310378_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: O Co ance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint 0 Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time: r)3 County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: � i + n
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: ! I f
Certification Number:
Longitude:
Design Current Design Cnrrent
Sw' a Capacity Pop. Wet Poultry Capacity Pop.
ean to Finish Z 23 Qo Layer
Design Current
Cat#!e Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
[DairyHeifer
Farrow to Wean
Design Current
Di . P,oult . Ca aci P,o
Layers ers
D Cow
Farrow to Feeder
Non -Daily
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Puuets
Other
Beef Brood Cow
Other
L_L(Lher
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 [2'1Vo❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ][ ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 31 - Date of Ins ection:
Waste Collection & Treatment
4. Is forage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
2.5—
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E jn<o ❑ 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 ❑ Ye 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 Ej No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E3 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? T
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 A�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ErNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V'�'4'0 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check t e*appropriate box below. �s [:]No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and i " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UKo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection:
24. Did the Acility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
ONo ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No Q'PAB❑ 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❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:)Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,� NA ❑ NE
33. Did the ReviewerlInspector 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 PXo- ❑ NA ❑ NE
Comments (refer to gaestron #) � Explain any YES answers and/or any additional rec€ rnmendations,or any, othercomments.
(Isedra*in s of facilr =, '"tp better ex lain situahons; use acl rtiousl° pages as necessa" 1 °
't 'ic 7,
on e) S, Je-- �1 A I.-
C_ 4
5
Reviewer/Inspector Name:
CrPX 0f,"5""yInc-A
Phone: T 1 a 7 F` 73ay
Reviewer/inspector Signature: L_
Page 3 of 3
Date:
21412015

East of Chinquapin. On south side of
SR 1817 approx. 3.5 miles East of
V - MURPHY SOUTH 31 1 378 Kina Pen Thomas King 2723 1 Wean to Finish Murphy 910.285-2588 Hwy 111. S grower # 8',

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral Q Emergency Q Other p Denied Access}}
Date of Visit: 4 2 ZI (1 Arrival Time: Departure Time: 0 County: Region: Vy
Farm Name: {• Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: W6(J 4't Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry3 KQ0,apacity
Layer
Design
Current
Pop.
Design Current
Cattle C►a).acity Pop.
airy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
D . l;ouIt .
JLners
Non -Lavers
Desigu
Ca act
Current
Po ,
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
(
Dry Cow
Non -Dairy
Beef Stocker
U
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Dther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 41 No ❑ NA ❑ NE
❑ Yes ❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA. ❑ NE
of the State other than from ad ischarge?
Page I of 3
21412015 Continued

[Facility mber: - 1 Date of Inspection: 12
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
'❑ No
❑ NA
0 NE
waste management or closure plan?
i
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 MNE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA FkNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) 77��
❑ PAN ❑ PAN > 10% or t0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes ❑ No
❑ NA KNE
❑ NA L NE
❑ NA NE
❑ Yes
❑ No
❑ NA
1�1 NE
❑ Yes
❑ No
❑ NA
t? NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA [7QNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA NE
YNI
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ® NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA 'NE
Page 2 of 3
21412015 Continued

' l
Facility Ai In - Date of Inspection:
-- 1
24aDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA Q4gE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [] No ❑ NA , NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
�] Yes
❑ No
❑ NA
E]�E
❑ Yes
❑ No
❑ NA
[V NE
❑ Yes ❑ No ❑ NA NE
f�
❑ Yes [:]No ❑ NA NE
❑ Yes ❑ No ❑ NA Q(NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ 'No
34. Does the facility require a follow-up visit by the same agency? [kYes ❑ No
❑ NA NE
❑ NA
MNE
❑ NA
[�CNE
❑ NA
❑ NE
3ornm6nts-refer to question #) Explain;any YE&answecs and/or any additional recommendations or any otherrl odiineuts
�. .. t „ , . �k � 5� � .
1se,dra�vmgs of facility to better ex lain situations" use addEt�o©al pages as lnecessa_ E,. �,
p ( ry) .
4u src4Nzn
Y�f p u 4%1-c rn 2P"� G1 S • VIS GV MA S S �- i tf e, w 1
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(Dw��cj,d iit�� a�-4w eyA -41u_ rdod �1-t& ywjt �a)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �i(1)- 111167- -713 21
Date:
11,1
21412015

Type of Visit: m Copliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency Q Other p Denied Access
Date of Visit: j 21 Arrival Time:, Departure Time: County:CV Region: Uv
1
Farm Name: VA Owner Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �1 r Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poul#ry Capacity Pop. Cattle
Wean to Finish I 11-ayer Dairy Cow
Design Curren#
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D . P■oul Ca aci P,o . Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts
Non -Layers
Beef Feeder
13oars
Pullets
Beef Brood Cow
11111
Other
Other
Turkeys
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M_No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes [:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
[] NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fpcili :lumber: - "j Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes I�1 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 �(No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes �9 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 [�1VE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.) 77��
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
[] NA
WNE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
❑ No
❑ NA
[1NE
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
t�rNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[)INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
OkNE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [—]No [] NA N NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No ❑ NA NE
Page 2 of 3 21412015 Continued

Fiteility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:]No ❑ NA l[\NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA TqNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-comp]iant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No [] NA [)(NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [!4 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[] No
❑ NA
NE
❑Yes
❑No
DNA
NE
0 Yes ❑ No ❑ NA ONE
[:]Yes 0 No ❑ NA �q NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA N NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA kNE
34. Does the facility require a follow-up visit by the same agency? [Kyes [:]No ❑ NA ❑ NE
Comments (refer to questton#) Expliii©�any,YESuanswers and/or:any additional recomrnendations or any other comments.,'
Use`drawings offacility�to hitter explain"siituatipisr(use a�iziitio►ral pages'as2necery)
s
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Reviewer/Inspector Name: W' +) \ �Lt`"- AkZ-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qt()^_11Q0^
Date: —RJ 2A
214120I5

Ii ype or v isir: y�mpuance tnspecuon v vperanon xeview v structure r,vaivanon l.J t ecnnicai Assistance I
Reason for Visit: Q.Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: oDeparture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine CapacityPop.
Wean to Finish
Design Current Design C►arrest
Wet Poultry Capacity Pog. Cattle Capacity Pop.
I ILayer Dairy Cow
Wean to Feeder
I INon-Layer—IDaig
Calf
Feeder to Finish
Daig Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish - GC
Design Urrent D Cow
Dr. P,oui Ca aci Rio Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
ether
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2,,No ❑ NA ❑ NE
❑ Yes ;j No
❑ Yes LR'No
[:]Yes [/]']vo
❑ Yes ETNo
❑ Yes Rio
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412014 Continued

Facili Number: - Date of Ins ection: %.
Waste Collection & Treatment
4. It 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 hio ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):r%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ.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 ENo ❑ 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 ffrNo ❑ 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 �. o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PKo ❑ 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 E2-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes e'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
[:]Yes �No ❑ NA ❑ NE
❑ Yes 4n-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 12-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes RJIN4o
❑ 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 2T<o
❑ 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 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
❑ NA
❑ NE
Page 2 of 21412014 Continued

jFacHity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe ? ❑ Yes Z No
25. t the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ETNo
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 ErNo
27. Did the facility fail to securea phosphorus loss assessments (PLAT) certification? ❑ Yes UNo
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;allo
❑ 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
PNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
TT
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
;?'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[;;No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�ZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2f No
❑ NA ❑ NE
Comments (refer to question. #): Explain any YES answers and/or ;any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional naQes as necessarv).
V'J �` �J '(450. -7/b)/y 6r J�.cn�. -2 c y
Cl-o
"'11-U
, rc/"� Q ,
j d LAJ Or
2-ol) C
uFdaV1G�. 4-o use
�P
S►7'�u[( ACC -NIA .
' f GT rn
—ecoY-
�ej /,id
e
Reviewer/Inspector Name:
Reviewer/Inspector Signature: zel
Page 3 of 3
Phone:
Date:
14414

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (),Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' G parture Time: County:
Farm Name: L Owner Email:
Owner Name: � Y'cP) Phone:
Mailing Address:
Physical Address:
Facility Contact: V1!2-2:j
Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: �( (
Design Current Design
Swine Capacity Pop. Wet Pbult `ry Capacity
Wean to Finish Layer
ill
Current
Pap.
Design C•ucrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
jNon-Laycr I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
I) , P,ouI C•_a aci
ILayers
Current
P.o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
FIBeef
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E) No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of Inspection: 2. 1-3
Waste Collection & Treatment
4 -Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo
a. If yes, is waste level into the structural freeboard? ❑ Yes /W 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 12fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 'Vi 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 [Z(No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
nj ' No
❑ NA
❑ NE
18. Is there a lack,of properly operating waste application equipment?
❑ Yes
[�J'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z] 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
❑ 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
JZ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'U No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: Z
24. Did the.facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to 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 Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�] No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[� No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
116 -74-al-"77 , Axe
Z?'/ , �r aC)
)Wl-- be A C
lei?-t /'� cd�G�s rn ddca,r c
L r
Q �
h � cP
�
Reviewer/Inspector Name: ��in (�,� Phone: l
ReviewerAnspector Signature: L�� Date:
Page 3 of 3 21412 II

`V uivts�an of Water Qualityu
�SDtvtstiin of 5oil,and Water Gonservatton
Other. -.Agency :. .
e��_,_.�'". G, .c.a. ,<Y w-�.'°' ...w�:' �� fix_ "" - ^'� .�f ,� •'„�, �., * ..:,rr'�`
�Factlity�Numtier�-
�
,3 7
Type of Visit G<o-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1Departure Time: l� County: Region:
Farm Name: P 'Intle S f f Fcir-,-z, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o =1 = Longitude: [= ° = d
K Design Curren[ ; k Design Current 1��,
lafiouryCoCe
A... mC.a..- . �1pahoa
❑Wean to Finish I JEI Layer ❑ Dairy Cow
Des"ign Current
CaSwine o elation
❑ Wean to Feeder
10 Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
,.;_ :,,,, , ❑ Dairy Heifer
❑ Farrow to Wean
Dr y ..Poultry ❑ Dry Cow
❑ Farrow to Feeder
�'�" �°"�'
- Non -Dairy
❑ Farrow to Finish
❑ Layers , ❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
El Turkeys
� sac y�1�ytiF' - ..:
Oth.`er
9 .- �•wa y�;.g, .
❑ Turkey Poults
❑ Other
❑ Other Number 0 Structures:
y
777 g... ..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ,21 No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes (0 No ❑ NA
❑ NE
❑ Yes ONo ❑ NA
❑ NE
❑ Yes VNo ❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Type of Visit: QoCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QIfioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:,a4a;�= Region:
Farm Name ;J6.9 ni &'Il 4 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C>apacity Pop.
La er
MIJEMDe—sign
Cattle
Dai Cow
Capacity
Current
Pap.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Design Current
Dr. P,uuItr, C►a acity Pao ..
Layers
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any.discharge observed from any part of the operation? ❑ Yes 25"No ❑ NA, ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o
❑ YesfNo
Yeso
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Ins ection:
Waste Coilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'C:]-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 ;24No
❑ 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 ,n No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Z 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 I:j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes P°No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ;No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Ca"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E'No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes RTNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes ff 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 ,I 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 Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [7 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 perm/ ❑ Yes [�JlNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J'fVo ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes 7No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2'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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P3'No
❑ NA ❑ NE
❑ Yes ;?I'No
❑ NA ❑ NE
❑ Yes FZ�o
❑ NA ❑ NE
❑ Yes ,fNo
❑ NA ❑ NE
❑ Yes 130No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES. answers and/or any additional recommendations or any, other comments.Use drawings of facility to better explain situations (use additional pages as necessary). `we
4JH'1 AeAJ
$l8 �/ l•o w�s� a�1y�s
1 J
e aG:� ova A3111 �6 camel h- 9&f�
lao
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: O
Date: /l l
214120 l

}
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J'Ftoutine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I /.;z
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: U Departure Time: County:
, .s 16 Ll IYl Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Region:
Back-up Certification Number:
Latitude: = o = ` �" Longitude: = ° "
Design Current
FEesign
Current
Design Current
Swine Capacity Population
Wet Poultryapacity
❑ Layer
Population
Cattle Capacity Population
❑ DairyCow
❑ We to Finish
❑ We to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ ers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
N
Non -La ers
❑ Beef Stocker
Gilts
Beef Feeder
P1__1 Boars
Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
❑ Other F=
Number of Structures: 11
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L;l'No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
;�Ko
❑ Yes
EfNo
❑ NA
FINE
❑ Yes
-e No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: j 7 Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo
❑ 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 /0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ,4f 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 PNo
❑ NA ❑ NE
8. Do any of the stuctures 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 [?'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
,
ElYes ETNo o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 1bs ❑ 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 ,0"NO
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,,&No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes J2"N_ o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,090
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes T _ o
❑ NA ❑ NE
Comments refer to: question # : Explain an YES answers and/or any recommend ions ( q } p y y or any_ other comments
Use drawings of facility: to better explain situations. (use additional pages as necessary) ,
w
✓{1 fit/`��✓ G�IG����
T
Reviewer/Inspector Name - — Phone:
Reviewer/Inspector Signature: Date: y
Page 2 of 3 12/18104 ' Continued

k
Facility Number: —3 Date of Inspection �O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: v
It
Page 3 of 3 I2128104

(Type of Visit � Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 0outine O Complaint O Follow Up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Time: Departure Time: County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: >0 " 44(? /a4t,4/�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator
Operator Ce fication Number:
Back-up Certification Number:
Region:
Latitude: = o = = Longitude: [� o = d 0
if
011000610
gnt
Wet Poultry Capacity Population
Design CurrentSwineion
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Non -Layer
❑ DairyCalf
Dray Poultry
❑ La ers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Non -La Non -Layers
ElPullets
Gilts
❑ Beef Feeder
P_11_Boars
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /No ❑ NA ❑ NE
El Yes
[I No
❑NA
El NE
[I Yes
[__1 No
El NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ YesoNo ❑ NA ❑ NE
❑ Yes rJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: — t1i Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes V No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA ❑ NE
Struct}tre I Structure 2 Structure 3 Structure 4
Structure
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ONo
❑ 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 ;KNo
❑ 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
El NA ❑ NE
maintenance or improvement?
II
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;"No
❑ NA ❑ NE
maintenance/improvement?
I t . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs ❑ 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
2I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
;2No
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�^o
❑ NA
❑ NE
Reviewer/Inspector Name .. .: _ :, 1 Phone:
Reviewer/Inspector Signature: Date: L�
Page 2 of 3 121281041 Continued

` Facility Number,'31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes No El NA ❑ NE
L%
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �^o ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists [I Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA . ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;�-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FelNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�lo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;?*No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[;;^No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
JVNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
7No
❑ NA
❑ NE
Page 3 of 3 12128104

vision of Water Quality
Facility Number % O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 016ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Techni 1 Assistance
Reason for Visit 0Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: &k_Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: I Title: Phone No:
IzaZU14
Onsite Representative: §2Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Curl
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
arrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
Back-up Certification Number:
Z
Latitude: = o = ` [= " Longitude: 0 ° [� ` "
Des Ig'n` _'Current:;7`Design Current.
~> ^Wet -poultry Capacity Population Cattle ` '-tapacityPopulation
❑ La er
`] ❑ Non -Layer
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
El No
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NF
12128104 Continued

FacilityNumber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): O7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
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):.,
AL
Reviewer/Inspector Name Cr!//Z —� Phone: U" J `
Reviewer/Inspector Signature: Date: h ��
Page 2 of 12128104 Continued

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

Type of Visit tErC ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit r0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of'Visit: /�isit: 27%' ,nArrival Timv e: •v Departure Time: County:
Farm Name: 17�'y/f 5�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C .all �� ►�
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [= o = 6 =if Longitude: = o E--] , 0
Design
Current
Design Current
Design Garrent
Sw�e
Capacity
Population
Wet Poultry Capacity Population
�
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
���
❑ Dairy Cow
.:,..s.�
❑ Wean to FeederI
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifej
Marrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
600
hQ O
❑ Non -Dairy
Layers
Farrow to Finish
El Farrow
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
-
❑ Turkeys
Other
❑Turke Poults
Number of Structures:
❑ Other
❑Other
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El -No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 7 Date of Inspection *Z6—
Waste Collection & Treatment ,��
4. Is forage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes I_I 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): r [
Observed Freeboard (in): }
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1:1-No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ETNo ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El -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 UNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑No ❑ NA ❑ NE
maintenance/improvement? �,/
1 l . Is there evidence of incorrect application? if yes, check the appropriate box below. El Yes IJ 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 O No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes ETNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes i,J'N'No ElNA ❑ NE
18. Is there a lack of property operating waste application equipment? ❑ Yes -ETNo ❑ NA ❑ NE
lk�`r
omments�(refereto,questYon #} �Explam any YES gnswerstand/or�any�recommendahons or any other comments.
ulsRe dra-v�ags of fae�hty to better a%plarn sitiahons ,:(use acldldonal,pagesras,�neCessary : -
Reviewer/Inspector Name Phone: CI- 7 7,)
ReviewerfInspector Signature: Date:
12128104 Continued

Facility Number: 3 Date of Inspection �p
Required Betords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes g No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 2No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
L 1VA
❑ 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 ❑ No
❑ NA
2'?GE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes D-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes EjNo
❑ 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 �o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes �o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes-J21qo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ❑
❑ NA
❑ NE
Additional Comments and/or Drawings:
'/�i///� yL(///1/
�� �C' tr[ ! • ,/9 0 4 V
r � /�� 1 �Q/ �� ��/� / / `7 l�%�l/ ��i�0%�7 l h Si£�?C.�.�r�Y• �'
12128104

Type of Visit WCompliance Inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit )Z Routine Q Complaint Q Fallow up O Emergency Notification Q Other ❑ Denied Access
Facility Number % -
Date of Visit: %;k 7 G Tune: .' (! 4
O Not rational Q Below Threshold
❑ Permitted ©Certified © Conditionally Certified 0 Registered Date Last Operated or �A,boove Threshold:
Farm Name: e t7 P S /H _ County: _ .,(te�! Cl
Owner Name:
Mailing Address:
Phone No:
Facility Contact: .. Title: Phone No:
Onsite Representative:..{ e �_ 7). e Integrator.
T,
Certified Operator.. . __ . __---------_____-_. Operator Certification Number:
Location of Farm:
r�
❑ Swine [I Poultry ❑ Cattle ❑ Norse Latitude • & Du Longitude • ' I�u
Discharees & Stream Impac
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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,0'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZrNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): �1
12112103 Continued

Facility Number: 3J— Date of Inspection
5+ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IZNo
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 040
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 ❑ Yes P(No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2rNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type G
13. Do the receiving crops differ with those esignated in the Certified Waste Management Plan (CAWMP) . ❑ Yes fiTNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �To
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes eNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ fqo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes .OWo
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 ;3'No
Air Quality representative immediately.
st a�arn sit�na�.�la�e atrE pages as. ❑ Field Copy ❑ Final Notes
5afft ere sio-r'ecx s ',r +-lP_lcL - 1Nlr Ocinneiiy
h a S h i �e 3 . f''1-o rct.•t �v �r� f e. pc,.: s , �5
Co S
e6ord S Q `e r1eg4 f-
Reviewer/Inspector Name
Reviewer/Lupector Signature:
Date:
!6/1L/UJ "Y"MucR

Facility Number_ �— 3] Date of Inspection i� D
Required Records_& Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
fif'NO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?—/
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[INo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑'No
❑ Waste Application [I Freeboard [I Waste Analysis [I 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
( No
28. Does facility require a follow-up visit by same agency?
❑ Yes
PrNo
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
j1No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo
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 ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

r
't
®Division Water Quality'.
of
.r
Dinsion of Soil and Water.Conservation
'
L x
��
f , .
Agency
- a h
'Type of Visit iS Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I l.�Tune: E= Pr anted on: 7/21/2000
Not Operation. O Below Threshold
M Permitted IS Certified ❑ Conditionally Certified ❑ Registered Date Last Operated
or Above Threshold: ..................
Farm Name: ........ 'L. ...... dl `�............................ County: ........./�u ...............................",-
OwnerName:........1.CO.kK......................................... Phone No:
Facility Contact:
Title:........
MailingAddress:....................+............................................................
Onsite Representative :..... 1/lrV!teJ..........................................
Certified Operator:
Location'of Farm:
Phone No:
Integrator :.....�kz.-70�jl.......................................
Operator Certification Number:... .....................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 44 Longitude C 66
Design Current Design Current Design : Current
r ,Swe
Ca ci . Population Poultry Ca aci Po elation Cattle . Ca Po iiiatiion
Wean to Feeder ❑Layer ❑Dairy
x I:
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
' Farrow to Wean =
-`" Farrow to Feeder G Other
Farrow
Farrow to Finish Total Design Capacity
-`" Gilts
:.:..
Boars Total SSLWE_
l:p:..... .. .....`-.. ....,..............;............................. ... .. ....... -- ........
Subsurface Drains Prest Lui agMArea
❑ Spray Field Area
en
No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8& Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; ...............................................................
Freeboard (inches):
5100
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued on back

Facility Number: 3 —
Date of Inspection 1 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
t4. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pcnded for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to, uest,on + Ex lam an YES answersAandlor. an recommendattons or a4 fotlier comments r _
gap y T..
PUsesdrawmgssoftfacrlity to better expiareisttuarions;(use ad[drhonal pagesias necessary) >-
;,.. ;. Field Copy ❑ Final Notes
kook A, iley m4eMe l ► e-�Ch R;S A'—'r�1�d�
44d Lost �G �"is rv;A,K y(4Q /as �. 1},e.r 'Ve -140
eIAI 1;r9
&-i tli vWl,.ty
&qui,*n ez- _ 7— did 4rl- yG✓�%M AA/ ^one- >J I514C7 ,00'! ult G09�ups !etAr�I" e�NA941
o� �al�6�v1h� Glee*),
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

i
d
Facility Number: ' Date of Inspection 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 ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Faciiity Number 37 Date of Visit: Time:
1Vat Operational 0 Below Threshold
J9 Permitted El Certifjjied 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: liJ�'iC/ County: _ Anb'l -
Owner Name: C Azle y Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: A 4 P-/ — Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ° « Longitude 0 C u
Design Current Design Current Design Current
Swine Ca achy P,a ulatioa 1Poultry Ga acity P.o ulationTEE
attle to acity P,o ulatian
❑ Wean to Feeder ❑ Layer
Da'
❑ Feeder to Finish on -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Li uid Waste Management System
136f,harees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 29No
❑ Yes allo
❑ Yes R No
Structure 6
Identifier:
Freeboard (inches): Z Z
05103101 Continued

Facility Number: 3/ — 3
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes CSNo
❑ Yes tEj No
❑ Yes ®No
❑ Yes ® No
❑ Yes, ®No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
k No
11.
Is there evidence of over application? El Excessive Ponding El PAN El HydraulicOverload
El Yes
� No
12.
j
Crop hype �� ,WUZ &,f7rri �t�l� �/rr.�st !/U�/SEC� e e �/T *Ze) l?i y
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JRNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
E,No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
14 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ERNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[S�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
8
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
BNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes NtNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cominents referto'iqueshon #): Explain any YE :answers idd/or any recommendations or any. other comments 1 "
w
��; � � mar
Use dfawmgsfdf facility to better explain situations: (use _additional pagesias,neeessary) ., .-I[:]FieldCopy Final Notes `
ee, T W c 4-A G At-I-X �`Gt s� p� Z"-'7
/
his% 41-
H,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �� 5 a _Z_
O5103101 `�J Continued

Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes eKNo
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 b 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 21:No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes El No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes t!rNo
5100

fa
R ry Aon of Water Quality ;.
Q`Division of Soil and Water Conservation
t r
Q Other Agency s a _
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number
[)ate of Visit: ' 1 Time: /C, Dp Printed on: 7/21/2000
f
Q Not Operational Q Below Threshold
Permitted Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
r"t fi( l Counh /n'1 Lv i r Q
FarmName:.........................................p........................................................... .... .......
Owner Name:........2�.4.K.�............ ....... MQ� ��� Phone No: .....................
Facility- Contact : ................. .... Title: .. Phone No:
Mailing Address: ................................
Onsite Representative: ........ 7'C..k,,,,,,,,,�. Integrator:.........
Certified Operator: ............................ ..........._.._.......................................... Operator Certification Number:...................
..... .......................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 .4 Longitude • 4 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish 10 Non -Layer I L 10 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder C- ❑ Other
❑ Farrow to Finish I Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade?
b. If dischar,-�e is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. 11- dischar�,c is observed, what is the estimatednow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatntent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier: ........... ......I ...............
Freeboard (inches):
5100
❑ Yes ' /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes `�No
❑ Yes AKO
❑ Yes No
Structure
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�INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �� Gra ,% C—,, ' (,✓ia 2v�
❑ Yes K
o
❑ Yes WNo
❑ Yes VNo
❑ Yes pfNo
❑ Yes �(No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
�No .
16.
Is there a lack of adequate waste application equipment?
❑ Yes
r 0
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1�7No
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
V7No
19-
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑.Yes
No
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
El-
�Cio yiolatieiris:or defeiericies rvere noted during �h�s;visit: You will receiveq further
this comes ondeiice' alboUt: V ISIt. : : : ' : : '
Com_ tnents (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):
r�
�l
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

a
Facility Number: Date of Inspection Printed on: 7/21/2000
Y
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? zw
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 XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesIWNo
30. Were any major maintenance problems with the ventilation fan(s) noted? O.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 /WNo
32. Do the flush tanks lack a submerged fill pipe or a pei•manent/temporary cover? ❑ Yes 1'1No
5100

i0 Division of Soil and' -Water 'Conse=vat<on - Operation•Revtew -
€ Division of Soil and Water Conservation .Compliance Inspection ' g
M DivlAon of Water Qeeiahty Cott pliance Inspection _.
Other Agency OperattoriReveew _ _ -_
LO Routine ® Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number 3 J 37 Date of Inspection 3 cl00
Time of Inspection 1 r 3O 24 hr. (hh:mm)
Permitted 0 Certified ❑ Conditionally Certified [3 Registered 10 Not O erational Date Last Operated:
Farm Name: � �` L 1 F zk, % S
6 t..........................•---.---...................................................... County:...------V • .�.�i..................................- .......................
...................................
Owner Name. ............... A.(.. k..... '}..db fey
....--•............................................................. Phone No:........................
Facility Contact: .......................................................•--.--................. Title:
Phone No:.........
MailingAddress: .................../..............................................................................................................................................................................
Onsite Representative: K[3G �S O �jte Integrator: ►'�rF
` .......................... 1..................... ...............................................
Certified Operator:
Location of Farm:
Operator Certification Number:
r
...................................................................................................•---........................................................................................................----.--...... ............-.--.. w
Latitude 0 4 Longitude �' �4 C]«
p Poultry.— ., _ p• ay p t Design Current
Design Current Design Curren
CapacityPo elation r3 � .- Ca act Po elation Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
iNubiber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
= Holdeng Ponds / Solid Traps ❑iquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): 3 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M No
Structure 6
❑ Yes ❑ No
Continued on hack

Fa�ility Number: 31 — 3 % [late of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
3 00
❑ Yes
[-]No
® Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
25 Yes
❑ No
❑ Yes.
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
ReQuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
y1olafttjris:oi defciencie5 mere noted itur�ng bis:visit' • Y:ott *Will •reeeiye do tutft
corresiondehce. abatis" this visit.:..... : ' "
G6mments (refer:to question-#):_ Explain 'a"ny YES "answers and/ oranyrecommendations or an_yottiee comments.
Use drawings.of.facility tTbetter- ex laih-situations: use additional a es as necessa ` -
p (_ pg_ ry):
A6
_-„ sper,4 ran was (,o17d vG+ed j n e65 pause 40 a Co M f f,,.,4 4414+ runnFF AAOC
oeGvrred Fri -�(�e spy f-
7.-rras� ck GA Ae6 �s i�ou be re-^1oved4 r if -N a50or\,
10. SPray jV7) Lugs orgoil� ct5 q!'e "rC6- AAVi5eA 1nr. I AIC -f'1)q_- �
Lomas JJ(�JoAd i__n//QQ ,1„��/11Go+'��Iai� �. Ty,-1)e'5 , C W, S1or ,ttdS Ct sc1W Sow/e_
P�SGes t errs rL61 o-q Ir""I �e S fcll1{;�0 YYlii �� Occ Oj 'eA RYlL�GOL(tGL
oCGV/ ;fr�v�vfe. xfd� seal �?f.r'iobie {a CAVI}ce f�;A -i S,,!-f•L.J44e-4F,,lxlpt,,,;fj�
4vese Ate45. WaAe,4v,0;4v Sq"t'(fZtnof eiC ,eQsGve�^t -,,ken.
Reviewer/Inspector Name 5 ^ ? . cam 1 / '- E G ,is . � 1J • y9 8:�
Reviewer/Inspector Signature: % 711�Date: 3lQ Ioo
0110X L1]

Division of Soil andwiter, Conse'ryahon - Operation Review.-
�, : = rv,
�.Divis�on of oil'and Conseryatton -,Compliance Inspectton
-� Division of Water Quality ' Compitance Inspection_
Other Agency - Operahon°Rev>iew _
Routine 0 Com taint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3I 37 Date of Inspection l 17 9
Time of Inspection E1= 24 hr. (hh:mm)
® Permitted 13 Certified © Conditionally Certified [3 Registered Not O erational Date Last Operated:
Farm Name: ........ ��1 r iC � �� r �1 County:........... V� ICY-)
............................................................................................. �.......----.................................. ... ....,...............
l�oGk rleblr_
Owner Name:.......... ......................... Phone No:
............................................................ .......................
FacilityContact:..........................................•.---............................... Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................................................................................................
Onsite Representative: .... K!L...... .m......D DleIntegrator: y.................................................. .�F
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
L-
......................... �
................................................................. : ............. ...................................
--
....................................................................................................................... . ......................I...............I.........
Latitude �' 0` �• Longitude
' Design Currents Design Current., Design Current
-Swine r" v .. - _ ... ,
Capacity Population Poult- ` -
ty rY.Capacity Population Cattle, _ Capacity Po rilatton.:�"
❑ Wean to Feeder ❑ Layer E
Dairy
Feeder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
Farrow to Feeder d� 7 ❑Other - - -
❑Farrow to Finish D Total esign Capacity
.._
:. ❑ Gilts
❑Boars Total -SSLW
Number'of Lagoons 0 Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Hold><ng`Ponds / Solid Traps ❑ No Liquid Waste Management System
_ �.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff 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 IgNo
c. If discharge is observed, what is the estimated flow in gal/min'? n/a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes iNo
2. Is there evidence of past discharge from any part of the operation? []Yes JO No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Cl Spillway ❑ Yes JgNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard(inches): '�...............................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes :8 No
seepage, etc.)
3/23/99 Continued on back

F,1
Facility Number: 3j -:jg?
Date of Inspection
Odor lssues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of property within 24 hours?
❑ Yes
C9 No .
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
gNo
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
C@ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
El No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
A44ktional Comments an or Drawingsc
�..
3/23/99

Facility Number:.] —B Date of Inspection •
i J
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
IN No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
PAN
11. Is there evidence of over application? ❑ Excessive Pon/ ❑
Yes
[]Yes
� No
/
12. Crop type 13 e r tide, 6V'e4 ze t c:Sew e '_4 ze Sjvt ct /j 1Ah C 4
Sd 6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
99 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
WrNo
b) Does the facility need a wettable acre determination?
❑ Yes
(9 No
c) This facility is pended for a wettable acre determination?
❑ Yes
E No
15. Does the receiving crop need improvement?
JO Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
19 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
C4No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
11 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0: i'Vo vMatidiis:or• &flci ndb:s •were noted• du' .r" ' ' this;visit; - You will receive lio Oukth , r.
... . .. ..... . ...........
correspori�ence a�otiti this visit..:.. .. : ........... ...
.
Comments (refer to; question #):- Explain any YES answers and/or_,'any recomme"ndataons or any"other. comments._,'!!--_-,
Use:drawings of facility to better explainSitua6_ {use addttional•pages.asmecessary)
-z
�'. There t'x .rdV%.,e ��or,d'�rt� i►� a fe1,V otren ^�f' 44v- �'e-.re_ue Wro% ,end `ae
/a.s4 pvmri 2Vc+f� WQ S on j�i/Z �J�l. l �11�C S-�e S -fp �eV�►7 anG1l,lt �h
4h:s -1re" ni 4�c Aend . P 5
15. Coe s4al bermudri 4';e1A vlced-s irnrrpVe►"en+. Ta ke
Se
.e sar�IQ A� �� It� t;' ,e gceord-*n 4e so;1 nrte,fy.�►�.
Cot. rUj Yazl�+� ofLtL4 reope:�j q.r, 'Oma�-" e Ar�t�s 1�-t e r
-�--h ; t''� 140{ y
1?�i�b-i�,�.•� ��'1a� Geri►F� e '�(CoVevekge Ind keep &r►4A reGtsr�ls•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: j T f 7
3/23/99

U Division of Soil and Water Conservation [3Other Agency
z ;
,Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
� Date of Inspection Facility Numberice.}�
Time of Inspection 24 hr. (hh:mm)
© Registered Itcertified [3 Applied for Permit [3 Permitted [3 Not Operational Date Last Operated:
Count
Farm Name. `�'�J1..'�5............... Y:....��
.................................
.........
....... ..............
G� ��}
Owner Name:...1L.......1�:\G......C>...ek�s,r� Phone Vo 1 `..�f1.e.....``.....�..j........................ ... .........�a 1 l
FacilityContact: .............•.....---......,........................................---... Title:...OL !.................................... Phone Phone No: ................ ................................
11L(
MailingAddress:........................... ... . �.... A .. .................... '°Z.......... ..........................
Onsite Representative:...!&14 ...L L` .A. ......................... I.- ......... ....... Integrator:....... "..-
�.............................................
Certified Operator: ................................................. .........Ij
............................................... Operator Certification Numrrber:.........................................
Location of Vi!rm: � = Q 1 �1<i,—'5 A
Latitude 0 ` " Longitude ' 4 96
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
2. Is any discharge observed from any part of the operation?
❑ Yes
jo No
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 Surface Water? (If yes, notify DWQ)
❑ Yes
15ANo
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
9No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
NNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
'E(No
mai ntenanceli mprovement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
*0
7/25/97

Facility Number: ?5 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
(Ilo
Structures (Lazoons.Ilolding Ponds. Flush Lbts,etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
MVo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): .......a.`..................................................................... -..................................................................
.......---.......................
10. Is seepage observed from any of the structures?
❑ Yes
KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
9No
12. Do any of the structures need maintenance/improvement?
XYes
0 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
VNo
NVas!M_.42plication
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or noff entering waters of the State, notify DWQ)
f [
15. Crop
type
...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
P(No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
•18. Does the receiving crop need improvement?
OYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
bINo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
PfYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
G No:violations or deficiencies.were otited-during this;visit., Yoi►:will irece-iveiro-hirttier : -
. correspOiidence about this. visit.-
�r.L�;tie �•-.�-N�. �+� �p (lac I�--�s ��, lt,�� , ��C� �-� ��- �,� �, _
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✓� �+T,�' '`ram' 7 "vt P LA7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature: �� �_-kV x Date:

__-... ....... .. ......... .........
❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
10Routine O Complaint O Follow-up of l)WlJ inspection O Follow-un of DSWC review O Other I
Facility Number
10 Registered [3 Certified © Applied for Permit [3 Permitted
Date of inspection
Time of Inspection I IL4 .3t7 1 24 hr. (hh:mm)
Q Not Operational I Date Last Operated: ,••„
Farm Name: .�x..I..Y.., a.( Y County:?..ut.Al.x a ....................................{...
Owner 1Name:....Fr.e '.� : e-..:.Q.................................... .. Phone No: [ 9..J..a......g..s..�....... ..........
Facility Contact: .,�,�.c,.•....T-!1.a....�.� Title: Phone No:
q.r........ 5..............
Bailing Address:... t�,.Q....... � e d ..�..... �-.a n n .i .ems.... .:........ ..... .....L h ...ra.. U.I? .~?.i..+^..r... (...
Onsite Representative:--,<.s? •••,.1"1.c1..Y.:...•--....._. ... Integrator:...i:-..
... .. .. .......................................
Certified Operator;.--1.y-.-t4-.�l,.t..q...... -.........tom S.L�.................................... Operator Certification Number ,-.-..��•�(�-`�............
Location of Farm: l
Q.n�...s.�.�s.�!►....S.3- .....A ..... ........�.. ..�..... a, r..ra.era.X.�..�lyr�.u..... .. Q.:.,a ..... ! ,..Ux....... Q.a.S..t......401 ...... fW.I.��r......
p.Y1....... t!4!!.. .... TQ..--1..la......-..... j......................................................................
Latitude • ' " Longitude • ©4 ®;k
Design Current Design Current Design, Current;:
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
❑ Feeder to Finish I0 \Ton -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder 5 g 0 ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW 3 0 Z-] b 0
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Managernent System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ®-No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, wa,, the conveyance man-made? ❑ Yes ® 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 k*al/min?
— t�) 4 --
d. Does discharge bypass a lagoon systein? (If yes, notify DWQ)
❑ Yes
21 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
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
RNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
19 No
7/25/97
Continued on back

Facility Number —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (1 aeoonsdlolding Ponds Flash Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes [R No
❑ Yes [.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): .......2 ,Z
10. Is seepage observed from any of the structures?
........................................................................
❑ Yes 0 No
1 I. 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type R:S.ss1.£........................... ..-----••...---.........---.•-- ... e.rry................................. .
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?
No -viol itions or deficiencies. were noted during this visit.- .You.wili receive no ftirther
' correspondence about this'visit:
,Yes ❑ No
El Yes ❑ No
❑ Yes ® No
❑Yes ®No
❑ Yes 9No
❑ Yes ® No
® Yes ❑ No
❑ Yes ®No
❑ Yes 7allo
❑ Yes allo
❑ Yes KNo
❑ Yes 91 No
❑ Yes q No
❑ Yes EkNo
�. P'%1 % ", C,�s ari t i , - -�� 3•
i o- ✓i c-j �4 .. o v f e- - W a. L i o 1 o-t rL o..n I`t oc r� cx.r
1 g• W r It t}� c 6 v v �c it A d=S i•'� 1`e S t-v
t 2 . [ ca —t--) 1.n 0-4-1.,
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: n _JAD -I. J'A qi % V,, .`� ... 0 r` Date:

3 /- 37s'
•
•
•
Site Requires Immediate Attention:
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: /10//S , 1995
Time: l OC7
Farm Name/Owner:
Mailing Address: _ ��%. 6e6e S zAr✓ ge_ Ago, _ (�t/!A/��/,®G�lG?� A��Z f
County: % JiJPLIy
Integrator. �e I� Phone:
On Site Representative: &y" �.-99
D� Ji
�CC Phone: ��f
Physical Address/Location: ��L(l 4`z,-E _ g 41710 A go A41,
vQ 18491
Type of Operation Swine ^Poultry Cattle
Design Capacity: _ 4&90 _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: '5V ° i'?�' 411 " Longitude: ? 7° 'es�' L-§"' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 incheVeaggoon(s)?
r No Actual Freeboard^�Ft. Inches
Was any seepage observed from YesOWas any erosion observe .Yes r No
Is adequate land available for spray? Yes oT No Is the cover crop adequate? Yes or Now
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific
Additional Comments:
IA-4
Inspector Name
with cover crop)? Yes or No
lAdLL /5 961
M11 1tA(- 416ece - s
0c)AI5 1-4 P1, � "0,9 9,!
LlfCTff A/ 0461- 9*frP,�
SiS
RF_S/Y4'0p�
re
cc: Facility Assessment Unit
Use Atrachments if Needed.

Site Require_ s Immediate Atten ' U
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: r 4' _, 1995
Time: ¢5 e.k
Farm Name/Owner:
Mailing Address:
County:)
Integrator.
On Site Representative:
2r�Jr i 2r'm 5
1.z��
L
Phone: TO _Z35
Phone:
Physical Address/Location: tbw->*—' beu/aAfie D•Kmi r v IUG�I .SI
Type of Operation: Swine ✓ Poultry Cattle �JU (�V rr►'�
Design Capacity: 500 Number of Animals on Site:
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: 17¢ ' 4-6( Longitude: -11 - 44* Cf-P•30 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) es r No Actual Freeboard: �Ft_ Inches
Was any seepaae observed from the agoon(s)? Yes or No Was any erosion observed? Yes or No
iIs adequate land available for spray? Ye or "o Is the cover crop adequate? Yes or `N--o C
Crop(s) being utilized: r i •er nPz
Does the facility meet SCS minimum setbac criteria? 200 Feet from 6wellinastgor No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes of No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line. Yes o N
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o COIf Yes, Please Explain.
k:
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes oNo S I�Qe�s
Additional Comments:
� L
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.