310354_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Le
pe of Visit: O Co iance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
ason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
IIYYYY� Y.I�IY 1 - • -
Date of Visit: 3f Arrival Time: 1 O /} Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: !' Title: Phone:
Onsite Representative: Ja C"av-9'_ o' I[ , —c_ Integrator:
Certified Operator: Certification Number: Mid ' 2-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
F
Wet Poultry
La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
W an to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish
20
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,v_ul
Lavers
Design
Ca aci
Curreut
P,v
Dry Cow
Non -Dal
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes a<o ❑ 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 NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No [ ] NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number----- - 7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 4 3 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑`IVo Q 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
0 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 environmenta
eat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
N ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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):
❑ NE
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No NA
E
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
ONo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Ot�-_
2 L D es record keeping need improvement? If yes, check the appropriate box below.
Yes
[:]No DNA
❑ NE
❑ aste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
/ ❑ 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

Facility Number: 3 / -' S` Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZrNo ❑ NA ❑ NE
J
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
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 reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [lNo
7
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ffNo
❑ Yes Vw"'o
❑ Yes
[:]Yes 0 Io
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
flmmnt5
Used entsl (refer to question #.): Explain any YES answers and/or any additional recommendations or.'any other comments."
gs of, facility to better ex'plain'situations (use additional pages as necessary):
c�5e�7,j
7c/u r
� .�� n � . L
157
no 51
Reviewer/Inspector Name:
ReviewevInspector Signature:
Page 3 of 3
- j. Iva ,-
! 1►'i►, Phone:
i2 Date: y b j A i
214YI2015

Type of Visit: 0 C pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up_ 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .Arrival Time:
© Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: OIJ)A r f
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
MI
I Layer
Wean to Feeder
Non-L�
Feeder to Finish
rallon-L
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other I I IN IOther
Latitude:
Poults
Owner Email:
Phone:
Discharp-es 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?
Phone:
Integrator:
Certification Number:
Certification Number:
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑Yes ❑ o ❑NA ❑NE
❑ Yes V)4o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Fac i Number: - Date of Inspection:
W4ste 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
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
ZZ
❑ 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/Xo
❑ 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
i'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�(No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2
❑ 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 [2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ No
❑ Yes yo
❑ Yes E�No
❑ Yes [ o
❑ Yes [ No
❑ Yes
❑ Yes No
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ,Number: - Date of Inspection:
24;,Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes dlqo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0"'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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
2$. 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [%No ❑ NA ❑ NE
❑ Yes P 0
❑ Yes ff No
❑ Yes �No
❑ Yes eNo
❑ Yes �]
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or any other comments., ]
Use drawings of facility to better explain situations (use additional pages as necessary). j
l � 2 0✓la1WE�/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` 10 116 ' A
Date: 10 12,6 /1 �
14/2 1 S

Type of Visit: 0 Co pliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Of Routine 0 Count Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: XAAA)_ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: v69ATh0-L(,(, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I ?1Q j
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Pouitry
Layer
Design
Capacity
Cnrrent
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D , P,oW
Layers
Design
C_a aci
Current
P,o
Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
iurke s
Uk-ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 Eyqo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of inspection: j 01 t
[`taste 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: IAGz-N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ 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 2No ❑ 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 environm21vo
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes UNo ❑ 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?
l5. 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 .7 No ❑ NA ❑ NE
6(yes ❑ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [No
[—]Yes YNo
[:]Yes dNo
[:]Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412014, Continued

Facili Number: - Date of inspection: 5! S
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes Zl�o ❑ 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
LA No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:a/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
ET'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
ZNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z0`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
I__I 1"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
6/No
❑ NA
❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilltv to better explain situations (use additional naves as necessary).
5.) [.jM( N(EOEO
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone( Q, t% !
Date: 10114s-
1
21412015

Type of Visit: UCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! 0- Arrival Time: I b Departure Time: 1 DO County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J o u 0 to MULL'E
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 D OI
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
ILayer
Design
Capacity
Current
Pap.
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layff
I
Dairy Calf
Feeder to Finish
- , P,oulh.
Design
Ca achy
Current
P,o ,
Dairy Heifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes E No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
[-]Yes []No
❑ Yes Ef No
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: I a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G-j-41 �2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rj_�, L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes V] No ❑ NA ❑ NE
waste management or closure plan? T
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 ❑ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require [:]Yes O/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 dNo
❑ 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
C3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
f XNo
❑ NA
❑ NE
acres determination?
?????T'''"
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
U�;o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
NN0
❑ 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 V Rainfall Inspections
22. Did facility fail install
❑ Sludge Survey
NA NE
the to and maintain a rain gauge?
[:]Yes
o
❑
❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
�KNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Racili Number: jDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q N
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
YNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
EYNo
❑ 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
[,_�4o
❑ NA
❑ NE
CZ
❑ Yes No ❑ NA ❑ NE
❑ Yes Q/hiO ❑ NA ❑ NE
❑ Yes No
❑ Yes ff No
❑ Yes F311
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 0
/,q
Page 3 of 3 214/2 14

ao3a53
PLAN OF ACTION. (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE 1 7/2/2013
1. Structure Name/Identifier (ID): I Z. Korne a -Paradise #1(31-354)
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker
b. designed 25 yr./24 hr. storm & structural freeboard
c. line b - line a (inches in red zone) =
d. top of dike surface area according to design
(area at below structural freeboard elevation)
e. line c/12 x line d x 7.48 gallons/W
3. Projected volume of waste liquid produced during draw down period
17.0 inches
19.0 inches
2.0 inches
62400 ftz
77792 gallons
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design 80705 ft'
h. current herd # 2448 certified herd # 2448
actual waste produced = current herd # x line g =
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 days/line f=
4. Total PAN to be land applied during draw down period
I. current waste analysis dated 5/1512013
m. ((lines e + k)11000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
PoA (30 Day) 2/21/00
80705 ft'
01ft3
39666.7 ft'
150063 gallons
2.51 Ibs/1000 gal.
571.9 lbs. PAN

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE 7I212D13
1. Structure Name/Identifier (ID): I Z. Korne a -Cam Branch #2(31-354)
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker
19.0 inches,
b. designed 25 yr./24 hr. storm & structural freeboard
19.D inches
c. line b - line a (inches in red zone) =
inches
d. top of dike surface area according to design
(area at below structural freeboard elevation)
65504 ftz
e. line c/12 x line d x 7.48 gallons/W
gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 184 days
g. volume of waste produced according to structural design 80705 ft3
h. current herd # 2448 certified herd #1 2448
actual waste produced = current herd # x line g
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i +j) x 7.48 x 30 days/line f=
4. Total PAN to be land applied during draw down period
1. current waste analysis dated
m. ((lines e + k)11000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
PoA (30 Day) 2/21/00
80705 ft'
©W
40121.7 ft3
150631 gallons
Qlbs/1000 gal.
0 lbs. PAN

II. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR./24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1.
Structure ID: Z. Kornegay-Pa rad ise #F1(31-354)
line m = 571.9 lb PAN
2.
Structure ID: Z. Kornegay-Camp Branch #2(31-354)
line m =
lb PAN
3.
Structure ID:
line m =
lb PAN
4.
Structure ID:
line m =
lb PAN
5.
Structure ID:
line m =
Ib PAN
6.
Structure ID:
line m =
lb PAN
n. lines 1 +2+3+4+5+6= 571.9 lb PAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD_ DO NOT LIST FIELDS TO WHICH -PAN CANNOT BE APPLIED DURING THIS 30 DAY PERIOD.
PAN b.
•
FIELD
columnrxs
Lai'��
•- •.
1 1
1 11
.1 1
-• •
'State current crop ending application date or next crop application beginning date for available
receiving crops during 30 day draw down period.
v. Total PAN available for all fields (sum of column t) = 7605,0 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) = 571.9 lb. PAN
x. Crop's remaining PAN balance (line v from section III) = 7605.0 lb. PAN
y. Overall PAN balance (w - x) = -7033 lb. PAN
PoA (30 Day) 2/21 /00

Line y must show as a deficit. if line y does not show as a deficit, list course of action here including pump and
haul, depopulation, herd reduction, etc. For pump & haul and herd reduction options, recalculate new PAN
based on new information. if new fields are to be included as an option for lowering lagoon level, add these
fields to the PAN balance table and recalculate the overall PAN balance. If animal waste is to be hauled to
another permitted facility, provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
Waste will be applied agronomically and hydraulically as weather permits.
PoA (30 Day) 2/21/00

(Type of Visit: (!aj Cp1�6Hance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access II
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M pn{(aiJ M-1 UJA _
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Da' Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Design Current
D . P■oulh. Ca aei P,o ,
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C2(No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes [:]No
[:]Yes o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of inspection: tk irt, ti
Waste Collection & Treatment
4. Is's'iorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:( }Z/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 110 �b &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CNo
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
e
[ 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 YNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes YNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes C2/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 FZ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes Noo
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6ZO
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Fa<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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [3Yes o ❑
� Vo NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection-
-24:-Did'the
facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
rNo❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[]Yes
IVo ❑ 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
25'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
2<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
To ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1Vo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better exulain situations (use additional aaees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( ! (Y
Date:
4/20 1

Type of Visit: j<-ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: r$Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ` eparture Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: m
Certification Number:
Certification Number:
Longitude:
Design C+urrent
h
7Eeederto
La er
Design Current
Capaciorr
Design Current
Dai Cow
r
Non -La er
Dai Calf
sh
111111,11esign
D , P,ouI
Layers
Current
C•_a aci Rio ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Immpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes KNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): CZ-0
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes Po ❑ 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 ETNo ❑ 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 TNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes !I__I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A 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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,!jNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes A!5No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?.
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .E�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,ENo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [—]Yes ,j 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
❑ Yes eNo
❑ Yes E(No
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?
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
24.-Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes 16 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes �No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes )d 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? ❑ Ye ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes allo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional,recommenda(ions or any other comments: ,.
Use drawings of facility to better explain situations (use additional pages as necessary).
• S(A.1G--z
SU� C
Reviewer/Inspector Name:
' P/eue- aaQcP CcpleS of acl "I,
�e��-fir %1cen5c -�-d �eco�o�S
re coCds l00r��oo�
Phone: ` 116 7`rc — 7!�
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

35q
Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 t Arrival Time: 1106Departure Time: l f S County: Dxtj..! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: v oN m-rWA r/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: q 5 a6 1 L
Certification Number:
Longitude:
$wine
Wean to Finish
Design Current
Capacity on.
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -Layer
EEE Dairy Calf
Feeder to Finish
zf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D , P,ouIt , Ca aci P,o , Non-Da'ffy
ILayers I I Beef Stocker
Gilts
Non -Layers
11 113eef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes N ❑ NA [3 NE
❑ Yes I-1 1V� ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 3 Date of Inspection:
Wa- a Collection & Treatment
4. Is torage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l Viaz* L6GOC4q -2,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T-1 3 7�
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen.�Mefl threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [%_No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes zNo ❑ NA ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes VNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�5 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
gNo
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0/�/Io
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
E(No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

1
Faeffity Number: 11 - 5 Date of Inspection: 1 t I 7—,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo
o ❑ NA ❑ NE
z�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Ed"No ❑ NA ❑ NE
❑ Yes LNo ❑ NA ❑ NE
❑ Yes %[� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
roo ❑ NA ❑ NE
rN
❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other commentsr
Use.drawings of facility to better explain situations (use additional pages as necessary). a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
SH►.)
Phone: m !3 00
Date:
21412 Il

Type of Visit: Q rRoutine
pliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: D Arrival Time: 1 0 Departure Time: / o County: DtA0(X,4) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J o t'JA-f 4jA #'.1 0/1. S_C,L't P_ Integrator:
Certified Operator: Certification Number: 57,0612,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
C*urrent
Design
C►urrent
Swine Capacity P p.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�ti
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1] , P,oult ,
Ca aci_
P,o ,
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) [:]Yes [—]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes ❑ o
❑ Yes VNo
1
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Numbe : IDate of Inspection: Lb)'L0121
Waste Collection & Treatment
4. Is storait capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: Ua6-do^ i CA60W %-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
[:]Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:)Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes E2]/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 [%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?
[:]Yes 01 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes [2/No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yesgo ❑ 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 0To ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PAKo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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

Dtvisio..n of Wafer Quality
'� Fai'tiity Number )3 5 Q=Division of Soil and Water Gonseryatton
f: herAg*
iOt eney
Type of Visit 0 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint (:) Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1p 27/ Arrival Time: © Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
i r
Onsite Representative: _.) arjW64 integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e = , = Longitude: = ° = ` =
De
Swine cap
"» ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish jyx
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Currenf Design ..Current
y :Population Wet Poultry „_Capacity, Population Cattle ,
ILJ Non -Layer
❑ La ers
ElNon-La ers
❑ Pullets
ElTurke s
❑ Turkey dEIM
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowi
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: . ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes V I No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
oElNA
ElNE
❑ Yes
❑ YesVN
W�, ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

FWI ty Number: 3 — " � Date of Inspection
,F
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LZNo ❑ 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: LA-(;V N_ I Lgcjdatj Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental Etlreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes iNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? Vyes
s
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 acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
❑l No ❑ NA ❑ NE
LJ No ❑ NA ❑ NE
Z(No ❑ NA ❑ NE
Z(No ❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any recommendations or any, other com tints°
Use,drawm s of facility to better. explain situations (use. additional pages as necessary)
IS�:�EKJKugl9 1�LD n1EFbs L�v+�+
Reviewer/inspector Name '" /�` Jt!� = ;; Phone:
Reviewer/Inspector Signature: Date:
L s 13
l6/ zLIJb _
17/7m/Ild Cn"dmrwad
Page 2 of 3

Facility Number: 3 f —35y Date of Inspection a L d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ 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 ❑ Other
No
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[:2
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Lam! No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L7 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C. o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N
El
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
YNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
To
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
M*<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,�� //
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
L? o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings: -
Page 3 of 3 12128104

Type of Visit O'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outineComplaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ��) / SS//�/I Arrival Time: eparture Time: County: Region:(
Farm Name: _`&� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone NN ..
Integrator• rn.Z
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ c = f = [I Longitude: = ° ❑ , = «
Design Design Current Design Current
—---AuM-�gen
Swine Capacity Population Wet Poultry Capacity Population C►attle C**specify Population
❑ an to Finish
I ❑ Layer
❑ Non -Layer
❑Dai Cow
❑ an to Feeder
❑Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
❑ Gilts
❑ Non-ts ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑Beef Brood Co
Other
❑ Turkey Pou Its
EEE Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Q'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 DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes �Xo
❑ NA
❑ NE
other than from a dischargeT.
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [(Yes ❑ No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z2 j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J2 No ❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (;Ko ❑ 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 12'No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J2 No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA
❑ NE
maintenance/improvement?
l 1. Is there evidence of incorrect application? If yes, check the appropriate box below. O'Yes ❑ No ❑ NA
❑ NE
PT-xcessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes "No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes �j No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes qNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA
❑ NE
m. y
Comments (refer to question #) Explain any YES answers a.:nd/or any recommendations or any=othercomments. ,� r
Use drawings of facility to better explain situations (use additional pages as neeessar}) e
7��rrc�
3
�/ �x 3�,
l.e �/ fte,�. �)
ReviewerlInspector Name y ^ Phone:
ReviewerlInspector Signature: Date: d2
12128104 Continued

Type of Visit 0co piiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: --�y�c Title:
Onsite Representative: '%Am i'knA MZ1A_er _ _
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o Longitude: = o = d =
di
Design Current
Design Ourrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
51 Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
ElBeef Feeder
❑ Beef Brood Co
ElGilts El Non -Layers ers
❑Pulle
lBoars
Turkeys
Other
❑ Turkey Poults
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes IJ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 -c3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
In No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: L_A6"M I LA6yryJ `L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): E4 35
5. Are there any immediate threats to the integrity of any of the structures observed?
Ela Yes
,
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA
❑ NE
/No
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1[J No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
IJ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑l No ❑ NA [3NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L/J N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA [INE
18. Is there a lack of properly operating waste application equipment? El Yes
Yes ❑ NA ❑ NE
Reviewer/Inspector Name I Phone: !6 -13V
Reviewer/Inspector Signature: Date: -1It 0
Page 2 of 3 12128104 Continued

r
Facility Number: 3 —3 j Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EYNo, ❑ 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 [I Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O��Nj
o ❑ NA ❑ NE
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? ❑ Yes
❑ NA ❑ NE
PPq Y25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Q No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes CfNo NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ,IdN ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
12128104

I
Type of Visit (3rCorlmliance 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: nWt0Jv0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �M Title:
Onsite Representative: CJv Nb ^Y_
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= c [:]' = Longitude: = ° =' = "
�Qign
Current Design Current Design Current
Capacity.l'apulation Wet Poultry Capacity Population_.. Cattle Capacity Population
r3yine
Finish
❑ La er
❑ Dai Cow
Feeder
❑ Non -La er
❑ DairyCalf
KI Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry poultry ❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Beef Feeder
PE313oars
Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
Other
F17 Other
❑ Other Number of Structures:
Discharges & Stream Impacts
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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
FN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
((No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued
r

jF;kciIityNumber::3j— Date of Inspection
ti
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: LA�—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3q -3Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑Ng ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environni ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Dyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 El Yes EO ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA [:IN E
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I� No
,
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E��Oo_'l
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;Zo
❑ NA
❑ NE
lid 13 Aek.,M..q L14 WtJ l s m
60,
AYZ-LM61 s Pq_g4,v(p kVb
Reviewertinspector Name I LJa'A/ ?tA f ( I Phone: II /DJ 1119 —15 V
Reviewer/inspector Signature: Date: a
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents ,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropirate box. WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Code
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
hdNoo
E? o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
UNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fob
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,�
[:Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3401❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EiNo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewerhnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
AdditionalaComments..and/or Drawings: ; u '4
Page 3 of 3 I2128104

Division of Water Quality
Facility Number ■-- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Co fiance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral o Emergency Q Other ❑ Denied Access
Date of Visit:Arrival Time: % Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: vptiiKlTf�A� �_LL(a( Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = C 0 Longitude:
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
[
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current.;
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Da
❑ Beef Stock -et
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ET� o
El NA
El NE
❑ Yes
L l�o
❑ NA
❑ NE
12128104 Continued

Faci4ty Number: — 3S
Date of Inspection 8�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Qkpaaj I IA 6rer(�-A.1 '?---
Spillway?:
Designed Freeboard (in): I I t ,S
Observed Freeboard (in): 7Z_9 3'?
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes , �No ❑ NA ❑ NE
El Yes LI No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes NN ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffN. ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 14es ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a No ❑NA ❑NE
7❑ NA El NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
6,) Fau> Z (Q ex..) aoaj lautES� 1JEEnS uEE� �e.lTit�oc Akio L64! AUA 4ECbs -rc
IF
Reviewer/Inspector Name j Phone: q/b ')Cl(, - 7
Reviewer/Inspector Signature: D41 ate: y o
72128104 Continued

.r
r
Facility Number: Date of Inspection
Required Records & Documents ,__,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [l Yes JD o ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Design ❑Maps [I Other
�
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
9 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�To
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�
[?1'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E;Xo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0,!` o
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
014110
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�O'g
0 14o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�/
`E 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
,,..,
OX-0
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
El❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,❑,�C
l 70
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

it
Type of Visit -(?'C-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: a
Cj
Certified Operator:
Sack -up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o ❑ d Longitude: [= ° = i
00 DesignMIUMent,Design
C►urrent
Design C►urrent
Swine C•apacLry
Population
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
IQ Layer I
❑ Dairy Cow
❑ Wean to Feeder
I0 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
L
❑ Turke s
Other
❑ Other
Number of Structures: El
❑ TurkeyPoults
❑ Other I
I
Dischar8es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

FaciiitV Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: _71—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑"Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)-
Reviewer/Inspector Name I jn I& [ Phone: pp;
Reviewer/inspector Signature: Date: V i1"C
Page 2 of
12118104 Continued

Facility Number: — Date of Inspection WT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[--]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
)� A,
s11d If 3
3. U
1/z 6/
Page 3 of 12128104

Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
X I
Reason for Visit Routine 0 Complaint O Follow up O Referral o Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Arrival Time: % .Q Departure Time: County: L Region:
Farm Name: raU i se, 4� _1 �M i- C mp'br ortcl ` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: l Title:
Onsite Representative: er MOM
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator: &46dQ
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = 6 ❑ Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes E/ No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Y
Facility Number: — Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): fl21 0�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes , /Q'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 ZrNo ❑ 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 „2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes'] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,TNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ ADplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ZYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P'No
❑ NA
❑ NE
15-
r{� fa CSI�/ls!-� 5fnull�✓ fir- pn S�/ `1
Reviewer/Inspector Name Phone: —3
Reviewer/Inspector Signature: Date: J�
12128104 Condnued

Facility Number:, Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .�ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ONo
Cl NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,Z'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
,0NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[;?NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ 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
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ 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
.ETNo
❑ NA
❑ NE
General Permit? (iet discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RTNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings: - F
.2 Collhy-40'lrrt
kslK� �Gw 71-7e/e✓7
�tawe� a1 Pen Caw4 c%- cv rA AeA
Gfo /01/^ a Cop foeS�Ju rre ai
a AGs ebprli Ml'SOlcew
-te
61061 oi^
12128104

1 0�Soil snd Water Conservation
Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit fi4tine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: Gi Time:
O Not Operational O Below Threshold
Permitted O3Cerdfied�] © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ..� .CLx i•• .�i }:s•lM--•.Oo(-
jr,4X).jC)1% County: _LP 1 3............... ..........................
Owner Name: ... . . . ...... ............................`...1........... Phone No:
MailingAddress: ......................- ............................................................................... .................................. ......... ..................... ..........................
FacilityContact: .. ...... ..............}........................................._.......--Title:.......................-----------............................. Phone No: . _., ............._.....- ---
Onsite Representative: f -�1 Integrator: ... ,.%!...,......._ .... .... _ �. ....
Certified Operator: p...._............................ ------ ................ - ... Operator Certification Number:........................................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 9 64
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes J;Wo
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 ZKo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J;?fiTo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,0%
Stnacture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... ...... C &............ .......... � __ .. _.._...._....
Freeboard (inches):
12112103 Continued

Facility Number: —3 Date of Inspection
5 Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Pdlo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes RrNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes E1 o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes An'90
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ,0090
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes.,,6No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;2r'&o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified
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?
.aste Management Plan (CAWMP)?
Odor Usues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ONO
❑ Yes ,ET&o
❑ Yes j2No
❑ Yes 2No
❑ Yes ONo
❑ Yes L?lQo
❑ Yes ,j;KO
❑ Yes _F"Ko
❑ Yes P4o
❑ Yes PAo
Co'mmeats'{refer to questEoa #)�E9:plarn�ahy Y1F.S.answers anri/or an �' Use drawings of %c�lrtyatu better expls�tnatsons�{use ad�ttia la pages �s necessary_) - Fteld COPY � Final Notes.... ���
-Fa rI +--y �o �"haQQ, f- WCOM6 CAN, nCq
d- o rde lr1
Reviewer/Inspector Name �-F`
Reviewer/Inspector Signature: Date: O
12112103 1 Continued

Facility Number: — Date of Inspection !/
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ,�io
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )VUP, checklists, design, maps, etc.)
❑ Yes 2<o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes L3-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 [moo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ;;No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes L3Ao
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes �No
28. Does facility require a follow-up visit by same agency?
❑ Yes J214o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes _L�-ldo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
,Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,0790
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes 'J�mo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes j2rNo
34_ Did the facility fail to calibrate waste application equipment? ❑ Yes ONo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes J2<0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

I
1,
Facility Number / 'late of Visit: Time:rO 3'
Not Operational 0 Below Threshold
ElPermitted MCertified [ Conditionally Certified ©Registered/ Date Last Operated or Above Threshold:
Farm Name: 4 N j t 6A 4 61dQ7 County: K I.,.
Owner Name: Q O iIl Q�iky 1'i Phone No:
Mailing Address:
Facility Contact: ! Title: Phone No::
Onsite Representative: ^6/,&A Integrator: LLY�1 h Y
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 a " Longitude 0
Design;-
Current Design
Current: Desegnt Current
Svtme .' _ a 'Caiiaciri.
Po e>ilatron _` _foul m Ga' acrty
;Pa ulstan Cattle...Ga sntt:v,t'a uEation
❑ Wean to Feeder
!
l❑ La er
I❑ D '
KLFeeder to Finish
4613q4
"%
❑ Non -Layer
I
I
I i;. 0 on- airy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
-
❑ Farrow to Finish
Tors! Design Capac>iri
❑ Gilts
❑ Boars
a, W Total SSLW
Number of Lagoons 'm-Y
© g
❑Subsurface Drains Present ❑ Lagoon Area ❑ -sp. v Field Area
i oldig Ponds;? Soitd
❑ No Liquid Waste Management System
Discharges S Stirearn Impacts
1. Is any discharge observed from any part of the operation?
❑Yes PNo
Discharge originated at: ❑ Lagoon ❑ Svrav 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 R Treatment
4. Is storage capacity (freeboatd plus storm storage) less than adequate? ❑ Spillway ❑ Yes )0 No
rufVe l Structurere 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: w✓
Freeboard (inches):
05103101 Continued

Facility Number: ,3/ —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are theie 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 2 No
❑ Yes %No
❑ Yes � No
❑ Yes JKLNo
❑ Yes ;S 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 JqNo
12. Crop type Qtf�::&'4z1_4V8 Ak
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IZ[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
91 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
09 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[�[No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
%No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
J,No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
C,No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5d No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_
`Comments other-,'commen t_s..
Use.dra vngs of fariltty ta-better e7ipiatn situatto� _(use: tional pages as necessary) "� El Field CopvD Final Noted
&Af vi-le- 4,.-& //ft
_ 4. _ ...._ ��
Reviewer/Inspector Name -`-'
Reviewer/Inspector Signature: Date:
05103101 Continued

0.
i
"P
Facility Number: 31 —
Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a pennanentltemporary cover?
AdditionalGomments..andtor Drawings: ,
05103101
❑ Yes K Rio
❑ Yes P\o
❑ Yes X-NO
❑ Yes PSNo
❑ Yes JAPS No
❑ Yes -{ Rio
❑ Yes le No

Division of Water Quality
:O Division of Soil and Water Conservation
O'Other Agency,
of Visit'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _pr"Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 3 1 3 Sty Date of Visit: /8 OI Time- q - I Printed on: 7/21/2000
O Not Operational O Below Threshold
j3Termitted [3 Certified 0 Conditionally
Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �oG�Yt¢ Za�! r`e h0e �}e a1 J r County V.'1.?.........................................................,
............r......... jj.............................p../.t.....��................/......
Owner Name: PA ad ► ,SC 7 09 1 it r?'1 �G { rCt wt �f� SIG`' Phone No:
FacilityContact: ✓ . Title:................................................................ Phone No:...................................................
Mailing Address:
Integrator:
zoC jPG.. ..✓•............ .... ... '`'�5Onsite Representative: .....A.Q�.......�............ . ..........................
er c T
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location'of Farm:
Kf 3wine ❑ Poultry ❑ Cattle 0 Horse Latitude Longitude �• �� ���
Design Current Design Current Design' Current
—Capacity Population Poultry. Ca aci Po ulation CattleCapacity, "p6pulation
_'
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish _492k 10 Non -Layer 1 10 Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other -
Farrow to Finish Total Design Capacity
Gilts
Boats4EE� Total SSLW_­ - __ I
, Ntamber of. Lagoons I❑
Subsurface Drains Present Iro Lagoon Area
Hol�oag Ponds lSolid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Spray Field Area
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If dischargc is observed. what is the estimated (low in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I �Sttructure 2 Structure 3 Structure 4 Structure S
Identifier: r I- e
C�. ..........................!.......�r..s...................................................---........................................................ .
Freeboard (inches): 3� 2-6
5100
❑ Yes oNo
❑ Yes o
❑ Yes �No
❑ Yes �No
❑ Yes �No
❑ Yes O-No
❑ Yes WlfTo
Structure 6
Continued on back

Facility Number: Cate of Inspection —� Printed on: 7/21/2000
51 Are t1i'ere any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ YesXNo
S. seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes)2r,0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑Yes N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes XNo
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 0
11. Is there evidence of over application? ❑ Excessive Ponding) ❑ PAN ❑ Hydraulic Overload
❑ Yes�No
12. Crop type �e ✓' ^1 UAQ �a 6 � ze ��a ( rq "k-, �' ! b 6ra-ze
13. Do the receiving crops differ with those designated in t e Certified Animal Waste Management Plan (CAWMP)?
❑ Yes�o
14. a) Does the facility lack adequate acreage for land application?
El Yes _To
b) Does the facility need a wettable acre determination?
❑ Yes 0
//.E],No
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes o
16. is there a lack of adequate waste application equipment?
❑ Yes
Required Records & Documents
/,�'No
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
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,)ZrNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes Q`No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes/�o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes �o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes,21"No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
.❑ YesJ2'No
24. Does facility require a follow-up visit by same agency?
❑ Yes [3'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes�No
0; �Vo.*iolati0Tis:oi• defidebdies •were poled. d& n i �.hts;visit; - You WHI-fe�eive ii6 i i thl, ;
corres�oiidence. about; this visit.... . . ... . ... . . .
Comments{refer to question #)s _Explain any YES answers and/or any recommendations or any other comments
Use`drawings of facility to better -x lain situations use additional a es.as necessary),. j4
p f.... p _ g-
FaG ;1;4 a�0( re Co,,d s are le- y w ell
7 /
C
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:411ve 5/00

Facility Number: 3 —3S Date of Inspection Printed on: 7/21r'2000
Odor Issues
•
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 WO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes NO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,� No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Addifional.Comments and/orDrawings:
a
5100

is Division of Water Quality
Q Di%ision'of Soil. and -Water Conservation
Other Agency
-M
Erteason
Visit pliance Inspection Q Operation Review Q Lagoon Evaluation
for Visit O Complaint O Follow up Q Emergency Notification O Other Denied Access
Date o£ Visit: Time: (� Printed can: 7/21/2000
Facility Number
Not O eratio 1 Q Below Threshold
Permitted [] Ce 'fled 0 Conditionally Certified 0 Registered Date Last Operate Above Threshold : ..................
7 ./ � ,fir � County ..... ,• .....................4�l1.:....
Farm Name:!i15�-• ...•'-�1�!`......... ........ ...
r
OwnerName: ............ J............... ...�......... ........ ............................... Phone No:.......................................................................................
FacilityContact: ............................................................................ itle:.......................................................... Phone No
Mailing Address : ................
.................... ...................................................................... ..........................
..............
Onsite Representative:>�/I G dj �' Integrator:
........................... ... ............... //! .'..�
Certified Operator: ................................................... .......................................................... Operator Certification Number:..........................................
Location 'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Desiau Current Design Current . Desi® GsorreiQt
Ca c ' : Po ulation
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nl ber:orLagoaus ❑ Subsurface Drains Present ❑ Lag^anArea lospray Field Area
II+g Ponds;/ Solid Traps] ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J�(No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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
ructure I 4tructurc 2 Struc re 3 Structure 4 Structure 5
r,
Identifier: �i%u..,if. `..................................
Freeboard (inches): 3&11
Q/ �!
5100 _ 1
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
<No
❑ Yes
TNO
❑ Yes ANo
Structure 6
Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any imm diate thre is to the integrity of any of the structures obse ed? ie/ trees, severe erosion,
❑ Yes
§e�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?
El 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
J6
11. Is there evidence of over plication? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload
❑YesNo
12. Crop type
13. Do the receiving crops differ ith 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
o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
o
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
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)
El Yes
o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
El Yes
o
24. Does facility require a follow-up visit by same agency?
❑ Yes
o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
:: �'�i,li yiglafions:oi def eiepcie� -r ere . Ofea- OtWing this:visit: • Y:ou will-VpaAye iio futther •
:•coriesooritieace:ahautithis visit:•:•:•:•:•:•:•.•:•.•.•.•.•.-::-:-:-:-:-.•:•:•:•:•:•::•:•:•.•.•.•.•.•.-.
Comments {refer to.question`#) Explain any YES answers and/or any recommendations ar any other comments T �r r
Use drawings of facility to better explain situations (use, adsithonai pages as necessary)
ly
4 -7 We
CJV
6,1 AI'vkA
i 5
Reviewer/Inspector Name W _
Reviewer/Inspector Signature: .� Date:

Facility, Number: Date of Inspection rh
Odds Issues
26, Does the discharge pipe from the confinement building to the st ra pond or lagoon fail to discharge at/or below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes pl�o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [;(No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes \\o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments and/orDrawings:,
f

w . - Division of Soil and Watetr_ Col
Division of Soil andatec'Coi
Division of Water Quality Cc
- -.
� Other: Agency Operathoi€iaRei
_Routine OComplaint O rollow-up of DWQ inspecti
Facility Number
ion - Opera
ion,- , Como]
ce I�ispect,c
Permitted 13 Certified 0 Conditionally Certified [3 Registered
FarmName: ..... S �1���.......................................................................... .
Owner Name:
........................... ,................ vi^.`y.....:.........
.............................
Facility Contact: ........................................
Review -_
�e Irispectii
w-ticof DSWC review
Date of Inspection
Time of Inspection
0 Not Operational
Title: .......................
MailingAddress:...............................................................................................
�
Onsite Representative�"c"�-� j , i , 10
CertifiedOperator : ................................................... ........................................
County:
Phone No:
O Other
24 hr. (hh:mm)
Date Last Operated: ..........................
'AL ................................. .......................
............I .......................
Phone No:
...................................... -....... ._........... I............................. .............
..... Integrator: mt`�6 ...................................
Operator Certification Number
.oc• do of Far r j - ,
rv%. ......... .......... M- ,.................................... ........ ............. ................_ _....................... ....... . ............
1�-,t.. .............................:........15. Q..,.............................................•---.............................................................._..--..---........................................
Latitude 0 4 Longitude �• �i i&
Design Current_ - .. Design Current Design Current,
_ -
Swine = Capacity Population' _Poultry Cs acity Population - Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish Non -Layer ❑ Non-Dairy:d
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish = Total Design Capacity
Gilts
❑Boars _ TotaI-SSLW
- Number o€'Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Feld Area
PHoldhng 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 inan-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. Dries 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 J�fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IV No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): 39 ........ .... ... C.............................................................................................................................................................
........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [& No
seepage, etc.)
3123/99 Continued on back

LracilAy Number: 3t —`3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
9No
(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
D(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
n No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
M No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
(?No
12. Crop type \C�,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'[9No
E�No
b) Does the facility need a wettable acre determination?
❑ Yes
&No
c) This facility is pended for a wettable acre determination?
JK Yes
❑ No
15. Does the receiving crop need improvement?
14Yes
El No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
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
VNo
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
0 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
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 jkv No
24. Does facility require a follow-up visit by same agency? ❑ Yes `w No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes j4 No
�q •.VR lalfions:or• deffickndes Were noted• during ihis:visit.'• Yoti will •reed*46 -rid futther:
corresporidence: abaat this visit. '
C©mments (refer to question #): Explain anp YES answers and/or any j
Use_drawings of facility to better explain'situaiions {use additional paki
C
Reviewer/Inspector Name
commendations or any other eom fait
as necessary)-:
" q6r6 t%,Q A ���
LZY �
t" 0-
r
V
Reviewer/Inspector Signature:
Date:
3/23/99

Fact ty Number: 3— Date ofInspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes [�Mo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? XYes ❑ No
Additional omm"eritsan or Drawiqgs.•
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
of DSWC review
Date of Inspectiony1 jL5
Facility Number 3 t 3S4
Time of Inspection �?A hr. (hh:mm)
13 Registered 19 Certified 13 Applied for Permit 13 Permitted 113 Not Operational Date Last Operated: ..........................
Farm Name ........... ...Pfi Lk S11S..�.4^ `�_p, �� ��2� F� .............. County: ......
�U�Ith..............................................................
`
Owner Name: ...............Snt....t2A.LP .........(/0! ttS...................................... Phone No:...1 �.�Q./c.S(P�..........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ..... 1.).&$......... Rer)... i.11........ F/a.........................................................1,[ .:..6..1:.lL j...._n1�1............................... .27MS........
Onsite Representative:.....? 0lke........11 c0Y..ks.1ltl................................................ Integrator: ...........kvx:0......................................................
Certified Operator.................................................................1................................................ Operator Certification N/umber:.........................................
Location of Farm:
Latitude =0=, 0« Longitude =• =` =11
Design, Current Design Current " Design Current
"Swme _- Capacity -Population- Poultry Capacity Population Cattle ;Capacity Population
4_ e
"y- ❑ Wean to Feeder :: ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I Non-Dairys
❑ Farrow to Wean -
❑ Farrow to Feeder - q ❑Other
❑Farrow to Finish Total Deslgn Capacity
❑ Gilts `
` 4 [I Boars ToIEASSLW
Number of Lagoons I Holding Ponds 0', ❑ Subsurface Drains Present 1101,agoonArea Io Spray Field Area
-z' ❑ No Liquid Waste Management SystemIt
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 11 No
2. Is any discharge observed from any part of the operation? ❑ Yes b No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EP No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated Flow in gaVmin?y IAA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ yes No
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes 6 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? 0Yes tANo
5. Does any part of the waste management system (other than lagoons/holding ponds) require M Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes V No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97
Continued on back

Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds, Flush Pits. etc.i
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes 5] No
❑ Yes 14 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
C..........................P.........._.. .................................... .............................._......................................................._......_..
Freeboard (ft): .............. :5.. ... ... ZIA....
10. Is seepage observed from any of the structures? ❑ Yes `A No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 9 No
12. Do any of the structures need maintenance/improvement? \P Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'' ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................+�..............sm&a..( Yl kA............................. ....................................................................... ........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 5iNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes M No
hi
18. Does the receiving crop need improvement? Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes CANo
20. Does facility require a follow-up visit -by same agency? ❑ Yes &No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes A No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
�] No. viol ations or deficiencies were noted during this: visit. • .You -will receive no further
. . eoerespondence. about this.visit:•
Comments`(refer to question`#): Explain any YES' -answers and/or any reronunendattons or any; other comments `'Je3`
lllU„. .. aliyoeexplain statse wngsocitunsuse additional tirvpg-
. ,.o
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be �+�
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e4t� uii. L oerr� f�Q���t1 SWtJIE1 �y. ecj��r]��t.. (,rr; vior- �^Dt' 7/25/97
Reviewer/Inspector Name x ram"
Reviewer/Inspector Signature: Date:

1
AnimalN.
Feedlo(Operation Review
❑DSWC
-.. . T.•L F
�DWQAnimal Feedlot OperationSlte Inspection
10 Routine 0 Complaint 0 Follow-up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection �]_—_L— a
3 3
Time of Inspection ) 3 : � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm States: El Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
B,Certitied ❑ Permitted or Inspection Cincludes travel and rocessin )
❑ Not Operational Date Last Operated:.... _.............. _...... _................. .......... .......... ........
_...... ._. _ ..._..... .... .............
Farm Name:
Land Owner Name:.a.c � �tat.� � �..� �.. _�.Y. x .�. c� �. _ �7C:... Phone No: 3. ..... .... _..
Facility Conctact:.... ...._......._....1............. .................. ........... _.. Title: Phone No:
Mailing Address: _..s ..- 1 -. -... ....._........ _....... .
Onsite Representative: ... aA- Integrator: y
Certified Operator: ... R0AAC 1...........zL ..... 4LI1 ..... _......._...... ....... _-., Operator Certification Number: _ % ......................
Location of Farm:
..Dx�._-..S.c:.�..1�1�.�n.s.�.....�s.i.d.e.... ....�.. ��.-l.. .�--.a..�..�a-�r..x�.�s. ..... ............:..Z.�......u+�.�..�.lw.t._..-so-u.Z:J��.�.tt...t-i...... 4
Latitude ' ° " Longitude ©• �' ®'
Tvne of Operation and Design Capacity
y DesgnerCurrent� i)esrgnCarrent x Design Current
Sn� Ca ace Po ulation'apl?YGa acity FPo utai�onle Ca ace Pa uiahon
❑ Wean to Feeder La er ❑ Da-
® Feeder to Finish Non -La er ❑Non Da
Farrow to Wean WO
Farrow to Feeder-�RTotal IAesigII .(5a a ty qb
Farrow to Finish y `.
TotaI�SSLW 6 a o
Other
u�Subsurface Drams Present gPf y A r^ ^ A^
❑Lagoon Area ❑ S � ray Field^Area
e era
1. Are there any bui%rs that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonsiholding ponds) require
4/30/97 maintenance/improvement?
❑ Yes IR No
❑ Yes 19 No
❑ Yes & No
❑ Yes .l No
❑ Yes
9 No
❑ Yes
allo
❑ Yes
& No
RYes
❑ No
Continued
on back

Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds/
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
�.?—L-Li.L.... _...... ............. -.
10. Is seepage observed from any of the structures?
Structure 4
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
,LNo
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type n........... .�.sa!`ld l r....A.r............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?.
21. Did Reviewer/Inspector fait to discuss review/inspection with on -site representative?
Eor Certified Facilities 1
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes B No
® Yes ❑ No
Ed Yes ❑ No
❑ Yes R No
❑ Yes J!jNo
❑ Yes No
❑ Yes No
® Yes ❑ No
❑ Yes ® No
JR Yes ❑ No
❑ Yes ® No
❑ Yes U No
❑ Yes 19 No
& Yes ❑ No
Comments (refer to``question ##}xplarn ariy YES answers'and/or any recommeiidationsJor any other corYiments'={
Use drawings of facility tii`better explain situations (use adclrtionai pages as necessary} , `° z
v-e- $ m FS t rti i w. S
i 1. 112- - I= I l . , e.­o t. o- r-L: -3 o w,- 10-3 ,-.j w a l i Z o--� , e v e_ e E a fie•
.s o p
Ma'1t. �zVkce, Cv,rtl d
e
1$- C o 'r r t cf w e Y -t i e�-�-i i r. % W ►•...� r�u .
4rt­­t W0-4 �c S0- -+bid � �^^. �AK-k 50✓e.. T-tw Qttl�
Irv- t. j 1�► v wl. 1• ;'i�r5 0-1 l .r r ,, oL 1I-a 0 tin ►'' *-, C-0 f -O
v-�✓1
1n U b •L vs 17C Oil 0� S [�L" a-✓� F1.-v�nit
Reviewer/Inspector Name `° '.:. . ; M.,'' 1-
Reviewer/Inspector Signature: Date:
cc: Division of Water 4uality. Water Quality Section. Facilitv Assessment Uyit 4/30/97

JUL-14-1 `�9� 1 5: 22 FROM DEM WATER, QUALITY S= �T ION TO
WIRQ P:02/02
Site Requires Immediate Attention:
Facility No.
. DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: i_ ► 3 v
Fazio Name/Owner:
Mailing Address: —
County: _ �V__ IA Q1'L_
Integrator. u _ Phone:
On Site Representative: zit _ _ Phone:
Physical Address/Location: (2CLe X14 Al It
Type of Operation: Swine '� Poultry Cattle
Design Capacity: Ofl `fie a ""�41 Number of Animals on Site: Y `-�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 T' OE,-_L3 " Longitude: =- _ ._' --Y_L " 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) 6br No Actual Freeboard: _S�Ft. —,0— Inches
Was any seepage observed from the lagoon(s)? Yes or 2o Was any erosion observed? Yes o
Is adequate land available for spray? Yes or No Is the cover crop adequate? 25br No
Crops) being utilized: = if-f
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ZW or No
100 Feet from Wells? Ooor IN. 0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map .Blue Line? Yes or i\To
Is animal waste discharged into waters of the state by matt -made ditch, flushing system, or other
similar man-made devices? Yes M62 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:
tv-& - - - -
Inspector Name S' , tur
cc: Facility, Assessment Utut Use Attachments if Needed.