310372_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

za
Type of Visit: ��ompl�pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ('Routine O Complaint 0 Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: p ; Departure Time: /2 County:--�
Farm Name: , rtic,_ i1 S' �2� Owner Email:
Owner Name: r—y�,�w�Cu�!!!1;✓;n� Phone:
Mailing Address:
Region:
LCJ 1�'O
Physical Address:
Facility Contact: �/'�.-���-.� �; �g� Title: �tJ`7 y/— Phone:
Onsite Representative: Integrator:�i��/'
Certified Operator: � s?� Certification Number: y�ID
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design C►urrent Design Current Design
Swine Capacity Pop. Wet Poul#ry Capacity Pop. Cattle Capacity
Wean to Finish Layer DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish D
DairyHeifer
DesiEEJ
gn Current D Cow
D . P,oul Ca aci P,o Non -Dairy
La ers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
ke s
ke Poults
Hter
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? R
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes KNo
❑ Yes Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 ..4� 1.."„A IV_1
21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D�_No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): yr)
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
R] 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?
J,Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [A_j�Io ❑ 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): Z/yr4 `�/fiY/STrd
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LM�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CO_No
❑ NA
❑ NE
1'6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1�§,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[KNo
❑ 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: / - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JANo ❑ NA ❑ NE
w•
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ig No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[0 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
[a 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
Callo
❑ 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
RNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
33. Did the Revi ewer/] nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®.No
❑ NA
❑ NE
Comments (refer to qutton #)Explainany=YES answers and/or,.any atlditvnatrecomndailons or any Qtpercomments.
Use drawuags oifactl�tyto better;explain sltnations(nse;addtional pages as necessary)..`.
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
i� •
Phone:
Date: �—�, _j 2
21412015

FS
type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q'houtine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rl��%� Arrival Time: ® Departure Time: �County: Region:
Farm Name: t"`�"''' , Owner Email:
�G
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C•apae'rty Pop.
Wean to Finish
Design Current Design C•nrrent
Wet Poultry Capacity Pop, Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Dry Cow
D , l;oult , Ca aci P,o Non -Da'
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
IPullets
Other
Other JELJOthcr
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes ❑ No
❑ Yes J;TNo
❑ Yes 2 No
❑ Yes O No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

J
Facility Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [D"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 1-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yeso
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes []'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,ETNo
❑ 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,,r]-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -f5No
❑ 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 M`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .�![_No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J Rio ❑ NA ❑ NE .
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ 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 J2'RTo ❑ 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EfrNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IFacKity Number: 3 - Z jDate of Ins ection: Z 6
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 4�:rNo
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ;],No
❑ Yes T�' o
❑ Yes r�No
❑ Yes P No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes j2fNo [] NA ❑ NE
❑ Yes EyNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 'Fj No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo 0 NA ❑ NE
Comments (refer toquestion#): Explain any YES answers and/or any additional recommendations or any other cotnments
Use drawings of facility to better explain situations (use additional -pages 'as necessary).
f- lizards ball (PICe/ktf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: hc
JF
21412015

(Type of Visit: A C � pliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Sd I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: o"- Arrival Time: /,3 a U Departure Time: County: Lh Region: L✓
Farm Name: k)j & h < Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: �rS...
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: M /45
Certification Number: qe)1 `f 3 c
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
I Layer I
Design
Capacity
Current
Pop.
'
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
iNon-Layer I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
La ers
Design
Ca aci
P,o
Dry Cow
Non-Dai
Beef Stocker
Gilts
I
INon-Lavers
Beef Feeder
Boars
I
jPullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes No ❑ NA ❑ NE
[:]Yes
0 No
❑ NA
❑ NE
[:]Yes
�►No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ''No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes 0jNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes eNo ❑ NA ❑ NE
of the State other than from a discharge?
I
Page 1 of 3 T 21412014 Continued

Facility Number: - Date of Inspection: v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
,,allo
a. If yes, is waste level into the structural freeboard? ❑ Yes 'P'No
❑NA ❑NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes En -No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
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 _J:j No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J2-No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f�' [D'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 coo ❑ 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.,,0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes j[;jNo ❑ 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? T
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Ycs �o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check ❑ Yes Z'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 �'N1
❑ 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? 0 Yes jZfNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes oNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
D NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: jDate of Inspection:
2A. vid `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 P No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 'PTNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes C2-No ❑ NA ❑ NE
[:]Yes [^No ❑ NA ❑ NE
[:]Yes [;?'No ❑ NA ❑ NE
❑ Yes �"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW T? ❑ Yes PTNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes WNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional -recommendations. ouany other comments.,.
Use drawings of facility to better explain situations (useadditional pages as necessary).
f e card 3 ec k
q'l J.11
3110 9,6b
Reviewerlinspector Name: 1 _) ��72 _ T Phone: 126 ri2 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G'<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County:
Farm Name. „��— �O}i� repi Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
I I
Wet Ponitry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle C►apacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I
INon-Layer
Feeder to Finish -
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,o_ult .
Layers
Design
Ca aci
Current
ON
P,o ,
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes oEj No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes -fTNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ,RrT�o ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [;'No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes_.o No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: Date of inspection:
._
Waste Collection & Treatment
4. Is ,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes]?�No ❑ NA ❑ NE
(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 ZNo ❑ 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 {� o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes 7No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ONo
❑ 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 �Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ,�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [2iNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes �Vo
❑ 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 i/�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0'"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2!rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
d 0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes 21 No ❑ NA ❑ NE
Comments (refer to question #t): Explain any YES answers and/or any additional recommendations or'anyother comments:
Use drawings of facility to better explain situations (use additional pages as necessarv).
-- CFO
pb f13 t, lg
4 32
i3e. sure 1L � slcc��
SP3)N / 3y SiniO% -Grc aolU
fal 11V z_ 2� � ��r.�-� r ►'e��d s lGok JrerA
Reviewer/Inspector Name:
Reviewer/Inspector Signature: �
Page 3 of 3
Phone:/
Date: o
zalb�./
21412014

t-,
f
Fai. .Number
',�V1Slon of�Water.Quality° ?
-b Division of Soil and~Water;Conser'vehdr
Q_ Other,Agency #'
Type of Visit,,J@'tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,-O'kOutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /ice Departure Time: County: Region:
Farm Name: nAlefmOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 c = 6 = Longitude: = ° = , a «
'"Design Current :Design"' Current �`�' Design, Current
5win 'Capacity °Population, Wet Poultry`"Caparity:Popalatio 'Cattle �. .•,.,'Capacity�:Population
❑ Wean to Finish
w' ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
e. ❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
- ;< g
w�ti El Dairy Heifer
❑ Farrow to Wean
W^�'"� ❑ D Cow
❑ Farrow to Feeder
17r �Ptiult v
❑ Non -Dairy
❑ Farrow to Finish
�.
1_ ❑ Beef Stocker
' ❑ Gilts
❑ Beef Feeder
❑ Boars
'�
, ❑ Beef Brood Cowl
Other""
.
❑ Other
NuMberof Structures:
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 �Q No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes l//111 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
Page
❑ Yes
� No
❑ NA
❑ NE
1 of 3 I2/28/04 Continued

Fapflity Number: Date of Inspection: Z
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �v
5. Are there any immediate threats totheintegrity 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
1P 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
[t No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
.� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 [:]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 ❑ 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 21412011 Continued

_71- 3 72,
Facility Number: jDate of Inspection:
24-Did the facility fail to calf rate waste application equipment as required by the permi . ❑ Yes grNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] NA ❑ NE
❑ NA ❑ NE
❑ 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 A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P, 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:
❑ Yes �No
❑ Yes PrNo
❑ Yes 'd No
❑ Yes J"""' No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes r'?( No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes bf No ❑ NA ❑ NE
Comments (refer to question 4- Explain any YES answers and/or any additional recommendations.or any other comments. —
Use drawings of facility to better explain situations (use additional pages as necessary).
l ®ti
� N + C� 1J6rd�r• s -�
7 z7�Jz 1<6� �
c�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /07�����
Date; 3 'Z
/412011

Date of Visit: Arrival Time: , eparture Time: County Region:
ye
Farm Name:A4I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Iiii it, W,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Capacity Pop: Wet Poultry @apacity Pop.
C*attle Capacity Pop.
Finish Layer
rHF-eeder
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
DairyKeifer
ow to Wean
Design Current
D Cow
row to Feeder
1) . Paint . Ca aci P,o
Non -Dairy
to Finish
La ers
Beef Stocker
s
HPullets
Non -La ers
Beef Feeder
!Farrow
rs
Beef Brood Cow
Turke s
er
Turke Poults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes
d No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
6o'
❑ NA
❑ NE
Page I of 3
21412011 Contid t

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage £apacity (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 p'flo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ 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
P"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
PNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['algo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
;2"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FZ]—No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;�No ❑ NA ❑ NE
the appropriate box. T
❑WUP ❑Checklists []Design [] Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J�f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. Io the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Pa -No
the appropriate box(es) below. 7�
❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
52No
❑ NA
❑ NE
[]Yes
r—
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes ;2No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes &No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E`No ❑ NA
'UNo
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other...comments.
.
Use drawings of facility to better ezolain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
2olX
' �13e surer +6 �u�
la ClkLn 0 �
C
qvy d'C— dFre-L r '5 h r_epr S t✓
Ut�kkt (eC0rPs.
DQ say ( -Coc e�-- I I ,
Phone; 7e'6 `T
Date: 2 Z l
2,141201

- Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Lk<outine O Complaint O Follow up O Referral O Emergency O Other ElDenied Access
Date of Visit: 2 / Arrival Time: v % Departure Time: County.� Region:
Farm Name: r Owner Email:
Owner Name: „ .- _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 ' = Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�. ❑ La er
II ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifef
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Coyd
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: =.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
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 2<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes 'No ❑ NA
El NE
,
El Yes 0I No ❑ NA
❑ NE
❑ Yes P `"o ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection d! !Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V1 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 Zj No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes OfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZT No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
01 No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments refer to uestion # Explain an 'YES answers and/or an . reeomutendations or an ether com ents _
�, Q ) p Y y... Y
a y �..
Use drarvings'of facility to better explain situations {use"addEti©nal pages as necessary.) _ '
p ?f��/yj /w t- _�Crc>r
Reviewer/Inspector Name Phone: )—ZK7 .3A
Reviewer/Inspector Signature: Date:
Page 2 of 3
Continued

Facility Number: 7j Date of Inspection /I 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;2'No ❑ 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 VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
VTYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E
El NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[?j'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _CWoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 O Arrival Time: C4�5i�parture Time: County: -1 Region:
Farm Name:
Owner Email:
of 7-
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: P n
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator
Operator Certi icadon Number:
Back-up Certification Number:
Latitude: 0 0 ❑ g ❑61 Longitude: = ° 0 d = «
Design Current
urrent
©esiIN,
Design Current
Swine Capacity Population
Wet Poultry Capaulation
Fiffil I= Capacity Population
❑ Wean to Finish
10 Layer
I
❑ Dairy Cow
❑ Wean to Feeder 1110
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 'EkAo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes KNo
❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - -- Date of Inspection
may.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
)21,qo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
&No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
///
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
L2 Fqo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
'P
❑ 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
�Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[INA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/❑►No
Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P<o
❑ NA
❑ NE
ReviewerAnspector Name Phone: - Q^
Reviewer/Inspector Signature: Date: Q
rage -, of 3 L,ununuea

.facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes P<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PTNo ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design [:3 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis [I Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ko
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PTo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
[]NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L�'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
�lo
❑ 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
;2rNo
❑ 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
P-'Ko
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�to
❑ NA
❑ NE
Add itionalCorninents and/or Drawtags ,..� „.
-31
El
Page 3 of 3 12128104

Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit g(Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
% d Arrival Time: //: Q 6
Departure Time: County:
Region: �/J#Z4
Farm Name:
_ �A/%ell OrdzjA Z7ei-m Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J_e ire_0 r.
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
i, Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o=' = Longitude: 0 e 0 l
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
;Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other If
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
DischaEges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
E]Dry
Cow
❑
Non -Dairy
❑
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 [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
lNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 :3� Date of Inspection %1 G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l Qr r
Observed Freeboard (in): O-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes UfNo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes f R I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PrNo ❑ 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 5�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5dNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) e—r G. C!/ /-? O J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
O 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 acre determination`
❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElV Yes
No
❑ NA
❑ NE
mmeats (refer to question•#) Explain any YES=answers4and/or.any,p
Reviewer/inspector Name I /< phone: llr/- 7/ 6
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box_ ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �a­No ❑ 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
4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
gNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
;�'NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�3No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'�?No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'PTNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�Vo
❑ NA
❑ NE
Additional Comments and/or Drawings:. -
,1y ,,, ,k. /YS/s,
,r Pjerc se, s e w .501011 5K Q "" s awn
Cal., Jau m O _ h kj x a ,�- t try * a0 rPc ru >L
OVe & 14Cql-,. ( '�
�-arczer 1>4
12128104

IType of Visit O'Compliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit �"outine O Complaint O Follow up O Emergency Notfcation O Other ❑ Denied Access
Facility Number 3 Date of Visit: d Titre: ,[
O Not Operational O Below Threshold
FPermitted Certified 13 Conditionally Certified` © Registered Date Last Operated or AbovePold•
Farm Name: rJ'_.+ i . l �. �L'� i�S IC=Yk� _ County:. .r, }.....__ . _ ..» ..
Owner Name:
?Mailing Address:
Facility Contact: Title:..__.
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No: _
Integrator: __," ! LI � .. _ _ . _...
Operator Certification Number:......._...._......__...._..._...,
I—_� �. l
ne ❑ Poultry ❑ Cattle © Horse Latitude Longitude �• �° Du
Discbares & StreamImpa
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 00No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1110
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0&0
Struct I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: _ _._------------------- -
Freeboard (inches):
12112103 Continued

Faeility Number: — Date of Inspection S �-
J 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 ❑ Yes XNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes XNO
elevation marldngs?
Waste AoNication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 90
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Co and/or Zinc
12. Crop type rdL
S'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PrNo
b) Does the facility need a wettable acre determination? ❑ Yes PNo
c) This facility is pended for a wettable acre determination? ❑ Yes RNo
15. Does the receiving crop need improvement? ❑ Yes ;;?No
16. Is there a lack of adequate waste application equipment? ❑ Yes R No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ;�No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes f a'N0
Air Quality representative immediately. /
s
�erc� lt< �rrrn �
ty,
Reviewer/Inspector Name
Reviewerftgmctor Signature:
❑ Field Copy ❑ Final Notes
Date:
12112103 / f Con inued

Facility Number: Date of Inspection � G'
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes (No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo
❑ 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
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ YestVN
o
28. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
/No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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 Fora
12112103

s ,sj;Divrston
of Water Qualrty -
? �
@ tvisron of Soil and Water Conseiiation '
n=
@Other Agency ti
�-
Type of Visit Z Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: j$ 20 Time: 13 z-S Printed on: 7/21/2000
'�( 372
--- @ Not Operational O Below Threshold
,Zrpertnitted ❑ Certified ©! Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: f ��OLJr1 �a� �^'1 Countv:..Ptl In
.................... .......... .....................
.........-....�......•..,..........1.....................................................................................
Owner Name: u ff e �, P.w► I ... ......._.... ...................-............................-..........-....... Phone No:
........
Facility Contact:
?Mailing Address:
Title: ................................................................ Phone No:........
Onsite Representative: r>rell /'pW''�
may
..................................................................I....... Integrator: •................. t' ---...-
Certified Operator: ................................................... •••, Operator Certification Number: • .-
Location of Farm:
I
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C�` 0�� Longitude
Desi ..
r gn
Current
Design Current
gn
Deli 9n Current
Capacitytioo
Po ulatian PoultryPo`
Capacity Population ttle.a
Wean to Feeder
❑Layer
❑Dairy
Feeder to Finish
Non -Layer] ❑Nan -Dairy
;3 Farrow to Wean
Farrow to Feeder
❑Outer
' Farrow to Finish
Total Design Capacity
Gilts
Boars
Total SSLV
H� f p-
JEI
Subsurface Drains Present 110 Lag-(m Area
❑ Spray Field Area
_
oliimg Porrds f Soltd Traps
;.
No Liquid Waste Management System
z
1
..
?, �+-_'`-. ,!.:e.,a. .,•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ETNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ONo
c. If discharge is observed. what is the estimated flow in gal/ruin? "(g
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes )dNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PINo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier. ............... I .................... ....................................
Freeboard (inches): 3 (o
5/00 Continued on back

Facility.Number: ,3 j —372 1 Date of Inspection U SO; 2,3
5.. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes J214o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes EfNo
(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 maintenancerimprovement?
❑ Yes ;'No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes _.ETNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ONO
It. Is there evidence of over application? ❑ Excessive Pon+�ding ❑ PAN ❑ Hydraulic Overload
❑ Yes o
�
12. Crop type Re+�myk NA4 1_.-o-yill t�/7rairw
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettabie acre determination?
Yes ❑ No
c) This facility is pended fora 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 ONO
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONO
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 ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ZrYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,2fNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 2fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes .ETNo
23. Did Reviewer/Inspector fail to discuss review inspection with on -site representative? ❑ Yes .EfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes Ef No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes. -0'No
i 16**iol_a }Qt>js:e defeWnci s wire p d0riog this:v fit: Yop 01 >reei<iye 40 fu>j't�gC
�oriesporitieita~e a�atiti this visit. _ .. . _
14. The -Ceti, . r1Pedts a we�ct6ie a,Gres de-{e�.titIrtie�ion w;-FL. q wo,S-{e I&
%o/ate 4o ,N►���Lti,a�d 4ke "E�et -la tP bid oq
-tie wi+ a bte acres. —heed 4p k,,ve wetible gGres do1e iLGI, 4t�
�I�r+hed ►^��3�;I'�cGtffo:;s criLovi a''F1ce lz eA4ionS) Ca.v .be,
oruo�.c+'�- des; °�r,ca[ acGo.d� ".� ;n)o lie.#kt bie otcrd:S �j���+�; • ,�o:., .
19. Need 4e uJe A `iceA roe, A ' 1 s�S �r Pae� d�Ocd w r ik �''
q��/i GEt-ricer+ �✓e/i�S o:� �� R�Q 2ij . IUee�i. fG be. svre 4, 4 k-e ysR ,files
tri 4-i,-te 4a covc-• c-4 e'v9n''$ /'GC9m►ue-nd 4',k;"5 ewer`? 64 AV 5
Reviewer/Impector Name
Reviewer/Inspector Signature: Date: ( l5 71�OZ� 5�p

Facility Number: ,�J --3� Date of Inspection ! da Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes eNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J'No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes .fNo
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 P No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -ZI-No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an orDrawings:. :
15. r. ho1S �e�'� P�gK�cd 1� F1P�IGC �L r A.
ed fa►r• -�r dues ✓LO V w 4o be, Gc+rt rw v�o . --C4 WC'
f1andcq i� T)eCemb&I S"-�s Me • �CJwr► - -The records do he--f
5it oG A n � c��r 'C; 01'd o �1 S"^q 1 j 9 rcaa " .
q?of!% I Mc OLceeed; � 4o se;l 4eq resu14-s G.-C+e,� Z-J' so i
-lest Rene veA M�- 3�own �lann+ �o �n� �v�! 5a plG.sse►Z�
jn e��+y Zoo2.
t�J , G I+swC itB�d S O �iLV� ✓t! !`6� �ree b oq �d �e �w► ne0% .
F q n �,P�'� 1'�1-FD GD►2��'ad i G�S )TSG1�- :-�aL�/G d�-�Gjn✓t iG�l
4ti; s � �d 1p�ovid� dv cv,kc - joy, opt i
rccvfds-
pl e . 4�r rti.t is- Yt 4eCz41 1 ke& -
J
5100

5"_Vs
_�" � Divisiot
'.`d ,tither -'A
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for.Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number tale of Visit: Time: d0 Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
Permitted Certified ` C(onndittiionally Certified 13 Registered ' Date Last Operated or
Above Threshold: ....................
Farm Name: �_''r4:1.....,1-7�t"'t.-� County: ... 1'`.1�......................................................
.................................-•----.......----............
OwnerName: Phone No:.......................................................................................
FacilityContact............................................................................... Title:.................................. Phone No:
MailingAddress:..............................................................
Onsite Representative: __. ?- ..........
Certified Operator:
Location of Farm:
Integrator:.... ...............
Operator Certification Number:
I&
l,w
[]Swine []Poultry []Cattle []Horse Latitude 0 �' �-' Longitude a ' ="
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish 10 Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagnan Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
DischarLes & Stream Irn� a
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-nnadc? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (if yes, notifv DWQ) El Yes ❑ No
c- If dischanze is observed. what is the estimated flow in gal/min?
d. Dees 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 ,t;rNo
3. Were there any adverse impacts or potential adverse impacts to (lie Waters of the State other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
StrUCtUrc I Structure 2 Structnrc ? Structure 4 Structure 5 Structure 6
Identifier: ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: -3 Date of Inspection Printed on.• 7/21/2000
''5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
VNo
(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
b(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
V No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN 'Hydraulic Overload
XYes
[:]'No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
_No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
KYes
❑ No
15. Does the receiving crop need improvement?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
AfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
1No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
b?rNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes N'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
yW afions:oi- deficiencies mere noted du itng �his:visit; Yore will reeeiye Rio urthe
comes orideizce: abouf 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):
o�l kbv 4L,Q,
VNeAe
kc
Reviewer/Inspector Name
ReviewerAnspector Signature:
Date:
5100

Fa`ility Number: — Date of Inspection C Printed on: 7/21/2000
" Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hglow ❑ 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 VNo
}
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 peimanent/temporary cover? ❑ Yes ANo
bona - Comments an or..Drawings: _
5100

13 Division of Soil and-Water•Conservatiori - Operation•Review '..;
13Division of Soil and Water Conservation - Compliance Inspection
(/
�.
ii ision of Water Quality Comphance Inspection m
d ae
atlon R'' u
O edrUther Agency. evjgw
f b.
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number y Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted Certified © Conditionally Certified © Re istered Not O erational CD1 LastOperated:jFarm Name: ...ro.W .... # _.............. U.... �.
t.LY...-r.l.....................I+�,�!v Count
Owner Name: Phone No:
Facility Contact: ...1, l..ir. Y L .... .......f..... r 0 ►.... Title: ........... 01 1ii �.......................... Phone No: ...................................................
MailingAddress: ......................................................................................... ...............j............................................................................... ............-...... ..........................
Onsite Representative:.................r.i!+............................. Integrator: ... C..................................................................
Certified Operator: ....................... ................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude ' =' Longitude ' 6 66
Swine
Design Current "_ —"Design Current _ Design Curreiat
Capacity Population Poultry Capacity Population Cattle . Capacity Population:
❑ Wean to Feeder
ELFeeder to Finish
23LLd
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number=of Lagoons ❑ ent Subsurface Drains Pres❑ Lagoon Area 0 Spray Field Area _
_ 0'
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? []Yes P(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) ❑ Ye jICNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes IRINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )krNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes kNo
Structure I Structure 2 Structure 3. Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):.....................................................................................................................................
..�........................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — 3 Z Date of I nspection
6 "Are there structures on -site which are not properly addressed and/or managed through a waste management or
'ciosurevlan?
(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
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17- Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�; NO -V atiQRs;ot- di ficlendes r�erE' noted• du Ring t;h1sMsiC - Y;ott will -receive iio; further ; ;
corres 6fideiRce.abhufth''isvisit...•.•.•.•.•.'.•.•.•.•.•.•.•.'.'.•.'... .
❑ Yes VNo
❑ Yes 91No
❑ Yes ](No
❑ Yes Dv No
❑ Yes XNo
❑ Yes;KNo
❑ Yes ZNo
❑ Yes ANo
❑ Yes J;�'No
❑ Yes No
111�Ces Y No
❑ Yes 'No
❑ Yes XLNo
❑ Yes '*%No
jxYes ❑ No
❑ Yes gNo
[]Yes j(No
❑ Yes XNo
❑ Yes A. No
El Yes OdNo
❑ Yes WNo
Comments (refer to gueshon #}:. Explain any YES. ansrveirs and/or"any recarnmendations or an- other comments.
Use drawings of faeihty to better explain situations. (useAadditianal"pages4s necessary) -
IS)�fa I S �d C�»r c &V -Ae1� �tW e✓ter Sj� et 4 ,fie ;� ,ace
i1 B C�e14 j nRk 4 -�-eZd ��r �-1- app�,
S/-
( AeePLs 40 he 4 = --r.�►-ram �/
�_WVQIC11114o t Ae
l
Reviewer/Inspector Name
Reviewer/Inspector Signature: <1 JI J,�+ i , t dj, Date: Z2. — 47 cy
3/23/99

Facility Number: 3 -- 37 Date of Inspection
Odor Issues
26. Does the discharg6 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 )CNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesANo
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 &To
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes X] No
3123199

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
1$2 Routine 0 Complaint 0 Follow-up of DNVQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 7 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Registered Certified 0 Applied for Permit E3Permitted JE3 Not Operational Date Last Operated:..••,,,,.,,,.,.
Farm Name: ................. jeYrv.ki11....... ... a vr�{....._��+..: ha ............... .................._.:....... County:........j�1 �ia^.............. _................ ...... ... :..:.......
Owner Name: ................................VC I[f.R �........ f 7f Cl lr............................................. Phone No: ..... `11i...�9.-...Z�j_............. _..................
FacilityContact: .................. . .......................................................... Title: ..... _....... _................. _............................. Phone No:
MailingAddress: ..... L_1.�........ Ljg.J.15...... QiYG.$.:.....R............................ ................ _Kuse...... ....... _....... ................ ... Z4.4.5F...
Onsite Representative:................_]CY.f..2..1I......... .............................._........... Integrator: ...... N1tlrj?........................................................
Certified Operator* :................................... _............. .................. ......................... - .......... :..... Operator Certificationulumber:......... _............. _...............
Location of Farm:
Latitude Longitude �• �' �"
Current'
Capacity
-. < x „-` , Design 4Current ':-'sykDeSlgli' Curree'
Poptilahon
t . - ,�
, Population
Pou@ry. " „Capacity. "Cattier - 1,Papiicitfkpoiuulation
Wean to
_
Feeder
Feeder to Finish
❑ -
(� Z
El Farrow to Wean
El Farrow to Feeder
[I Farrow to Finish
❑ Gilts
[I Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IX 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 convevance man-made? ❑ Yes Q No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ($No
c. If discharge is observed, what is the estimated flow in-aVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Ed No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [4 No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes (� No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IX No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-made? ❑ Yes Q No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ($No
c. If discharge is observed, what is the estimated flow in-aVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes 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 Ed No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [4 No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes (� No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

Facility Number: 3 — 3-72-
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures 11,aQoons,lloldine Ponds, Flush Pits, et
9. Is storage capacity (freeboard plus storm storage) less than adequate?
- Structure 1 Structure 2 Structure 3 Structure 4 Structure. 5
Identifier:
Freeboard(h):..... ...... ...3.,S............ ....................... .........
.
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancetimprovement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............ �Z mlij ..................... ........................... .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations•or. tleFiciencies.were,no- ted-during this:visit. Yodw'ill re'ceive-no further
corresp6itdehte. about -this. visit::.:
❑ Yes
Q'No
❑ Yes
CO No
Structure 6
...............................
❑ Yes
9 No
❑ Yes
V,No
PaYes
❑ No
❑ Yes
No
❑ Yes
[b No
❑ Yes
[% No
❑ Yes
M No
Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
No
&Yes
❑ No
❑ Yes No
Yes ❑ No
Yes ❑ No
I L 1 A?U 6'ML use (I o� ta��
s ia� t)JJ txJ Yvwwed a*' 5p>7~✓y eJ -fie eoAiVV ( WCVr)&,
(� &rrA J o-
-GkooM be 4,, 5;rvVfJ i e. 5!1 YaU zwvs
#Z.
evA&"ceS ihav)d
6e CJCtlL�t�lU1;. v
lbs'ac, AvrK6er 6m 4L tju�,
1-� r2S Mtrwr
OJC4� � [; T7Uh 0 C
Ytl"c' Sci. if-, S�rcj
*-Z. 451�51AC - Ni e_ t -qjp W"A_
4-
SV�]'�ac� pVL►a ���Cafi�t�
�vc„— iu Stv�eit c3Y�,c. .�c.�ce
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: ... / , /,A_ _ Date:

Routine O Complaint O Follow-up of DW ins ection O Follow-up of DSWC review O Other
Date of Inspection�
Facility Number �-�-~�
Time of Inspection ljt? 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 I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..... .......... ._......
Farm Name: L3CL.�Ixii k�.?!�..... i u i1�1.... ..._ _.. .......
Land Owner Name: _.. L1e YLt �.�..., _. .L71L.i!L .... r.... _....
Countyt ",2LIZ16..........__......_.... M11.I-IS L
Phone No: ._�3 .... ..._.... . ......._..... .....
Facility Conctact:...__.............. _ .... .............. Title: . Phone No:
Mailing Address: _ 7.,i _. �i s..... --- . ! 4 ..... _........... _...... ..... i .... `[. � ...
1 ' ' .................. .....
Onsite Representative:..... .. _...._ Y .... Integrator:...__
Certified Operator: _:. ..... .. �.� � �!1.. _... .. _ .... _ ... Operator Certification Number: _x.h.7E
Location of Farm:
,.$n._.sa�.�.._.:.._..._...ii. :.. .... ... .. f.....a.�..A.x.�.�E:x.M�.. +.....�1rx.x....�rS.......scu.s...C..f.... ...:�.L'A.. .. � 4
.s .� a:�.... _sue. -�. l..:..... ........ --... _.......... .... --... .......... _.... ................... ......................... ....... ..........
_....._._ a
Latitude ®• ®4 � u Longitude ©• ©4 64
Type of Operation and Design Capacity
�Design Current �" Design v, Current�Design� Current.
. Pou1 "r tie-,1
Sw�ne�n Ca acr Po ulahon :. a ,. ttY .,, . Ca acePo dlatEon ',..,q=-Po ulat�on•
❑ Wean to Feeder Layer A ❑ Dairy
Feeder to Finish ❑Non La er ❑Non -Da
Farrow to Weans
Farrow to Feeder Total Design Capacity a,w 1. z-
Farrow to Finish +
.. �....s._�: ::..rv..-..e.,..: _n ��
Other SSW � A 4w
a
_ _.
' Nuinber of Lag ns IHaI g Ponders ❑ Subsurface Drains Present ME
' ❑Spray Field Area r
goon Area
....
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes JK No
2. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes q No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes B,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 IN No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes FjNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JKNo
S. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
4/30/97 maintenancelimprovement? Continued on back

Facility Number:.... ..L
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
9. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes EZNo
❑ Yes 13-No
❑ Yes IR No
❑ Yes KNo
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type llidw ...... ..Yy`Sik...��, ..... ....... ...._..... ................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
ninents (refer to `gpestron�#) Explain any YES answers` and/or:any recol mc.ndatron
5. D i � c � ... Ft ,...,, +. S p �. � i+., S 4..�w. � � � �� '^ e. �' t � � 6 a �-'►.
2• e. e a "—a—I o ! c.-q 00 w a f I
(0 0� o a t �—•�. s P 6 �ii-a ,r-t
t s ID W
Q t c�4 c_ t v O v% t_%) S G Go —dL f
❑ Yes MNo
❑ Yes JE!�No
Yes ❑ No
❑ Yes ffNo
❑ Yes J.No
❑ Yes
ff No
❑ Yes
ELNo
❑ Yes
9No
❑ Yes
® No
❑ Yes
2LNo
❑ Yes
aNO
❑ Yes
JKNo
❑ Yes
4RI No
® Yes
❑ No
7.
r--E_cr0 .44
Reviewer/Inspector Name tea' F m
Reviewer/Inspector Signature: Date: ' 17 q x
T'T —
cc: Division of Water Quality, Water Quality Section. Facility Assessment Unnit 4/30/97

Physical Address/Location: t*-'
t99(o Cr
Site Requires Immediate Attention:
Facility No. - 22 -Z,)
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
i DATE: 9-3 , 1995
Time: _ 4.00 ;�,
Farm Name/Owner: elrre out
Mailing Address: 652 Z845 $
County: r- Z'Zq Wells —4. 6ry ev
Integrator: 14urph y, _ _ Phone:
On Site Representative: Phone: 2 ' Z 35 2
r 5 - Cra55 19 H, 1 eft-- on 1141, o n
Type of Operation: Swine 1/ Poultry Cattle Pn 1 Sh
Design Capacity: 2445 Number of Animals on Site: 244 S _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ° _'�D - 16 _" Longitude: -11 ° S7 ` 4� Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: —A- Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes No
Is adequate land available for spray? Yes or No Is the cover crop adequate? es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o Na
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 4q;) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No Z
Additional Comments:
Inspector Name
A0___
Signature
r_..r.1
0
cc: Facility Assessment Unit Use Attachments if Needed.