310355_INSPECTIONS_20171231

7
M Iv 3io q ter IZ ou ces
�: ax
Yo er ato
1
,I
Type of Visit: &7FoMpliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Tlme:j _/,22.3 0 1 Departure Time: County:Region: )7z_0
Farm Name: ��2 r.� Owner Email:
Owner Name: k ecC - Q Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: joy
Certified Operator: �aa%
Back-up Operator:
Location of Farm: Latitude:
!� Phone: ``
Integrator: r/
Certification Number:
Certification Number:
Longitude:
Discharges and Stream LMacts
1. Is any discharge observed from any part of the operation? ❑ Yes [E-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes [:]No ❑NA ❑NE
❑ Yes jallo ❑ NA ❑ NE
❑ Yes NA ❑ NE
21412015 Continued

Facill Number: - 3777 Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F;LNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [SNo ❑ 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
E3-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health, or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[] Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
53 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?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EL No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): yr
13. Soil Type(s): A 4
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
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fKLNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XLNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes J&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of inspection: -- C7--'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �K No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �a No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes [5.No ❑ NA ❑ NE
❑ Yes 21'No ❑ NA ❑ NE
❑ Yes ,LNo
❑ Yes 54 No
❑ Yes E No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone: 9%l! '0.?- U (-5-1
Date: Jr Mo -�
21412015

Type of Visit: ompliancc Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0,Woutine 0 Complaint 0 Follow-up O Referral O Emergency _ 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:JQ4.z1___
Region:
Farm Name: j f �%r t,f,'(a -"S--- -calf 4-2,_ a Owner Email;
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Lgez al.02
Phone:
Integrator: e)—Zza
Q
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Disehar es and Stream finpacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Certification Number:
Longitude:
❑ Yes ®'No ❑ NA ❑ NE
[:]Yes Z'No ❑ NA [3 NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 4?fNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes Z No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ff No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts.to the waters
[-]Yes 2 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

F'acili Number: jDate of inspection:
Waste Collection &Treatment
,r I's 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 L-2"No ❑ NA ❑ NE
Struc� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes L'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 Ca"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes qNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r7rNo 0 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P-No [] NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;;?No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
_ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
r_7No
❑ 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 _ 2n
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
o ❑NA [3 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [;I No [] 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? []Yes Ea'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PINo E] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
L'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
[2-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
�Vo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(40
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
[] Yes
;5-1No
Too
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Signature: _ ! - Date:
Page 3 of 3
ZL
21412015

Facili Number: - Date of Inspection: :
Waste Collection & Treatment
4. Is7sstorogeleapacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �" o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes j,_jNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 -�j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,Callo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j2-No [DNA [] 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 J,3No
❑ NA
❑ NE
maintenance or improvement?
Waste Avvilcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Zf No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 12-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):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'L3,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes _ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,�No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes.'�T10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �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 13'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q-1�0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
2/4/2014 Continued

Faciii Number: A jDate of Inspection. I a N
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 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 CAWMP7 ❑ Yes VTNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ZNo ❑ NA ❑ NE
omment fefer to uesE o Ifil'n at., ;M1' � anew r and/or any additional recommendations or any other comments-
U" drawl s of facUP `t r iin go In . s u eg add, ltional` a es ;bs necessu '�
f S 4e Jvreb e%F u,111/ ap.olr,
D Yes WNo ❑ NA ❑ NE
❑ Yes (ZI No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
Reviewer/Inspector Name: Phone:�r
Reviewer/Inspector Signature: Date: fa ! l
Page 3 of 3 2/4/2015

Type of Visit: Compllance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: ► *eparture Time: County:
Farm Name: 1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L4 (p 4.0
r
Certified Operator,
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and 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 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 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
❑ Yes J�jNo
❑ Yes : ►No
❑ Yes �No
[] Yes ❑'No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Dumber: bate of Ins ection;
Waste ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes PiNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L2rNo [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes, E7 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) G11—
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�o ❑ NA ❑ NE
waste management or closure plan? 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,ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �Eo ❑ 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 ❑ NA ❑ NE
maintenance or improvement? T"
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 P 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 ❑ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rrNo ❑ NA ❑ NE
acres determination? /�
IT 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 rl No
❑ NA
❑ NE
Re uired Records & Documents
T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2�No
[DNA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check
❑ Yes �Po
❑ 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`;2-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 j No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes /'K ❑ NA ❑ NE
Page 2 of 3
2/4/2014 Continued

Facility Number: - Date of Inspection: 14 S
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes j''No ❑ NA ❑ NE
25. Is the faeility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ 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 C214o [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes ❑'A10 ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes RNo ❑ 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 file 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 CAWMP7 ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
ommen.'ts (refer to c)uestinn.#} Ex laln any 'ES answers and/or any additlonat 'recommendatlons or� gtly.other comments-.
lase dra;" In s..of;fuctlit`.tq b tter ex ni , situ w yg _ )_ >4tions,(use.additinnal a es as necessa )
71a 9 y
51 ucj�e e) - uy* I ac)6.
A&pi L/ 0 ­3`0� 13e sur-r, 1-o �t6rzA-4-6., 5
//b// %-- V
/ '_7 ne, 4�
' r_Qrrn �7 RCCWC�5 1Cy3'c3aGP
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 796 7,3��
Date: % /3 114
1412014

Type of visit: ompliancc Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival ��jo eparture Time: County: Region:
Farm Name: 1�i Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Integrator: W /jr�
Certification Number:
Onsite Representative:
Certified Operator:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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 :?No [] NA ❑ NE
[:]Yes [:]No
[:]Yes ❑ No
❑ Yes ,EfNo
❑ Yes Z f No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Faclli Number: Date of Inspection: 2,
Waste Colkction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 2!rNo ❑ 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: �L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesKNIo
[] 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
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J;rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�No
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
J'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
oNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff 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
�'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes N
❑ Waste Application Weekly Freeboard Waste Analysis ❑ Soil Analysis Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
o DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: Z
24. Did_thc4acility fail to calibrate waste application equipment as required by the permit? 0 Yes Z No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo
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 ONo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;''No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or.document ❑ Yes ff 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 ONo ❑ 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 XNo ❑ NA ❑ NE
permit? (i.e., discharge, frceboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ,6No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fait to discuss review/inspection with an on -site representative? ❑ Yes ONo ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA 0 NE
Cowments (refer to.qu.estion #) Explain unyNE$ answers.and/or any additional recommendations or any other comments a = +. "
Llse dra"in a: of Cacillt to better eX lali� situatlor_ (use additional pages as necessary).
ou"d
Gc vl t �.^� J` hog it�c1� uS'�
/a/ y��� p. 7d P
so
�P (.tip
ri d ,sa t S I ?6� o9 o
5131111 • �� I
•Flo,
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ZVI - 1y4 —'
Date: l Y }Zee,
2/4C011

Type of Visit (D-Cbmpliance Inspection O Operation Review O structure Evaluation O Technical Assistance
Reason for Vistt11:5Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: rrivul Tlme: Departure Time: County:
Farm Name; Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: -�- Title: Phone No:
Onsite Representative:. Jed f/f' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ e 0 f 0 « Longitude: = ° 0 ; 0 {1
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? (Il'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 0 No ❑ NA ❑ NE
❑ Yes P No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes JZNo
❑ Yes 10No
❑ NA
❑ NE
El Yes El
El NA
El NE
12128104
Continued

Facility Number: - Date of Inspection: a
Waste Collection & Treatment
4. I: 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
o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �3 No ❑ NA ❑ NE
(i.c., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PTNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,0'tfo ❑ NA [] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )allo ❑ NA ❑ NE
maintenance or improvement?
Waste Anollcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZ'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;D ❑ 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?
❑ Yesj�jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J:D�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes eallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [:—fNo
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [�;lo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily availablc7 If yes, check
❑ Yes ®"No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2-N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Eno
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes 0 No
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: Date of Inspection:
24. Did the. facility fail to calibrate waste application equipment as required by the permit.
[:]Yes
,� No
❑ NA ❑ NE
25As the facility out of compliance with permit conditions related to sludge? If yes, check
El Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
JZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E f No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
PNo
❑ 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
JZNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
NA ❑ NE
1/1
v
Reviewer/Inspector Signature: �j ` Date:
Page 3 of 3 2141201

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1A
' 1 Arrival Time: epnrture Time: County: Region:
Farm Name_:1'' -S Owner Email:
ir
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: e� L Integrator:
Certified Operator: Certification Number:
� d�3
Bach -up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and 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 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?
Page 1 of 3
❑ Yes 0'*No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ZrNo [_]NA ❑ NE
❑ Yes P;rNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
21412011 Continued

Facili Number: JDate of Ins ection:
Waste Cgllection & Treatment
4.-is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ YesT�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oz. Y
5. Are there any immediate threats to the i—ntegrity of any of the structures observed? ❑ Yes ,' No [DNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ';allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Mo
❑ 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 oNo
❑ 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 PrNo
❑ 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
t2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2r&o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes P�No ❑ NA ❑ NE
❑ Yes tj!rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes TPeNo ❑ 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 P+No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes '[2"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0'06
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2141201.1 Continued

[Facility Number: - Date of Ins ection:
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
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 0,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jZNo
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 l ,KNo
❑ Yes /ONo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes P�No
❑ Yes j�]' No
[—]Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Gn tiln� its ( e nA.0�c�ticst)o��#�� �.xpls�i��an���(i1S Answers and/or any additional recom�neudafi.nns or.any other-Ti �ments.
LJ e,dra, ? n s.of Cac.ili kv to hetfcP eat I,ainl3,sit 3 oh$'(nse additional pages as necessary).
113 l3 0.13
' r,07Yi'n
V/Py// a 7�
/,/( , //,Z- 0 gr,7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9L_7ff_._-z
Date: -i0116
14120 fJ

�-Division of Water Quality
Facility Number O Division of Soil and Water Conservation11
Q Other Agency f
Type of Visit .42)Gompliance Inspection O Operation Review O Structure Evaluation O rec
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency O Other
Date of Visit: /1 Arrival Time: 1,�qQ Departure Time: County:
Farm Name: 24 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: UZ zae2ke-- —
Certified Operator:
Phone:
Integrator:
ical Assistance
❑ Denied Access
Phone No. -
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede.
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region:
Latitude: = o = ' 0 Longitude: 0 ° 0 ' 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I 1=--j
❑ Non-Layet
Dry Poultry
Pullets
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?
Design Current
Cattle Capacity Population
Dairy Cow
❑
Dairy Calf
❑
Dairy 1-leifei
ElDry
Cow
❑
Non -Dairy
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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 &eNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ;2'No
❑ Yes �;Ko
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 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
Struc re 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �ZNo
❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA [INE
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 PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes ;2No
❑ 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 ff No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;314o
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect 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 7 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
[�JPQo
❑ 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
M-No
>10
❑ 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
j2rNo
❑ NA
❑ NE
x. m - ,
o�nntyye¢snt f �ef��to q e i, w �xP am any YES n�we si dl any,,
a om ation3 0 R .ytoti a r nts. .
d BaW ng a a t. to etter a �plaln situations
d o �a a
a 11' es ary
4y M'.
"i.4 .
Reviewer/Inspector Name;
Phone:
Reviewer/Inspector Signature:
Date:
ave 2 of 3
1248104Continued

Facility Number: Date of Inspection y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ZYes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard �TWastc Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weathcr Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss reviewlinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
�/� Jty W as joille
/b1 q1a a, %y '5ctv�'PL so
6A/o J-o G0 Uzi'
In h(04.,
��i/iv 4 • �� n
6Ve cd rk
G , 7 Cr-;'
5�'15
❑ Yes
12'90
❑ NA
❑ NE
❑ Yes
12�o
❑ NA
❑ NE
[:1 Yes
p4o
❑ NA
❑ NE
❑ Yes
;],No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
;;i'No
❑ NA
❑ NE
[:]Yes �'ltlo ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes J2'14o ❑ NA ❑ NE
❑ Yes Flo ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
Page 3 of 3 12128104

o Division of Water Quality
1 2zj:= 0 Facility Number Q Division of Soil and Water Conservation
Other Agency
Type of Visit QaCoo'mpllance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ra Routine O Complaint O Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival •time: OCI Departure Time: County: W/7`7t Region: 4 /
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
jj
Onsite Representative: .5 b lGJ&A- JgUn It� Integrator: J
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: 0 0 = + = ++ Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Cattle
o =I ❑+i
Design Current
Capacity Population
❑ Dairy Cow
Dairy Calf
❑ Dairy I•Ieifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
' Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
,[]Yes
P'No
❑ NA
El NE
Discharge originated at: ❑ Structure [] Application Field' ❑ Oiher
„i
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 cstimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any -part of the operation?
❑ Yes
J'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential -adverse impacts to the Watc� of the State
❑ Yes
IT No
❑ NA
❑ NE
other than from a discharge? , •
12/2"4 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: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes No
El NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J2"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 Eallo
❑ 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 C2?lo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
CR'No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[2rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ZNo
❑ NA
❑ NE
Reviewer/ins ector Name ^'y
p Phone: E i
Reviewer/Inspector Signature: Date: % D
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Q' qo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 �3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes fNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 'Tlo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
P�No
❑ NA
❑ NE
Other issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
.�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9—No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P 190
❑ 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
ZNo
❑ 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
ENo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
A
G_ gip'
.' Avrt�pt Vx 're ec"-�s ke /�� a e� e"
rage 1 of ) 12128104

'Division of Wit ality
Faejlht Number 31 3S,$" O Division of Sol a afer Conservation
O Qther Agency;
Type of Visit e Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit J2Moutlne O Complaint O Follow up o Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: (l Arrival'I'ime: r 7c30 Departure Time: t.J County:
Farm Name: I'/ S --let C' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: In. -Ledo, Lance
Certified Operator:
Phone No:
Integrator• tM
Operator Certification Number:
Region: L&/
Sack -up Operator: Sack -up Certification Number:
Location of Farm: Latitude: ❑ o ❑ d = Longitude: ❑ 0 0 6 ❑
Design# Current
Capacity Population
''4 ❑ Wean to Finish
El Wean to Feeder
Feeder to Finish q Vr 0
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
JLJ Boars f
Other
Other
efilgn` GurKent Design Current
Wet Poultry ff�apacity ,Population' Cattle Capacity', Population
1LJ Non -Layer { t
Dry Poultry.
Non-L•
Pullets
❑ Dairy Cow
UFDairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
10 Beef Brood Cow
Its
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?
Page 1 of 3
❑ Yes Z No ❑ NA ❑INE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑No
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
_'No
❑ NA
❑ NE
12128104 Continued

>racVty Number: 3 -- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
XYes J10 ro[E]
NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 9 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 Z No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0'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 Cl Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apelleation
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 -0 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) 0er�./i�,Ce.. L fe l / .SigjodltE , t,'- r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 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 Fr No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Zlo
❑ NA
❑ NE
Comments (refer to question #): explain any YES upswersand/or any recommendations or any other comments.
Use drawings of facility to better explain situations: (uc additional pages as necessary):.
-4e a"'-
R
Reviewer/inspector Name Phone: E7lT7
Reviewer/Inspector Signature: Date: 0
Page 2 of 3 12/28104 Continued

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

jType of Visit 4Zf Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
IReason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: _ /�7 Arrival Time: 12= Departure Time: County:
Farm Name: %i'T/�P- J 6e- ,s 7 _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 11-1
�
Certified Operator:
Region:
Phone No:
integrator: , R
Operator Certification Numher:
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: = = ` = Longitude: = o = 1
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finisl
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non -
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?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
Dairy Heifei
D Cow
❑
Non-Dai
❑
Beef Stocket
❑
Beef Feeder
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[]Yes
jDfio
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
12128104 Continued

KaciliYytNumber: 3 — Date of Inspection
•
Waste Collection & Treatment
❑
ZNo ❑ ❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
NA NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Struc ure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[;fNo ❑ 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
VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo ❑ 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?
I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EYNo []NA ❑ NE
❑ Excessive Ponding ❑ Hydrauiic Overioad ❑ 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)
IA
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
E'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETI�o
❑ NA
❑ NE
J. q,uesth
di 4 tw;
Reviewer/Inspector Name I J s r''r ` '` " `z` Phone:
Reviewer/Inspector Signature: Date:
121;
Continued

Facl y Number: 3 f -��5 Date of Inspection
r
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;6 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? Il'yes, check ❑ Yes [�(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain it rain gauge?
❑ Yes
[$No
❑ NA
❑ NE
23.
Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
VfNA
❑ 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
P1 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
2fNE
Other issuer
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
ffNo
❑ 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
K
❑ 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 tail 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.. Commenfs,sndlor, Drawings f
Al 0 '50i/ �� a00 .
" We G o r co -IS %i ea 7� d` d r'Pl�/ /i
12128104

nfvon dfwuteriy
f
pfD(iViSiOn. ofAt& C'onseevatioII "
' � � °
,Sbil and, 4� ,
'� '-r'1./s
, /
}
�V41e�r/Agen{�. 'r +m
r
y
Y
,.x t -
'fY e
. z
tL
.q.
L
Visit 0 C plane Inspection O Operation Review O Lagoon Evaluation
or Visitoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number s - Date of Visit: I �- 8 0+�1 Tune:
O Not O eratioual O Below Threshold
Jdpermitted Certified ❑ Conditionally Certified 0 Registered Date'Last Operated or Above Threshold: __ . _._._....
FarmName: .._.?-i.... ........Fe.2........ County:......Q.pi: P�?...»..Ww_...............» .....»..._....._.
OwnerName: .................».»........»..» .»_....» ....... 'Phone No:..._.......... _....._.....
MailingAddress:.... ....._..._...........».............................. _ . _...........»........._
Facility Contact: .._....._._._.........._..._....._..._._._WW_.... __ Title: __. _._...... Phone No:
Onsite Representative:.._.�o .!Itp Li H._..LF1 r-iz - ;.........»._ _ _....Ww_.w... Integrator: .w. iJ2. J.__......_............. ......... .............
_ .
Certified Operator:.. „...,,.,,.».._...... .. ........ ...... . .... .„.__ ,.»._ _»....»...... ,»........... Operator Certification Nutrrber:._•__.___. ___ _,_ . _....
Location of Farm:
❑ Swine ❑ Poultry [} Cattle ❑ Horse Latitude • C ` &° Longitude • 4 64
. Design- Current
Swine •'Cnnarit r Orkiinlatinr%
Wean to Feeder
Feeder to Finish
2 4 I
�, 4
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars
Design Current "Design! :Current
1.p,,onitry Ca' cityCa Po uladon, 'Cattle' ad ."Population
❑ dyer , L7 Day
❑ Non -Layer L I Non -Dairy
�F
e ❑Other . , , .
J.
Tdiai�Design Capacity
- .Total'SSLW .
Nirlyer of Lagoons ! iir
,
Roldin1 Nm ti.. / Sehd,"["rgric
Discharges & Sty m act
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
eNo
❑ Yes
eNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ''[„ /No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._._.W..� .... ._ _ _._._.._._._...W.__ _.... .....»» . ». _ »» . __..._. _._...._ _...... .................._ ._ _ W.._.»........»._...
Freeboard (inches): Z
12112103 Continued

Facility Number: Date of Inspection 7G o
5. 1 there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes%(No
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes U10
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ' No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �/No
elevation markings?
Waste Application /
10. Are there any buffers that need maintenance/improvement? ❑ Yes BNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2<0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 6to-M UTA ( N) 56- U
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Flan (CAWMP)?
❑ Yes
ENo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P10
b) Does the facility need a wettable acre determination?
❑ Yes
BZo
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
[ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
UJ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes []40
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes U10
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 2N/o
Air Quality representative immediately.
12112103
Continued

Facility Number: J 3SS Date of Inspection: t
r
Re wired ecords & Rgeuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[a N
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Yes
O/No
No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑
❑
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
YO
;<o
❑ Yes
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�
C No
28. Does facility require a follow-up visit by same agency?
❑ Yes
(7No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
L7o
NEPE dfto acilities
Yes
No
30. Is the facility covered under a NPDES Permit? (If no, ship questions 31-35)
❑
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

0 Division of Water Quality 11
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit QCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Vialt a Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ benied Access
`—'ri�-�-�'—�
Facility Number Date of Visit: Time:
0 0 e a'Belaw-1hreshol.571
®-Permitted 0 Certified1 0 Conditionally Certified Registered
Farm Name:T
Owner Name: U d q, '<
Mailing Address:
Date Last Operated or�bove Threshold:
County: _-- 6e IOX
Pbone No:
Facility Contact: Title: ,Phone No:
Onsite Representative: integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' « Longitude 0 a 0 1 w
Design Current Design Current Design Current
Swine _ Ca achy Population Poultry Capacity Po ulation Cattle catiaeltv Po ulation
El Wean to Feeder 10 Layer 10 Dairy
El Feeder to Finish I Z f5 Non -La er ❑ Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total .Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons
Holding Ponds t Solid Traps
Discharges &_ Stream Imucts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes 1B No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes SNo
Waste lr & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ®.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
Freeboard (inches): 27 "
05103101
Continued

41 -{`
Facility Number: 3 —
Date of Inspection / GZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type / k Ilk " /T C/ /S IPtA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
ReQuired Rej2rds_Aj�ocuglents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a activeiy certified operator in charge?
22 Fail to notify regional DWQ of emer ency situations as required by General Permit?
❑ Yes B'No
❑ Yes E�l
❑ Yes Eta'
❑ Yes 91-N-0
❑ Yes ZINo
❑ Yes 9-NV
❑ Yes ED-No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
G-No
[Mo
❑ No
❑ No
-No
Fro
❑ Yes O'No
❑ Yes ZWo
❑ Yes MNO
❑ Yes ZFNo
❑ Yes S-No
g
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑-1Vo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (E-No
24. Does facility require a follow-up visit by same agency? ❑ Yes [9-No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑NO
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #):. Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ❑ field Conv ❑ Final Notes
.sO'� ski�r�l� �✓ 24UZ h e,eAf -7s he 7G,Zelj
- d r`r re lea Sc Vd r P e- <`n e 1 3 q e { Ws 1�v G e ,-ex ee
-tt ` /a -0 ,eke tee.lS%y Aek
ReviewertInspector Name
Reviewer/Inspector Signature: _ Date:
09103101`
Continued

Facility Number: j — bate of Inslicetinn [p
dor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes Z?No
❑ Yes El-Ro
❑ Yes ZKO
❑ Yes Z -Nu
❑ Yes 22-No
❑ Yes M-igb
❑ Yes 9-<0
Additional Comments andlor Drawings:
w
05103101

s161k.4w
tY
aipn of Soater
Conservation
Age�cyi
-�
er
.� isz
Type of Visit _(),Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number S Date of Visit:
0 Permitted [3 C-e-rt�ified Q Conditionally Certified 0 Registered
Farm Name : ............J—.,r'..r,rc... .... l�'4_ !'��f................. ...........................
OwnerName• ........... ...°!, 4...... 1�.!..�r................................................
1 r' D I Time: $: s
Nat O erational Below Threshold
Date Last Operated or Above Threshold: .........................
County:.. U ............................................. .......................
PhoneNo:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.................................................................................................................................................................,................................ ..........................
OnsiteRepresentative:..`a.�.�C,r-....................................... Integrator:.......+ r ` .............................................--
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 " Longitude ' d 66
Design Current Design Current Design Current
Swine capacity Population Poultry Capacity Population Cattle capacity Po ul>tdoh
❑ Wean to Feeder ❑ Layer I ❑ Dairy I I —d
❑ Feeder to Finish ❑ Non -Layer JL 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
Roars Total SSLW
Number of Lagoons l I❑ Subsurface Drains Present j`❑ Lagoon Area 1❑ Spray Field Area
Holdfing Ponds / Salid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. li'discharge is observed, what is the estimated flow in gallinin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier- ------- ------ -)
❑ Yes eol1Vo
❑ Yes111—
❑ Yes j2 No
h 1 C1
❑ Yes ONO
❑ Yes 'EfNo
❑ Yes 7&0
❑ Yes )2110
Structure S Structure 6
Freeboard (inches):
sioo
Continued on back

Facility Number: — 3Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .2(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 XNo
(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 Mo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes o
Waste Application
10. Are there any buffers that need maintenance/improvement? yEs ❑ Yes L31No
It. is there evidence of over application? ❑ Excessive Ponding []PAN &Hydraulic Overload s Yes gNo
12. Crop type �er �''� v a �cs 5;r ai rye ►"r1
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 ,dNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes )?fNo
15, Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes O'No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available? ❑ YesZNo
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 JZINo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 01No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes /ffNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes PNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �No
24. Does facility require a follow-up visit by same agency? ❑ Yes )ZNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ;ZNa
dgficjenple4 #Ore 00(ed• O4tri tg thjs'vIs1t; Y00 ;wilj •tepoife too thgr;
ctirres otideitce' a"bo if this :visit.:
Cbm_ merits (i4er.to question #): Explaln any YE5'answers and/or aay ridetn' rec6mmeios or siny'other comntients ,I Y. ,,.
Use drawings of facility to better explain situations. (use additional pages,," necess46) '
t ►. 13e s I/r-e 1104 4,0 otret >VIQre 4k tiq ;ncti rev, acme
an apio��cct�,o , rkr{,G�{arl be G.t-,ra� o-F --tl; s on shorgav �A-
IS.9Qod11
Need 40 1O�ah SY`^GII plrai� Glo� 015V
Reviewer/Inspector Name d c'1,ti
Reviewer/Inspector Signature: Date: 1119 to 1 5100

utility Number: 3 j -_75'
.5-1 Date of Inspection r
l � •
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes log
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'OVO
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 _O'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ''No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

0 Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
jType of Visit O Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 3S5 Date of Visit: 11-7-xaal Time: 15:45
0 Not O erational 0 Below Threshold
® Permitted M Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: TI pleJ FismajRr............................................................... County: R_ulIiU.................................... WJRQ......
Owner Name: jQlgtuls----------------- Trspit»1:.._------------------------- Phone No: 4aQ 32:�Zq7--------•-----------------._..
Mailing Address: J,%7...0,1d.r,.awp.RgAd.............................................................. . Rude..k�il�..�!llw.................................. . Z8.4511..............
......... ......................
FacilityContact: ...........................................................Title:............................................... Phone No: ,.....................................
Onsite Representative: J�landa.laaaier--._-------_-----.._-------_------._- Integrator:�py
Certified Operator: JjalandADJjalaadAD. ........................... LoWu.........
Location of Farm:
Operator Certification Number: tQ{(t6............................
West of Rose Hill. On West side of SR 1100 approx. 0.25 miles South of Hwy 903 along Sampson Co. line.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 78 a 09 6 37 ..
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer I
Dairy
® Feeder to Finish
2448
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to finish
Total Design Capacity
2,448
❑ Gilts
Total SSLW
330,480
❑ Boars
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. I ............. ...........................
Freeboard (inches): 29
ne/AIInI

liacllity Number: 31—•355
Date of Inspection I1-7-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
Luntinueu
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ieI irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ieI discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): EJ Field Copy ❑ Final Notes
I I.Be. sure not to apply more than 1 inch per acre during an application, particuarly be aware of this on shorter pulls.
15. Bermuda crop is good and much improved since my last visit. Need to plant small grain crop ASAP.
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

�w
05YO3101 Continued
Facility Number: 31-355 Date of Inspection 11-7-2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 ® 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, mussing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 355 Date of Visit: 11-7-ZOD1 Time: 15:45
Q Not O eratlonal 0 Below Threshold
■ Permitted E Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: _ ......._ ....
Farm Name: Tr.4 le,1.FArm&,htr............................................................... County: Raipaial.................................... )' IRO......
Owner Name: dQl�&---------•-----._ i.�nJcr..---------------•------------ Phone No: 1�.Q:�32.2247-------------------•------._..
Mailing Address: 1547..01d.CAmp-RoAd....................................................................... RQ5s..Uill..NC........................................................ . 18.450 ..............
FacilityContact:...........................................................Title:............................................... Phone No:......................................
Onsite Representative: .Jplandlt.ltllelIntegrator:
Certified Operator:JAIAgdtt.l?............................ Lartigr ............................................... Operator Certification Number: 1964t6.............................
Location of Farm:
West of Rose Hill. On West side of SR 1 100 approx. 0.25 miles South of Hwy 903 along Sampson Co. line. A
® Swine ❑ poultry ❑ Cattle ❑ Horse Latitude 34 • 49 1 17 " Longitude 78 • 09 , 37
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
0 Feeder to Finish
2448
10 Non -Layer
I
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2,448
❑ Gilts
Total SSLW
.330,480
❑ Boars
EEI
Number of Lagoons ! ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Fonds / Solid Traps ❑ Nn Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Water ofthe State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. 1............. ........................... .......................... .......................--............................. ...........................
Freeboard (inches): 29

ti
+��iv�ivt "nunueu
Facility Number: 31-355 Date of inspection F1177-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Apq ication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ® Yes ❑ No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
RMuired_
Records _& Docum_e_nts
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?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
jComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
jj Use drawings of facility to better explain situations. (use additional pages as necessary): ❑ Field Copy ❑ Final Notes
11.13e. sure not to apply more than I inch per acre during an application, particuarly be aware of this on shorter pulls.
5. Bermuda crop is good and much improved since my last visit. Need to plant small grain crop ASAP.
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

r►
05/01bl Continued
Facility Number: 31 .-355 Date of Inspection 11772001
Udor 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 ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

r
• Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 355 Date of Visit: 11-7-20Q1 Thne: 15:45
.. - .] O Not O erational Q Below Threshold
Permitted ® Certified U Conditionally Certified 0 Registered Date Last Operated or Above Threshold:.............
Farm Name: Tr.(ale.d.Felanajne............................................................... County:I?aI.ptAiui.................................... )? IR,S?.......
Owner Name: ,IU1�pt1S-----------._._._ f.atlllJ:_._------------------------- Phone No: �JlQ3�:��4?--•-----•-----•-----------•---
MailingAddress: 1547...QJd.lGAwP.RQjid........................................................................ Rqu-;1.iIIAC........................................................ ZHU .............
FacilityContact: ...........................................................Title:............................................... Phone No: ......................................
Onsite Representative: ,jglalitia.41e1--------------. .----.--------------- Integrator: ll�]1[p11X�Hm11vX�ttxill.� _----------- ---•
Certified Operator: J.QjAt da.V............................ LA)AJCX ............................................... Operator Certification Number: 19006.............................
Location of Farm:
West of Rose Hill. On West side of SR 1100 approx. 0.25 miles South of Hwy 903 along Sampson Co. line.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 OF 49 f 17 « Longitude F 78 1 F 37
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
JEJ Layer
❑ Dairy
® Feeder to Finish
244$
10 Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
2,448
❑ Gilts
Total SSLW
330,480
❑ Boars
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area JEJ Spray Field Area
Holding Ponds 1 Solid Traps �� ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ............. I ............. ........................... .......................... -•--•-......-•--•-.................................... ...
Freeboard (inches): 29

fAk"Jiul
Facility Number: 31-355
Date of inspection 1 11-7-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify•DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Uununueu
❑ Yes ® No
❑ Yes ® No
❑ Yes % No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes OR No
❑ Yes to No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ❑ Field Copy ❑ Final Notes
I I.Be. sure not to apply more than I inch per acre during an application, particuarly be aware of this on shorter pulls.
15. Bermuda crop is good and much improved since my last visit. Need to plant small grain crop ASAP.
wer/]nspector Name Stonewall Mathis entered by Bette Rose
F
wer/Inspector Signature: Date:

�05103101 Continued
Facility Number: 31-355 Date of Inspection F 11-7-2001
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 244 hours? ❑ Yes ® No
28. 1s there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

+t 1 * DiAslon of Water Qnahty'' y;v
Division ar5dil and Whter Conservation
Other Agency,.-
-i, � � .. � � '1:� .n l.•f sr lw�":.��'fid
71
Type of Visit MCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number T)ateorvisit:
allot
rime: 60 Printed on: 7/21/2000
7 erational Q Below Threshold
Permitted 0 Certified 0 Canditionally Certified 0 Registered Date Last Operated or Above Threshold: .......... ..........
4
Farm Name: ...........�.. ..................f.--�P.N�r�%�......................I.... County......... 1....'...��,................
... ..........
OwnerName ................................................... ....................................................... Phone No:......................................................................,,...............
Facility Contact: '::I .? ...../-a ......Title:.... .. ........................... Phone No:.............................................,,....
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Q ..
Onsite Representative: J�—k 4s.,�,................ integrator: �...................................................
..... 1....1...•....
Certifier) Operator: ....................... Operator Certification Number:
Location of Farm:
4wine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�` +' Longitude 0
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
arrow to Wean
❑ Darrow to Feeder 10 Other
❑ Barrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag ... +n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharge- & Stream Impacts
I, 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?
h. If discharge is observed• did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is obticrvcd, what is the estimMecl lluw in gal/thin?
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?
1N':iste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Idcntificr: ��..................................................... ....................
Freeboard (inches):
5100
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes o
❑ Yes WNo
Structure 5 Structure 6
Continued on back

Facility iVpmber: Date of Inspection O0U Printed on: 7/21 /2000
)Frees,
5. Are there any imme iate threats to the integrity of any of the structures obscry d. severe erosion,
❑Yes
(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
1�110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
11
Waste Appllcat1On
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of QYrV aDplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type 974(1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
5 jNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
*0
b) Does the facility need a wettable acre determination?
❑ Yes
�No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement`?
"<Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
�NO
Reuuired Records & DocEimenls
17. Fail to have Certificate of Coverage & General Permit readily available'? ❑ Yes Of No
18, Does the facility fail to have all components or the Certified Animal Waste- Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes KNo
19. Does record keeping need improvement? (iel 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 F
o
21. Did the facility rail to have a actively certified operator in charge? ElYeso
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Mf No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes o
24, Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
1Q Yiola(i0ris'ot. 0 f1cjencie$ W ri� nirtiit wfrtp�r
cor'res orideince: a�ntit. this visit: ' ' ' • • • ' ' ' •
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
s _ I
Reviewer/Inspector Name 10j/
Reviewer/Inspector Signatur Date:

Facilltf-Mumber: — Date of Inspection pp�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead ar6mals 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 ONO
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 Wo
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 p6qo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Xi'es ❑ No

11�k PI eo,s v n o4e n et v e G4 j 6 n
© Division of Soil and Water Conservation - Operation Review
y D Division of Soil and Water Conservation - Compliance Inspection
B Division of Water Quality - Compliance Inspection
© Other Agency - Operation Review
® Routine C Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review C Other
Facility Number 3/ Date of Inspection I�
Time of Inspection S 24 hr. (hh:mm)
SPermitted © Certified U Conditionally Certified 13 Registered � Not O erational Date Last Operated:
Farm Name �r,��e .t1..... �R!''►�s County:.... .��. l�L......................................................
Owner Name: °.. ^.... 't a! h t Phone No:
FacilityContact: .............................................................................Title:............................
MailingAddress: ..................................................................................................................... ..
/ F
Onsite Representative: ..�Ta.l..!'��!is .....................r...................................
CertifiedOperator:................................................................................................................
Location of Farm:
...................... Phone No:..............................................
.............. ........................................................ ...... I.,.. ..........................
Integrator: ........ N.r., 1.................................................
Operator Certification Number: ..........................................
......01,.....+Ne.r ........AdQ....nf...S. .....1...Q.�7..., ..c ...Csx ...PkQ... ..�/... ...r���.[e:... �£.. 9Q3............................ A
.. ............ ... w
Latitude ' 6 .6 Longitude =' =' "
Design Current
Swine Cnnacity Ponnlatinn
❑ Wean to Feeder
IN Feeder to Finish
Z
4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy I I d
❑ Non -Layer ❑ Non -Dairy
❑ Other I I
Total Design Capacity
Total SSLW
Number of Lagoons I!� ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Arca
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
t. 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.?
h. If discharge is observed, did it reach Water of the State? (Il' yes, notify DWQ)
C. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (Il'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
❑ Yes Da No
❑ Yes 16 No
❑ Yes IM No
nA
❑ Yes X No
[:]Yes ,R No
❑ Yes ® No
Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
IT
Freeboard(inches); .................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IQ No
3/23/99 seepage, etc.)
Continued on back

Facility Number: 3f —3$ Date 411' Inspection /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
X No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
CbNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
elcvation markings'?
❑
•gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
O No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[gNo
12, Crop type L3 erin i1 Ar" 1 e, Ir""t I I 6 r-0 I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
59 No
14, a) Does the facility lack adequate acreage for land application!
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
09 Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
H No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Mi) No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
9 No
(ic/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
In No
24. Does facility require a follow-up visit by same agency? ❑ Yes MNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,® No
�'�iQ yibla�igt s;olr d >l lce cies i�trr. 0004• l 0ift 4Ms'visit; YOO Will •Nelriye 00 furft
corris 07idence. aba6f this Visit.
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
4, le,5aopN a reSrnns;bla 6"A 4;w,e-I
/w4rinef A,
i� • l=ac i Ii-(• iJ i't,,, �Q( -6,, ii.e# e ALne G4e4ee.^loA+iC, •
15. Cn4•s-NI 66rn•►v4 f,, OIA ' n eeols �►.+t�al'ot%t;�M6►t- rw��IJ� ,n,tip q�y�,¢rl�;
iiol4l [tw,eo O C6ando'+) 4o sail 4CS4 �o Inelp i &"rroof
New wzo4e �1r_ set,, le �t.otJ0( � eat L�1g5-le �7ex o' n5 k1i a
d
i>n Navch^bf.+` s ccld. to G1t r rrc(W{� + rvgro( Syvxrti( ) rA l'n,
Fr
Qbscrv'e gpplrc�kroh w;ndawS �a ►- c.�o s.
p
Reviewer/Inspector Name 5,1. y� e ( �f'1 Q % Q �tl) 3*9'� _-7d V vk - 211-7
Reviewer/Inspector Signature: Date: 11 / % QGl
3/23/99

Facility Number: 3S5 Date of Inspection l.�l
Od .Issk
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
D9 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
IN No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
j No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
a(No
32.
Do the flush tanks lack a submerged rill pipe or a perinanent/temporary cover?
NfYes
❑ No
3/23/99

Divtston of Sotl and Water Conservation Other Agency
,�gj Divtston of Water Quality _ � .
Routine O Cum taint O Follow-u of DW ins croon O Follow-u of DSWC review O Other
Date of Inspection
Facility Number 3�H �5�
Time of Inspection 3100 24 hr. (hh:mm)
E3 Registered lb Certified 13 Applied for Permit 13 Permitted 1E3 Not Operational I Date Last Operated:
FarmName: ........................Tri.P& ex. `a ...................................................... County: ..... 4.f.n......................................... .......................
Owner Name: ........................... ,1t1.L).1tn., .................................................. Phone No:.... ... 7..'t!i.3........................................
Facility Contact:
Title:
Phone No:
Mailing Address:....... old ... C'%k,P....... ?J................................................. ...... iS4lX..... 41.1.1.i.... iV.l191 ..................................... 11.W.51 ..........
Onsite Representative:..............�1G.a.........A Integratr:......i.................................. th. .
............................................................
Certified Operator;............................................................................................................... Operator Certification Number .........................................
Location of Farm:
Latitude 0' = ' =11 Longitude =• =` "
Swine Capacity Population Poultry Capacity Population Cattle
I❑ Wean to Feeder ❑ La e I ❑ Dairy
Feeder to Finish Z4Q Non -Layer ❑Non-Dair
❑ Farcow to Wean
❑ Farcow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated Flow in gal/min? yA
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 1@ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require A Yes ® No
maintenance/improvement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number: — 3
t1
S. Are there lagoons or storage ponds on site which need to be properly cluseV
❑ Yes
[A No
Structures (Loons 11olding Ponds, Flush Pits. etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: .............................................................................................................................................
......................................................................
Freeboard(ft): ................................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
Q,No
11. is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
CO No
12. Do any of the structures need maintenance/improvement?
❑ Yes
® No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
00 No
Waste Application
14. is there physical evidence of over application?
❑Yes
A No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
��
15. Crop type ................... . CrhV k................. $0nu. ..... ., i-ru,...............................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 12 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
or Certified or Permitted Facilities-
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
244. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0: No. violatiohs' ,or' dericiencies' were: notied•during this;visit.:.Y.ou,will �kei ve, nti further,
comes'pbodence iib:ottt this:visiL, ' •' "
❑ Yes M No
Yes ❑ No
❑ Yes M No
❑ Yes M No
❑ Yes (9No
Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
❑ Yes EN No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any outer comments.
UW dz%win s of facillty to better explain situations. (use additional pages as necessary)*.
+.h
M$- gernnV�o. si�irlr} be irn.�„rover) � Y'f�U�+� �1et,r�S.
,��. �'tiEit.�.-r •wee � n �'t,l � � sl��� be- rtt�o ve �. 4 Lx' S r or Sl�oc� be 1 �' S P V k nuyh6v- UJ'i. Corrut MN
'e�vl�' �Or � W�, ca.f tvf�� � � bh rte— "Stk SL'* S6.0 be-
'� 4
li�t)�C�LI. v t1t.� IM-Z or` c� �OnYth� takS: S. (lrri QCton h�wp Shou�d be. ire �L CCry .
hgtji co, ot` d.Vc (e' ,r Srv�k r�M(y` Shovjj at~ Ox e ,2d, 1
7/25/97
....... W.
Reviewer/Inspector Name s
Reviewer/Inspector Signature: r Date:

0 DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection
® Routine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 3 i/111
Facility Number
Time of Inspection : o 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status, ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Ins section includes travel and rocessin
❑ Not Operational Date Last Operated : ....... .................................. _................. .................................................................................p......
FarmName: S� Lxi.r...:......................................... ..La.r�.................................. ..W.J... .1.......
Land Owner Name: ........... .................................. Phone No: ... L.A..I.4J... ..�.!,,�.�r..'.�.7.`� ..........................
FacilityConetact:.................................................................................. Title:................................................ Phone No:
MailingAddress:......... .y. ......cl.........................................F..n.5...... 1.ti...t..fJ .............................. ... s� ..
Onsite Representative: .1.0..... 1~.0 ^^.!.. w�.T �.ct,^t.%....� c - h!..r............ Integrator:......i....................................................
p L�n.i.�.r..................... p �... . Certified Operator: ........:......................... ...................., Operator Certification Numher:...... � �t.Gt.!P...................
Location of Farm:
�n.....nx s s .....s..i c►,R�.....:A........P,...I..I..Q.t7 t....� i-taa t^ 9�...... .(1.t.. Nr,n.........,3L..al. a......an.............. 4
....1S &I. R 0Z............................ ......................................................................... ............... 2
Latitude a ©" Longitude ®• ®3' '
Type of u eration ana liesign capacity
Swine Design. Current Design Current Design Current
Ca acl Population Poultry Capacity o ulation Catty Candeltv Po ulation .
Wean to Fceder ❑ Layer 10 Da'
Feeder to Finish ❑ Non -Layer ❑ Non -Dal
Farrow to Wean
Farrow to Feeder Total Design Capacity 74
10 Farrow to Finish Total SSLW 33 D 7
❑ Other
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present
❑ Lagoon Area I0 Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes I.No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ®.No
c. If discharge is observed, what is the estimated flow in go.lhnin? Al J -Q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes AR No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 5a Yes NNo
4/34/9 7 maintenance/improvement?
Continued on back

Facility Number: X.i....... — 2-S
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
AR No
Structures
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Z No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
....... z............. ............................ ............................ ............................ ............................
............................
10. Is seepage observed from any of the structures?
❑ Yes
8j No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
®No
12. Do any of the structures need maintenance/improvement?
RYes
❑ 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 Auolication
14. is there physical evidence of over application?
❑ Yes
El No
(If in excess of``WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.K�..nr.rrr�rf.n.r..ci�rrA.....�+�an.s�...��.:ci.L.r............................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
2 No
17. Does the facility have a lack of adequate acreage for land application?
RYes
❑ No
18. Does the receiving crop need improvement?
KYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
❑ Yes
O No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
❑ Yes
® No
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
91 No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
24. Does record keeping need improvement?
9 Yes
❑ No
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):
5 • f 17 . 0 � avu,.�a r d.o r� ►^-� $ � r'r � q 0. d w pip , � � { u � n i g,t�p ''�- C�,r.t� Q
M.o i r-a knr jr4 t
cn s �..-.-. t--t-d. t
tv'-c ot.e.ru. l ,r- v..o itia�-� 2...�0 v' L► V_ t &
S I i­j %L {-; d " -o V^A [ " 0.
lZ• w �- w o .1 (0 W a 0, X 1r, o( P_
+ g u►� -R-d.e �, a •e-d �Eo 6 t� ! a i S p .-�. r . P V4 r . LJ
a Lk 5'i e-e i�o 5 0 i p -w �s� 5 i .f w i Y-k a C +�2.,r ►"� co r� {
v ,re -t-itia &A-1 .a, W-, i .+tiw L,t ra�►^e. v�-e..,� o v� 2..! �+-o t-s.e
t "t^A w a S 4.v ;
Reviewer/Inspector Name + A. -115 tom_ '., t , l�..i. r I�) i. I
Ole_t.
Reviewer/Inspector Signature:
Date:
ce. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97