-
DrygPoultry�
4 ❑Farrow to Feeder
❑ Farrow to Finish'
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoyA
N
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 Z] No ❑ NA ❑ NE
El Yes El No
El NA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ZI No
❑ Yes 21rNo
❑ NA
❑ NE
❑ Yes JQ No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 2 jDate of Inspection:
i
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes [;'No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T� 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 ;?tNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ 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 V No ❑ NA ❑ NE
❑ Yes pe No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ja No ❑ NA ❑ NE
[:]Yes 2fNo
❑ Yes 2 f No
❑ Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any :other comments 'p
"g 7
Use drawings of facility to better explain situations (use additional pages as necessary): 4
(Ajec( /. /9' On (rec+
l � 7 C`��-��e �l� s� s � �s 1 ��' -CY�- j-e lI � � �w
f�
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature:
Page 3 of 3
. Date
21412011

Facility Number: - Date of Inspection:4 C`
,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VNo
❑ 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
;0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Vf No
❑ NA
❑ NE '
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [A No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C6 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 C9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [XNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ;9No
18. Is there a lack of properly operating waste application equipment? ❑ Yes 131 No
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ea No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes VrNo
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RI No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes VI No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

..QfDtvMon of Water Quanty �
taCtltyNuItlber �Q Division of Sots and Water'Conservahon �"
,- =. f -
' Other Agency
.r
Type of Visit ,'ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,, Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:-6 "-V Region
_/ I'l, - '� _ - p_ Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: dq
Title:
Onsite Representative: & �w
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c =1 Longitude: = ° = =
Design 'Current
SWine Capacity Population Wet Poultry(
.:1 ❑ Wean to Finish ❑ Lay er
Current ` «"
Populatton`- Cattle""
❑
Wean to Feeder
W ❑ Non -Layer
❑
Feeder to Finish
❑Farrow
to Wean
©Poultr "
❑
Farrow to Feeder
y .
LJ
Gilts
:p ❑ Boars
°Other
ELJ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy_
Beef Stocker
Beef Feeder
Beef Brood
F
�Numt�er"=o
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 .2rNo ❑ NA ❑ NE
❑ Yes ❑ No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy_
Beef Stocker
Beef Feeder
Beef Brood
F
�Numt�er"=o
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 .2rNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes /ffNo
❑ Yes dNo
❑ NA
❑ NE
❑ Yes ,21 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes FeMo ❑ 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? ElYes EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o
(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 gNo
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P�No
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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)
❑NA ❑NE
El NA El NE
❑ NA ❑ NE
El NA El NE
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes 21 �`o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ET No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ;�TNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Vej No ❑ NA ❑ NE
Comments (refer to'question #) Explain any`YES answ ers'and/or any recodimendafions:oe any other c©moments
Use drawings of facility tobetterexplain situations. (use additional.pages as.necessary.)
IReviewerlInspector Name Phone: ;7 ^ 79' I
ReviewerlInspector Signature Date:
Page 2 of 3 12128704 Continued

Facility Number. — Date of Inspection
Ifeciaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PkNo ❑ 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 ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L2 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 ONo ❑ NA' ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
QDid
the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
F—] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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?
[3 Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional C6mfnents and/or Drawings:
7
Page 3 of 3 12128104

I
Type of Visit (D fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Jalioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
TO
Date of Visit: oZ6 Q Arrival Time:. Departure Time: County: G Region:
Farm Name: VP 4P S O Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: / Title: Phone No:
Onsite Representative: gut �01�'Lt Cc �i Integrator:
Certified Operator:
Back-up Operator:
Operator Certification \umber:
Back-up Certification Number:
Location of Farm: Latitude: = c = ; = « Longitude: =1 o = I = It
f Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish I00
❑ Farrow to Wean j
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
i\ 2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �P o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
_aNO
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
12128104 Continued

1
Facility Number: 1Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O—No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -7
Observed Freeboard (in): _7p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EJ 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
2rNo
❑ 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
P 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
2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J2 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplication Outside of Area
12. Crop tyPe(s) Z?PYM4�e4aJ J 6
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �TNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'Rio.LR❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
Q'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�"
❑ NA
❑ NE
Reviewer/Inspector Name J Phone: I
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection o 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0_1'es ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ZDesign ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0/ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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
ZrNo
❑ NA
❑ NE
❑ Yes
ZfNo
❑ NA
❑ NE
❑ Yes
❑ No
jg NA
❑ NE
❑ Yes
12'No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ,ENo ❑ NA ❑ NE
❑ Yes R<O ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
lddkhonal Comm/e�ntsand/or Drawings:
do ' f t c� � � Op V) 0 i Q 5o o n PSI 13 rn � trt VY? &-'e4 I
l J Ye Lo V"
h a;_5 pPPrt c, iV /77e,-7 01Ov J
�& �e 1 sl"p7ce,
d /0�;7
12128104

(Type of Visit tF Compliance Inspection O Operation Review O Lagoon Evaluation E
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: e:
Tim
- - -18 Not erational O Below Threshold
13 Permitted 13 Ce ' ed .13 Conditionally Certified 13 Registered
Farm Name: _�SQ �'? ....,��
Owner Name:
Mailing Address:
Date Last Operated or Above Threshold:
County: ...---z- f»
Phone No:
Facility Contact: ..__._fi�J/. ... Title:._ _ . _.. Phone No:
Onsite Representative: �LL LS )h \ l l Integrator:
Certified Operator: , Operator Certification Number:
Location of Farm:
Lq
(] Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • < " Longitude • u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PAO
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 Iallo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6'
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: .31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures ob&erved? (ieJ trees, severe erosion,
❑ Yes SI No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
0 Yes O'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes j]'No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
❑ Yes . Ofio
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes CKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes O'go
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 014o
❑ Excessive Ponding ❑ PAN Hydraulic Overload ❑ Frozen Ground ❑ Co d/or Zinc
12. Cron typeZ CfiffadL
13. Do the receiving crops differ with thokc4esignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes P-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?
0 Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ,1�0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
liquid level of lagoon or storage pond with no agitation?
Jj21Go
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes j2 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes �Wo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes ;JJ16ior
Air Quality representative immediately.
.''. "' = ,_�'xx':='� a-i"^�"' E.'c..-""'^"...i�:�^�" ""6'ex'z .tea=. .��#"'�., �•----:s..��X^' ��y+.�-, ��F�- .t ---�-�r� .:-+-..- �.a� .
Camaz crefera,gosi iirEais�uay YF.S answers aacilor aay . or aripoffie nt.
'USe � �. ,�- E P niY) ❑Field Copy ❑ Fina! Notes
GvG / C'PYI to
�
Reviewer rName_..,<—� Em —
Reviewer/Inspector Signature: Date: G
12 I2103 'Continued

Facility Number: Zjjj= Date of Inspection
m6red Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0-90
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,R'Ro
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes . 8-No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Jallo
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes Jallo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Z No
27. Did Reviewer/Inspector fail to discuss review/iaspection with on -site representative? ❑ Yes j2No
28. Does facility require a follow-up visit by same agency? ❑ Yes '1 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J214o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ,UNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
.12112103

Facility Number I
Date of Visit: Time:
Not O erational $elow Threshold
® Permitted ® Certified 0 Conddiitional1v Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: i. D n 7 f "-M 7i County: Al n
Owner Name: [S f Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: �lt! h+L ✓ _ _ _ , . .
Certified Operator:
Location of Farm:
Phone No:
Integrator: Ur
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C' u Longitude
;Design; :
.Current lDesign Current;: F,Destgn Current
Swine" . ca Pa city;
_
Po ulavon _Pouttn actty.�rPa ulatian -Cattle Ca ac�ri . Pti alatson
❑ La er _ = ❑ Da'
e
❑ Non -Laver -Dairy
❑ Other
Total Design Capacm.
f
TotaISSLW
Number of Lagoons
© ❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
-Holding Ponds 1 Sohd Traps
❑ No Liquid Waste Management System r
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
r
❑ Boats
'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes ��
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 [4vo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes L`I"No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: I
Freeboard (inches):
05103101 Continued

Facility Number: 31 — 3"2_
Date of Inspection <0 I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes Q No
❑ Yes 2No
❑ Yes Ulo
❑ Yes ®moo
❑ Yes 2fIo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [BNo
11. is there evidence of over application?
❑ Excessive PPonding ❑ PAN ❑ Hydraulic Overload ❑ Yes [fNo
12. Crop type LO4A1Aft<i. " G �lyla!! 4! YAr PL DUP✓S�C
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑'1Qo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [5-90
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
0'ITo—
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑<o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RINo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[Pq'6'
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑-lq-o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ o
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑-go—
24. Does facility require a follow-up visit by same agency?
ElYes
EE o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E5 o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer t©:question #) :Ezplatn any YES answers auwoi any recommendations or,any.nttherJcomme€tts, r
i�se.drawiitgs of fact7ity to iiettcr eiplain situattons (use addtttoaal pages as ttecessary) [! Field Copv ❑ Final Notes
_.
� / 9
ef� . J.�s°nGt'i`G�7�� Uy 7�3D�4 Z ✓ps��f,.
-- 7—,-AfA i1t t ZZ, ep1t rtpe.�s Yv it re,rtokleo
-- JA Q 4e.Af-e, s� �+ -r 4& 1v9 X0vScr �¢S «n dQP4eed A5/,q7
H.
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date:
O5103101 V Continued

Facility Number: j f - 33 2Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes �o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [!P'Vo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes ED'-'�6
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 E 0
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 Rio
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes BIFO
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes UKo
Additional Comments. andlor'Drawingsc T
�PyT O� f�GD���j ►�- >�rlrl �v(CS (�--Do�L. .
O5103101

Type of Visit 6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Vlslt O Routine O Complaint A!fFonow up O Emergency Notification O Other ❑ Denied Access
Facility Number 33 Z Date or visit:
5 r,..
© Permitted [3 Certified © Conddiitionally Certified 13 Registered
Farm Name: ...... r r: s n v.......F`G: ✓'vv% L .................... .
Owner Name:... ea.... ee., 1_ -% ..........................I............
Facility Contact:
Title:
Time: �Q
O Nat Operational Q Below Threshold
Date Last Operated or Above Threshold: ... .......... ...... _....
County: ..�T?v �i ✓�..... ........
... ................._ ... .. __.
PhoneNo: ................................................ ........................ ...
Phone No:
Mailing Address: .......... ..... ....... . ..............................
Onsite Representative:... ar`"6 1` &' Gr r 1Ii00 Integrator: ' " Y v r� „.„...............__. ��
............................................................._.... .Y.
Certified Operator: ................................................... .... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' 4 it Longitude �' �4 Du
Design . Current Design ' Current Desigia Cu treat
:Swine --" Ca cPiP-capacity Population. Ca aci Population op ilon:T'
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design :CBpscrty- -
Gilts =_
❑ Boars Total Sstw =
Number of Lagoons❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds"/ Soli&Traps.. ❑ No Liquid Waste Management System -
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................. ....................................................
Freeboard (inches):
5100 Continued on back

Fai:;jity Number: 3 -32Z Date of Inspection la z
}rf5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ 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 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?
•yiglri-oir d rcjen*-wire nQe(I 00ift s.visit; - Yor wiij-teeeive Ro futthor -
acorrespO ence. iV
i6 #) Eieplau= any'YES answers and/or any,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes_.L?(No
❑ Yes ❑ No
❑ Yes ❑ No
Tie AP6 A 6ehVK4 41,P J1,0j L,tat.t-k-- Where -4)e Xo)Zd-c hiA zjv•^'LJC4
0n4o Vw%s beeri d;sceof ) Iev�c)e,4) gPnd --ecded �e � Aese, va
AJ M--. PC4CrsOJ-\ And T di'_5cV-5-01d,
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ _ ,, Date: 1,51Z 5/00

I
Type of Visit © Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 332 Date of Visit: 10/17C1001 Time: 9:30 Printed on: 10/1 W001
EO Not O erational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _ __ ..........
Farm Name: P_1ste=o-O..F_A1aA2................ ......... County: D phn._.__._
Owner Name: ,)!8mE58A_-- P_et@CSOA_-------------------____-- Phone No:
MailingAddress: ..7.95Q.t! CHig1AWAYAJ.........................................................................willard.Ac ........................................................... 18.47.8 ..............
Facility Contact: ........................................................... Title: Phone No:
.....................................................................................
OnsiteRepresentative; .]a1ppP�terQD__._._.____________Integrator:Xpj�y��py�_-___-_____-_-___-,
Certified Operator:darmcs..................................... F.CtRJMQjj ........................................... Operator Certification Number: 1.64,t5.............................
Location of Farm:
T.ast of Greenevers. On North side of SR 1953 approx. 2 miles East of SR 1949. Take left farm path to facility. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 52 L 35 u Longitude 77 ' 57 ; 35
Design Current - Design Curre
_.
CPoultryaacePo�Swine Ca aci - Po ulatidn ulai
❑ Wean to Feeder
® Feeder to Finish
2448
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Curr
Cattle _ Cauacit r - Pobuli
❑ Layer ❑ Dairy
❑ Non -Layer �❑ Non -Dairy
❑ Other I I-
Total DesimV Capacity 2,448
TotaISSLW 330,480
s�
Number of Lagoons. 1 ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
Holding Ponds / Solid,: Traps ❑ No Liquid Waste Management System�!]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (1f yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..-----------------------•---•--------------•-----•------•--------------------- ------------•-----------•--...........................
Freeboard (inches):
nem�ina

UXU_Vul
,�]Pacility Number: 31-332
Date of Inspection 10/17/2001
t,onstnuea
Printed on: 10/18/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ 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 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to questio #) )+,xplamVany YES answers and/or aWrecommendations or any otlier comments
�.. W
Use drawings of faeElity tp better explain situations (use additional pages as necessary) ❑ Field Cop ❑ Final Notes
Is.y
:a a,
_ .
This inspection was conducted as a followup to monitor the cleanup activities of the discharge which I discovered on 10/16/01 during a
outine inspection. Mr. Peterson said that he was having trouble scooping the solids up with his backhoe to put them back in the lagoon.
e agreed that he could disc the waste into the area behind the houses and plant fescue here to take up nutrients and provide vegetative
cover. He is to have this completed by Saturday 10/20/01.
Reviewer/Inspector Name Stonewall.Mathrs ,
Reviewer/Inspector Signature: - Date: /4 Z l 8 OJ

Facility Number
Date of Visit: ! 0 D I Time: SO D
1 3Z-
Q Not Operational Q Below Threshold
p Permitted 13 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name: r 1`1
e C ✓ s..-.. ......... `..`. `..... Z.................................................... County: L.l v l............................... .. ...» .
Owner Name: Jiv-NHS Pe4C.-:r0 i .......... Phone No:
........................................................................................................... ..............................
FacilityContact: .............................................................................. Title:................................. Phone No:
Mailing Address:.... .........................
Onsite Representative:a'^'�eS j9e-}sovt „•„•. Integrator: �' I,�}
V�' !L
...................................er.... ............................................. ..._ .. - - - •.....» ». »
Certified Operator:...................................................................... .... Operator Certification Number:...
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 64 Longitude • 4 f4
Design < Current Design Current Desrgri _ Curremt
'Swine: - Ca ci Po elation Po - =. Cii act Po ulatioa ' .Cattle Ca act Po dlatien.
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
ElFarrow to Finish Total Design Capkity
Gilts
❑Boars �TotaUSSM
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds /:Solid Traps. ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than-madc? ❑ 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 040
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 - Structure 4
Identifier: ..................................... ..............
...................... ................................... ....................
Freeboard (inches): 4Z
S/00
❑ Yes �No
Structure 5 Structure 6,
Continued on buck

Fhaility Number: 3) — ? 3 Z Date of Inspection Q 1 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes _`No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes .,O No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,ENO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �10
12. Crop type &e AV%%-yclot Can-t—a! G-CzZe)5•�11 �✓�ih
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Xj 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 )ONO
16,
Is there a lack of adequate waste application equipment?
❑ Yes" No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ,,,eNo
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 ff 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 )QTNo
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/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,E!"No
24.
Does facility require a follow-up visit by same agency?
❑ Yes PNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes ❑ No
P
iv 0Mb a>tiQris;or. deficjendbs were )now 00649 this;vIsit; - Yo> wig[-NOiye I futthor;
coraresi�deike' about: this visit.: ...:..:.:. ::.:::::::.............. .
- - -
t to better exp#atii situations _{use addrtional. pages as necessary} _
2. Ae4; At vvosr4e has d; 56,A je4 -f -or-t ra C I egrko-4 ji.s-61'ned ..
140 A 0,e +^,e4 �e r��kCd wa-�Q�r ��-f�c Safc, wa-�er q�al
ej
22. -ratid 4ke 14/61 el efnd
fePo4Gd � 40 '37" fs on 101 Q1 . �q.n, * s tea; G( +'1F d�`d� i2a-1-�r -�� Ga l) DWQ .
25• Tames sq.d hp d: d rW leak fo -<eC i-F wash tl^d 64en 4,o 4ke 44,ck, 6v4 tie
xre,j '-t was 6e tx,,.\t 4ke A,L4, e , 'tj,, GAwmio .r9 vires -kw.f � �x-{� A�F
�ZtF ��►!! Leo,ssCrSEd, w
Reviewer/InspectorName 'S_k#1tVV411'1
Reviewer/Inspector Signature:: J `�I/lt fj� Date: 1 D lbp l Y Sion

acility Number: Date of Inspection r l d 1(0 01
e'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RoNo
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 ONo
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 7No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes EJ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an orDrawings:
There qfe gr-werrz,4 -naw r-q-el be used -err v-. 4Lke -�rt4yz-2-
-5-C..,es vihx�. nee'4x 4'e be dd he i, 4,ke feerer
�l�w ,rQ�e weeds �a Used on 4P, e- ��Q,Z►s
5100

7777
iv�sion of Water Qualriy �,;
' Q D!rsI6h of S©il and ••Watei�_Conservatron .`
0 Other Agency'
Type of Visit ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Bate or Visit; dine: QQ . Printed on. 7/21/2000
Facility Number
0 Not Operational Q Below Threshold
t6ermitted Certified © Conditionally Certified © Registered Date Last Oncrated or Above Threshold
Farm Name: r'.. .......... 4 ✓1 County: D' P I.ViLAJ
) ......-...
..... ......... .......................................... D
Owner Name:...........1 {, a......C. C!..:V�t.� [J .......... Phone No:...............................!.........?.........----..................
�•..
Facility Contact: ........
Title: ...............
Phone No:
.-Mailing Address: ................y...............-............................
...........
...............
...............
.........................
.............................................
..........................
resentakive......... p............................. .......
Onsite Re .... x �v�..�..`��................................. ............. Integrator:.... -.. I" !
.....-........ f�� ..........
Certified Operator: ............... C v41' Operator Certification Number:,,,.
.1. f.. 1�....
Location of Farm -
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �` �� 0 Longitude
Design Current
a wi ne
kQZean to Feeder
Feeder to Finish Z
❑ Farrow to Wean
❑ Farrow to Feeder
M Farrow to Finish
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ YesVo
Discharge ariginated at: Lagoon ❑ Spray Field ❑Other
a. If discharge is observed; was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State`? (if yes, notify DWQ)
c. II' discharge is observed. what is the cstiieated 110w in gal/rein?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..-..-...-. .................................................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
ElYes No
❑ Yes �(No
Structure 6
Freeboard (inches):
5100 Continued on back

Facility Number: 5 1 — Z Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or !!!
closure plan? ❑ Yes )?rNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes i o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste APPIication
10. Are there any buffers that need maintenance/improvement? ❑ Yes eo
11. Is there evidence of oAapplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYeso
12. Crop type
13. Do the receiving crops dider 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? (el 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?
No•yiglafio[is:ot- deficiencies Were noted• diW ig this.visit; • Yoir W-HI . . . I e to . #'. i tI .
..............................
:: correspondence: Aau this :visit :............... ............ ,
Com_ meets (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):
/`rft ; 1,h oocl 6kGv:�te_
❑ Yes
❑ Yes ,(No
❑ Yes ❑ No
❑ Yes ❑
❑ Yes ;eo
❑ Yes Ir0
❑ Yes ro
❑ Yes 01�o
❑ Yes
❑ Yes �_No
o
El Yes
(( ��'' o
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes No
w
Reviewer/Inspector Name Qvz)s l
Reviewer/Inspector Signature: Date: 5100

Facility Number:
Date of luLspection -D -q Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor hplow
❑ Yes
No'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
t�o
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
o
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a pei-manentltemporary cover?
❑ Yes
1 Auutnonank-omments ancvor Drawings: = n r 1
w
5100

Facility Number I 3 3 2 Date of Inspection
Time of Inspection ! 2 SO 24 hr. (hh:mm)
C3 Permitted [3 Certified 13 Conditionally Certified © Registered f [3 Not Operational I Date Last Operated:
Farm Name: S# { ; h a� s
�'+r,............................................................... County:.-D,a ! --.....................................................
...............................
Owner Name: ..... IZ �`C .�...................... g v C_ ✓1 a v . in ................................. .. Phone No:........-......-
............ ............................ .
FacilityContact: .............................................................................. Title:........................ ..... Phone No.................................
Mailine Address:
Onsite Representative: A � Ca V e n au ° Integrator:, ,r, - V 'ks
................................... .� ,....;��..n
Certified Operator:... .............
Location of Farm:
................................................. I........... Operator Certification Number:..........
...............................................................................................................................I.............. .. .. ....
Latitude Longitude
=' Design Current y 'Design Current:- " ` Design Current
Swine Capacity Population Poultry Capacity .Population ":Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
24 8
2-448
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Ca aClty
Total .SSLW
Number of Lagoons - ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding:Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? PO f4,
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JO 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 5D No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: {
Freeboard (inches): ...........z. I ............... .... ...................... I ........ .....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 —332 Date of Inspection ll 3a `t°I
6. j pie there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes $I No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
I t . Is there evidence of over application? ❑ Excessive Ponding ® PAN A Yes ❑ No
12. Crop type g3er-06(-, C.-4,oI(ed G,caae� SS.-IIII ]xgir
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Of 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
Reguired Records & Documents
17.
Fail to have"Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18_
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
F9 No
V-iofdris:odfcdre oea-dui�his:visit.' • You Wfvfeeye iio futther - 0:
.. w
correspondenceahauf this .visit. • . • . . . ... ... . ... . . . . .. . . ........ .... .
to-mments ("refer to. question #) :Explain any YES' answers and/or any;recommendations ;or any: oilier comments F
UseArawiiigs of-facilrty to better explain.sitnations pages as use additional -^ necessary) a 11. AN e--or' 4-x Cc0 GV C) 1cJ;,-+i, a ('estAkcck ir% e1 1 {7, oue-cjop vGA+;,o, A.
cC FAO on +Lxe r�e C or 7P I`�q 8 - 1191 tiN F; o� 1 .
—Tt e is Qe►nAeCk -For Ct we 4'a6le- 1RC -e
M'. and Wirs_fC-'Vr-tav5k sa:al `�f.j +11c- weoctble acre dc4crw,:ytc0'ra
1 S i�c:'�5 �tBdo areal .
19. A -view w4s+c0 n-, trle yk,,jok be }akc-vt. Wr-s4c sA��O1es are good
-For (,,6 0(aI s be Fore- a+cat GO dgls Q�l�r' -fi e Qq+e- ok 4ke- eA.,q lysi's.
L ;,,tee ,st,dt~(d b_ appliGA Acc a-ra:4�
Reviewer/Inspector Name }-} r
DVV�WR1�..` A?.�4�s Colo :3�5� :3qa°oaex4,:ZO-
Reviewer/Inspector Signature. Date. 1 i ?a 19�
3/23199

- - Y.
Facility Number: gJ — 33Z Date of Inspection I l 30 q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 9 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, e(c.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 91 Yes ❑ No
Additional 6mmenan _ gr__ :rawrn r r
74
AL
No4.= avi 9LO 'S off' ♦ke -farm fc,+), is
$eVc►rC[4 exooteeA Jus+ �rior +,o 4(ic ICZtGii�q inao f i,e
,Pns4vre ova ftne f i�Enf s;Ae of -�6 Fgrwti Gt-�6j. So."e.!
ha 6a}es L.a�e been Pub Ivi d;�-ri., +o e[ -1'+O e�^os;oh.
`j p f
M rc- -for. a55' S}oLvxC
L.1 � �-�+ .#-In ► S , �I
3/23/99

❑ DSN C Animal Feedlot Operation Review
DAVQ Animal Feedlot Operation Site Inspection F
Routine 0 Com taint 0 Fallo%%--u of DNN-'( ins cction 0 Folioµ'-u or 5s 'C revivw 0 Other
Date of Inspection 7
Facilitt• Number 3l 33Z
Time of Inspection � 24-hr. (hh:mm)
© Registered I`-` Certified 0 Applied for Permit © Permitted 0 Not Operctional I Date Last Operated:
Farm lame: li Countr: �..c1�� •-
._.........._.f,` ...._..�?CYO.....................................__.............._._..►n..... ....... ....... ......... ............... .......
Owner Name: _ ............................. ..................L,:rKV.trl[sAt1S4� Phone No: �`!.1Z_R�-.. ...........
Facility Contact ,J] tile: Phone ?o: .......... .................. T-......................................................._-. ....-----••......
MailincAddress: .... .7G..... X..._. 11.1 ........................................................................ _ .... r.e.i..lJ.c ............................................ 2 SS..... .
s
Onstte Representative: ......... ...._...nf....__..�vul.1asl�y�> ................ Inte-rator:._.._._ �1r�
.1 ...... ........ Iet...............
........................................
..._
Certified Operatorc................. —..... .......... _............. ._..--....._............._............... __.-._...... .. Operator Certification (Number s... ...... ._...... ....................
Location of Farm:
Latitude �• �� �« Longitude
Design . v,-Current -Design Current Design "Curre[jt
Stvtne Capacity.: Population Poultry CapaeitV Population , Cattle Capacity.. Population
❑ Wean to Feeder
Feeder to Finish
Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Laver ❑ Dairy
Number of Lagoons % Holding Ponds �--� ❑ Subsurface Drains Present J10 Lagoon Area 10 Sprat- Field Area
l�LJ
❑ No Liquid Waste Management System
General
x
1. Are there anv buffers that need maintenanee/improvement? ❑ Yes j No
2. Is any discharge observed from any part of the operation? Yes V1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field D Other
a. If discharge is observed- was the conveyance man-made?
b. If discharge is obscrv_d. dial it reach Surface '"'ater? (If vcs, notify. DWQ)
c. If dischame is observed, what is the estimated flow in cab'min?
d. Does discharge bypass a Ia_oon system? (If yes, notifti DWQ)
I Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to thewaters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility- not in compliance with any applicable setback criteria in effect at the time of design?
T Did the facility fail to have a certified operator in responsible charge?
7/25/97
El Yes [N No
El Yes
[P No
iJ
❑ Yes
jj No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes 1p No
❑ Yes lP No
Continued on back

l Facility,Number: 3 l —'3-3Z
S. Are there lagoons or storage ponds on site a-hich need to be properly closed?
❑ 1'es No
Structures ILa; oons.HoidinR Ponds. Flush Pits. etc.t
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (ft): .... .... &:.I ..............
10. Is seepace observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If anv of questions 9-12 was answered ves, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. `Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AVplication
14_ Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
P%No
Structure 5 Structure 6
❑ Yes
JZ No
❑ Yes
® No
PYes
❑ No
15. Crop type _...... Yl✓Y1.0 .....................StYl6.1l......... ....... ................................ ...............................
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 reviewfinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fait'to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
{ 25. Were any additional problems noted which cause noncompliance of the Permit?
D No.violations or deFiciertcies.w' ere -noted during this.visit- Yoii.rvill receive-iao €tirther
cdrrespbndence, about this`.visit:•
❑ Yes W No
❑ Yes P No
❑ Yes Ef No
❑ Yes No
0 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes P No
❑ Yes No
❑ Yes No
I2. �o-rc o-+cgs nh �tv� U0,11 s - Should 6e_ rtnif- J, .`
tg �e�mv�a 54zoJ�J he it►tiQrOVW, eS��ciA{{y -{{{�� # ppZ f +ram �{roytf 01 "L ffffkul 6VSes.
a vc'M4 rtcock-ti,kodd die- (�t b S�lrMj �lul�}} f- 1'�cO nuWK6c Us+v) `� Gor►n e
�Y- PJIt. i+JG�Sk S��e� a �:[U no 5a nw- w 3o d s r7or
�a `rl�ur ��rowt� &MSG,, M, 6vvntlja_ �Iry_, CAbr..�` � .4 id.�e,rmc.`tioi. s►1OA 6.. w��' _
`u , Qww, re wv) s. (1 d&w So. ( kst- SW,) be- In, '&Cr, V'ccor�s .
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �,(,��/`,�. A,lz� Date:

41 Routine O Corn laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection 1 7 =LP _11 J
.33� �-- �-��,
Time of Inspection LIB 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:l 25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... ............................. .
Farm Name: _.... kt..J l .... ......... Ewan ..........-....__.... _......_........
Land Owner Name:.. Q.]f.............�(Srl'�} Phone
Facility Conctact:........ _.-----------------........... �jTitle.................. „ W. Phone No:
Mailing Address: � � � W.�Zp. x._.'� Z�...,........................ _.._..... ,.... ...............�.lL. � ir....... _ ..._ ..... M ... �g���....
Onsite Representative:.._.... ..... Integrator:. _.
Certified Operator: Q �t 1Gell c` �. Operator Certification , umber:..J..tZ; ..7.....
yP......._..:.............. __.
Location of Farm: ((
,.�.. ,cra�.es.�....r.t�.e.�...a ..�.$ j..�.'�..t.......�.�.�.x�a�"�.ur.....c�.........�..._.�........�t.ls.�s........ �...a�r�. ... � ".
Latitude ®•4 ®K Longitude ©• �«
Type of Operation and Design Capacity
Destgn� Ctitrrent, ", Design Current _ „ Design 'Curr11
ent
Srv�nev-Foul K Cattle ..4
a act °. Po elation tT�' Ca aci .::Po `ulatton -� Ga act Po ulahonv
Wean to Feeder ❑ er ❑ Da'
Feeder to Finish ❑ Non-LayerNon-Daify
- Farrow to Wean,'.
Farrow to Feeder Total Design Capacity $ " ��
'_ $
Farrow to Finish 1 dtaISS
RK
LW a.
t❑Other ,� �� � �- �'" �� '' M
�� * Numb of Lagoo f Holding Po�iads �9Subsurface Drains Present
Hera
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 12 No
❑ Yes
®No
❑ Yes
® No
❑ Yes
® No
t@ Yes
❑ No
Continued
on back
7

Facility Number:.....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
IR Yes
❑ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons andlor�liolding Ponds)
9. Is storage capacity (freeboard plus storm storage) Iess than adequate?
❑ Yes
RNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste ApUlication
14. Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Ip
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
No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes,
[KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
or Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
❑ No
24. Does record keeping need improvement?
1KYes
❑ No
Can�ents (refer to'queshon° � ¢Explain an}r YES answers`andlar"any recommendat�ans or anyother comments ~ .;�-
Use drawings of fac�Iity to better explain §rtuations }(use addrtional pages s necessary} ��� � � -"'°� °: {'
tv r- . vi t K-eJz.r d. 2OO t / b,u. b e. ��tl-c�z,..t...w-e t�k a�� 4
A V•- �` 0 V j a a.. cam. 1 0. �. G o S '�` Z` L Q.- Ld . Al V V.,,, G 5 � p L i-
•S" v LCL b t K-trF f 1a e { vr-Cam-^-� wiz t` �-d �a� a--„�rJ{ P ,, e � r, V%t
L* O �.v_ L.
7in 6- .,y
C.�f
o- ,,L cL [ i d c4-Z4 . Th, es 4. -� +...�-.,� b e ►'�-u
$ . k t-e-v- L-5 wy ti s P � Le. c-a -^-ti f l2- � C d-�-o! , � e u c w
,s L-a ..� a e v-6 I t t w i Ha c v a-+h a f p r~a r-r V-e"V- .
i
. •
Reviewer/Inspector Name F T ., ; � i .0
Reviewer/Inspector Signature: `' _ - „ Date: 7 1 t I q :1
i ky(
"It
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

rn
4

Site Requires Immediate Attention:
Facility No.1-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: _ 3 - 3 , 1995
Time:
1
Farm Name/Owner: KZ4 Cave l2 11 `1 e <-4211 t y1 Q Jr
Mailing Address: `f L1, 212ce 2 P(o
County: hJ01 11 _
•
0
Integrator. MUr j2
On Site Representative:
Physical Address/Location: _
s(- 4q
ry MIM2 WC
o 2 w) 0/ 7 rV
Phone:
Phone: Z
-,I V111-.e, h 4 hit
,;jw e row zs
Nero?-,4—
Type of Operation: Swine l� Poultry Cattie]/J
Design Capacity: -4.4-?S Number of Animals on Site: o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude::7+ Longitude: 11 ° s3 ' 103 " Elevation: Feet
Circle Yes or No -
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: —L—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erosion observed? Yes o No
Is adequate land available for spray--JJ
spray? Yes Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: ���' N?2_ _ _ Z'S ecre5
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:' do W il.
�2r rn i ss� on �,�-�►�. on jor tnY,r) 5 Gwn S zl[-,u
- Lt-nAz
Inspector Name
Signature
5)
cc: Facility Assessment Unit
Use Attachments if Needed.