310388_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

f$_
Type of Visit: compliance Inspection U Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 04 routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: 11 -2— 7 Arrival Time: j 4 g' Departure Time: /S County: Region:
?�l
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ��5r' R �`r' S Integrator:
Certified Operator: Certification Number: 1 `
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design C►urrent
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder I
iNon-Layer-
Dairy Calf
eder to Finish 2-1
Daiiy Heifer
Farrow to Wean
Design C►►urrent
Dry Cow
Farrow to Feeder
D , $ouItr, Ca aci I;o
Non -Dairy
Farrow to Finish ILayers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turkey Poults
01 Other I
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes gXNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

>Facili Number: - 3 ;p Date of Inspection: 171
14
Waste Collection & Treatment
e00
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ffNo ❑ 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 reat, 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 540,
❑ 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 Ej4o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
d�NVNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[� ❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ N ❑ 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

Facili Number: - Date of Ins ection: Z a. r
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 [�NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No F3�A❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes C rNoO NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
F
�❑ NA ❑ NE ❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: /,�� ,�� Date:
Page 3 of 3
Py
z �{ ­7
21412015

Type of Visit: 0"Co iance Inspection Q 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: t C Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r5 7 `' �a 1'5
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
)Afean to Feeder
I
jNon-Layer
I
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1 U117
Dt, P,ouitry
Layers
Non -Layers
Design Current
C_a aci Pao
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other I
Turkeys
Turkey Puuets
10ther
Discharges and Stream Impacts
No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑
❑ 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
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ff J/N o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: is
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r5No ❑ 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 ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes TNo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes LNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EIINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 ]jT0
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑Yes
®%
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L a Co
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 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 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

Faelli Number: - Date of Ins ection: 5`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes D<O ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ONA ❑ 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 tiie 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?
Comments:(refer to;question:#)
Use:_drawhigs Of facility to=betty
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
c � U -41
ers anwor any aami
additional nacres as
❑ Yes [J'/No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ]'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA <E
❑ Yes ONo ❑ NA D NE
❑ Yes 10,--,'No ❑ NA ❑ NE
❑ Yes L J"vc ❑ NA ❑ NE
uns or any other comments.
Phone: 3 0 73
Date:
21412015

Type of Visit: CKompliance inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Orkoutine 0 Complaint, 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: %err, R s _ Integrator:
Certified Operator:
Certification Number: 17277
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine C•apaeity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
I 11-ayer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish 1-TOO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P.oultr� Ca aci. Pao ,
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10theT
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes fNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ❑N ❑NA ❑NE
❑ Yes [' ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: IDate of Inspection: !o
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): lJ 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E3"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EJ'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E I o 0 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E31N o ❑ NA ❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Imo_,,O ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�To ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
[:3 Yes
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
N"No ❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps [—]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and I" 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? ❑ Yes6-K-o' ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 13i - Date of Inspection: 5 ZL' 115
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�. ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No [5—NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CTNo
❑ 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
[rNo
❑ 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
�o
❑ 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
[!fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F!�No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: S 1611l�
Page 3 of 3 21412015

(Type of Visit: pYCoHance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q Arrival Time: ® Departure Time: 2 30 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Prone:
Onsite Representative: iz12ycDe_S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current Design Current
We# Poultry Capacity Pop. Cattle Capacity Pop.
[Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
'Feeder to Finish
b
Dairy Heifer
Design CEEJ
urrent D Cow
D . loult , Ca aci_ P,o , Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees 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 No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ o
[:]Yes Zo
[:]Yes WNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

1F'aciliNumber: - Date of ins ection: 10
}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: 4c�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1VZo ❑ 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
dNo [DNA
❑ 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 hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ 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 J�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): ool
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C] No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
d-
[3 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
El Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps []Lease Agreements
❑Other:
,
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5/No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection: j p 1
2. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EKO ❑ 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
�To ❑ 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 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes;20/
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.'
Use drawings of facility to better explain situations (use additional bates as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: p
4/2 44

I
Type of Visit: 0
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:;�M Departure Time: County:
Farm Name: V_1� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number: j7277Q9_0!y
Certification Number:
Longitude:
Design Current
Swine C**opacity Pop.
Finish
Design
Wet Poultry rN Capacity
Layer
Current
P.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -La er
Da' Calf
o Finish
o Wean
o Feeder
FF
Design
Dr, P,oul_ , Ca aci
Current
P,o
DairyHeifer
D Cow
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes KNo ❑ NA ❑ NE
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) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes j6No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ 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 ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes -No
❑ NA
❑ NE
waste management or closure plan?
T'
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ZjNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes PNo
❑ 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 VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes XNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes )6 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):
- -
i
14. Do the receiving crops differ from those designated in the CAWMP? 5
❑ Yes J21-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 71 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes KI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'W'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design []Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 21412011 Continued

1
a Faciti Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes YrN o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes f fNo ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
❑ Yes PINo
❑ Yes: • jeNo
❑ Yes j6No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes eNo
❑ 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? ❑ Yes ZrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary).
P"(4e
�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:���
tom_ Date:
121412011

Type of Visit: Compliance Inspection Z5 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: �iZoutine O Complaint O Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:�� �`�� l A� Owner Email:
Owner Name: �t;r �Q-� I `� ` • 1�-140�� S Phone:yo -9go -/_O 38 Cw�
Mailing Address: J� / �J� O� `7 ��-l4 U ] LLB 1 Y G A a-S le
Physical Address:
Facility Contact:
OnsiteRepresentative: �E2fL �L�ataCS .
Certified Operator: JE �(t-y M • �1`N��S
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Cerrtifica�tio Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
gapacity Pop.
Design gurrent
Wet Poultry Capacity Pap.
La er
Design gurrent
Cattle gapacity Pop.
Dairy Cow
Wean to Feeder
on -Layer
airy Calf
Feeder to Finish
Design Curren#
17 . P,oultr. Ca aci P,o ,
Layers
airy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
HOther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Ficility Number: - -2, jDate 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? ElYes 9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: M C_
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 0
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 7No
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
R
12. Crop Type(s): 56 &SGu E C—(Z
13. Soil Type(s): CAD N(j _IKS4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
oNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
kN
❑ NA
❑ NE
Required Records & Documents
0. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
kNo
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists 0Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [:3NA ❑ NE
ElWaste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis [�[Vaste T sfers Q Weather Code
M. Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections Q 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 21412011 Continued

ili Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso ❑ 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 fast 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 10 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No [DNA ❑ 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. 14
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 9 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond C1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes (VI No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments". --
Use drawinEs of facility to better explain situations (use additional paLves as necessary).
w. A
111181)1
-qNC—C� 4c� I S Lt�04' (_-' (_A-5
�
qw i / w o(ACE a01 oL
Reviewer/Inspector Name: 1(4 lJ{I
Reviewer/Inspector Signature:. .
Page 3 of 3
Phone: 916-196-? i CPIT
Date: Q// / / Q
21412011

M
Fac�Lty�Number�
Division of Water Quality ' , � : ,
Division of Soil and�Water Conservation �WIM
O#her�Ageticy
Type of Visit Compliance 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: Z,•-►�1 ]Arrival Time: I .� Departure Time: County: ox Region:
�y
Farm Name: Y t IVl DQk.A CREEY TAQ-� Owner -'Email:
Owner Name: Phone: 9/0 -CX0 - ► 63J?
Mailing Address: 'P3� *4 F_ N C _Q L-/ 9 E��-A%_M CE /rrc
Physical Address:
Facility Contact: I Title:
Onsite Representative: E C>Es
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = I =Ag Longitude: = e ❑ 6 = 6i
Destgn Current,R Design Current : , Design Current
,-.
Swine =j - Capacity Population p -Wet Poultry Capacity Poulation Cattle �a 4 CapacityPopulafion• .
❑ La er = ❑ Dairy Cow
❑ Non -Layer
❑Dai Calf
*s,❑
„tt Dairy Heifer
Dry Poultry
❑ D Cow
..:,;�
❑ Layers
- ❑ Non-Dai Ey
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑Pullets
❑ Beef Brood Cowl
-- Turkeys
Other�,_... -. �,_� ❑ TurkeyPoults
...
❑ Other
❑OtherNumer.of'Structures:
,
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
oElNA
rNo
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3
I2/28/04 Continued

Facility -Number: 31 -3& Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ANo
El NA
El 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: Cn �
Spillway?:
Designed Freeboard (in):
3 `I
Observed Freeboard (in): u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo
❑ NA
[I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes _0No
❑ 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 fNo ❑ 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 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Area
12. Crop type(s)f�:--E'S uew:)CA C�
13. Soil type(s) en f--S.'dV
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
IqNo ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes�No
No ❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #). ;Explain any YES answers and/or any -recommendations ©i-Any other comments=,; R
Use drawings of facility to better explain situations. (use additional pages as necessary)
n-
� Y
AL
Reviewer/Inspector Name Phone: ��6�307
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number: Date of Inspection 1
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ko ❑ 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. Elgn WUP ❑❑ Design ❑ Maps
Checklists p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ taste Transfers ual Certification
0 Rainfall ❑ Stocking 0 Crop Yield El 120 Minute Inspections 3 Monthly and I" Rain Inspections ✓El 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
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ 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?
ElYes
No
K
❑ NA
ElNE
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
4 No
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
I 1
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes:No
❑ NA
❑ NE
Additional Comments:and/or Drawings::-
CACA 60 TIC-
w.A . 6H MC_
1fL1111 I. S 1•(D
jopn'jo o.qL 4
251 �
Page 3 of 3 12128104

Type of Visit F& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �6 Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: My0 Arrival Time: ® Departure Time: County: 1 U A/ Region:
Farm Name: C(-E E K FAQ-m Owner Email:
CND lo- a48-3at1
Owner Name: oz(L n - fznowes Phone: (w) 4ip- 34a- iUFr
3
Mailing Address: « J C )VC- cQfLa --t�C-14 V1 LLF4 / Y I a951 g
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ` = Longitude: = o = , = "
Design Current Design Current Design
C►urrent
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
d
❑ DairyHeifer
El Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish ❑ La ers❑
Beef Stocker
Gilts ❑Non -La ers❑
r
Feeder
Pullets❑Beef
Boars
ElBeef Brood Cowl I
❑ Turke s
otl ID Turkey Pouets
Number of NumStructures:
❑ Other IEJOther
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 ❑ No
❑ NA
❑ NE
❑Yes El No
❑NA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes 12�No
❑ NA
❑ NE
12128104 Continued

ar
.Facility Number: 3 1 — 3E
Date of Inspection y /D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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: _LQ(f QD1J
Spillway?:
Designed Freeboard (in): , S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ 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 to No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes % 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? 1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesP
No ❑ NA El NE
maintenance/improvement?
l 1_
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo ❑ NA
❑ NE
ElExcessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
[�E 2 �G� S <� 66)
12.
Crop type(s) U ,� 5ci.Af✓ C_ "
13.
Soil type(s) (��0Q9p/ f/G j C3j1w'
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
KNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
6 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
ONo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
'640 ❑ NA
❑ NE
- - _
Cominents (refer to questiop #). Explain aay.YES-ansKers and/or any.recammendationsor anyotherc©mments,
Use drawings oftaciiity tol,better:explam situations (use:a ldrhoaal pagesxas ne essary;) ' w
Reviewer/inspectorName F— x C A &V ES `" _ Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 31 Date of Inspection r O
Required Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
El NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 'gNo
❑ NA
❑ NE
the appropriate box. WUP 0 Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
ElNA
[INE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis O Soil Analysis El V/aste Transfers ❑ A)dual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections El 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
v'r 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 E�`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
ElNA
ElNE
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 11 No
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
l
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes "�'ff No
❑ NA
❑ NE
12128104

IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit- Arrival Time: ® Departure Time: County: ow Region:
Farm Name: (Ylc,l�D� CSLEG& i`r AR (�_\ Owner Email:
Owner Name: a- Phone �� �� �' 3 i Gx T 393y
Mailing Address: CQ G/ 1► C D W R G LIL19 U 1 U_f=_Y c
/p(IRS
-T
Physical Address:
Facility Contact: \ (� Title:
Onsite Representative: .J�-�%1 �M�> R_ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c =' 0 Longitude: = ° =' =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultr:•y... Capacity. _Population
a
Cattle Capacity Population
,
❑ can to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
[01 urkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo ❑ 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 N No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes )allo ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12,128104 Continued

Facility Number: j —
Date of Inspection Z�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: "Q OOA/
❑ Yes] No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): LQ.S _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) -0
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 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 ❑ 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 El Evidence Drift ElApplication Outside of Area
/of�Wind
12. Crop type(s) `�S Ct{ E (G�
13. Soiltype(s) (L_bcsb r TUy C1Qir,�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .4No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes K No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes A No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes J4.No
❑ NA ❑ NE
.a +.Avg_: �gsr.. • Fva.._ .r. . _ , .. �. �.. 'a., - ` r t�s •, '�." , _ s � .i?. •-...;,r,..... . _:.. ,
Comments (re%r to question;#) Explarn sny YES answers andLor anyrecamtnendatrottsor anyrotheir comments.
;Use ilrawmgs of facility #ogbetter explainsttuahons (use additional pages',as necessary)
-� a,& �n4ka� - ,1..:.vz9e..e..a< ""�'+ _ 4-P *_.wx-•.-+r,.",., 2a _:irsn?... `+2 F,� .�..."°�� c%%�,:-r,.
AL
Q
Reviewer/Inspector Name i r AM C S Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

t
Facility Number: '�� -�j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl 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 appropiate box. ❑ wup ❑ Checklists El Design El Maps El Other
2t. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ �aste Transfers ❑ Ynnual Certification
❑ Rainfall El Stocking 0 Crop Yield [1120 Minute Inspections 0 Monthly and I" Rain Inspections E]Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
DO 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
F�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

V
Division of Water Quality
Facility Number 3 3 0 0 Division of Soil and Water Conservation
--���—�--�----� 0 Other Agency -
Type of Visit 1�6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1§ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % Q Departure Time: County: Lt N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ` Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =1 =1 1, Longitude: ❑ o = 6 0 u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish 9100
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current ,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy 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?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
12128104 Continued

Facility Number:3 1 --38rs
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LAenolV
El NA ❑NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
tZ 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
Q 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
50 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 [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
]A No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill [:]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
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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):
C I
Reviewer/Inspector Name /� Phone: 9 16 -� / `3 3
Reviewer/Inspector Signature: Date: CQ ] 31d
12128104 Continued

r` ^Facility Number: 3 3 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ 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
jaj No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
It No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EZ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
&rNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PQ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IR No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
{p 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
91 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
34 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

l
Division of Water Quality
Facility Number 3g8 0 Division of Soil and Water Conservation
— ! - 0 Other Agency
IType of Visit gCompliance 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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
"aw Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
�j Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = n = 1
Design Currents Design: Current' D
wine Capacity Population `Wet, Poultry:: Capacity Population Cattle ` . _.Cz
Li Wean to Finish r'
❑ Wean to Feeder
Feeder to Finish / 0
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
— — .-7 --
I❑ Non -Layer I I I
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?
ty Population
❑ 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 I of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 —
Date of Inspection l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JXNo ❑ 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: Adl
Spillway?: O
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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? ❑ Ye�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 P/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. ❑ Yes [INo ❑ NA [3 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JZNo ❑ 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 Ed 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 0No ❑ 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):
ew �/1DL /U���DF�J /12au� A,
42,5*-4 -7 s i nky,
r,
Reviewer/Inspector Name i�,Gs�� P g� Phone:
Reviewer/Inspector Signature: Date: Z
Page 2 of 3 12128104 Continued

Facility Number: j P Date of Inspection �I I
Required Records & Documents %��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .0"No ❑ NA ❑ NE
the appropriate box. ❑ Wj Jp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /C3No ❑ 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
yNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ONA
❑ 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?
[IYes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No/ZINA
❑ 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
l.Q No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
ElNA
❑ 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
ElNA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
El NA
❑ NE
Additional Comments and/or Drawings:
�.D o61
A0
Page 3 of 3 12128104

W Division of Water Quality
Facifity Number �� t 3 gS O Division of Soil and Water Conservation
Other Agency
Type of Visit .0 Compliance Inspection O Operation Review O structure Evaluation O Technical Assistance
Reason for Visit J6 Routine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: D : SO Departure Time: ; OD County:
Farm Name: _ 17)a.J.Or/ � �Ee _ AAAM _ Owner Email:
Owner Name: 'f_l2V fi/Ol%Es Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Region: &"IIA0
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 4 =6. Longitude: 0 0 E--] ' = «
Design Current Design 7 Current DesignCurren
'. Swtne Capacity Population Wet Poultry Capacity .Population Cattle Capacity Populatton:,
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish j Jool
❑ Farrow to Wean Dry Poultry
M.o ❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & 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)
❑ Dairy Cow
[:]Dairy Calf
❑ Dairy Heifer'
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures - .
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
8No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:gg
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aq
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes /2fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)AflelnW4954t'104ZAS:
13. Soil type(s)
14. Do the receiving crops/differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes Y No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Cl Yes 9 No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations 6r.any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): `. V
h
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
,Page 2 of 3 12128104 f Continuer!

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No [I NA El NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
to 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
1d No
T❑
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
[(NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes4No
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?'
❑ Yes
❑ No
Z 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
ElNE
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
X
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

E
f Visit j0 compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit N Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 i 0 Departure Time: C nty: Region: &! A®
Farm Name: _ ,�f�%(� �Q .`1,n7 Owner Email:
Owner Name: �)fYJ�/ ir'ie:f' : Phone:
flailing Address:
Physical Address:
Facility Contact: f% Title:
Onsite Representative:i2iL' i />L ►FS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = . = Longitude: = o = i ❑
dl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
❑ Layer I
❑ Nan -La et - - --- — —
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood CowL
Number of Structures: F Ti
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 J[f No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
evNo
❑ NA
❑ NE
12128104 Continued

4
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0No
❑ Yes ❑ No
Structure 5
El NA El NE
❑NA ❑NE
Structure 6
❑ Yes Id No ❑ NA ❑ NE
❑ Yes 0 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 �SNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) P
9. Does any part of the waste management system other than the waste structures require ❑ Yes IV
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a'4wy
13.
Soil.type(s) �/I�DOD
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
V No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
V1No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Reviewer/Inspector Name 4
t, 5N Phone: �-
Reviewer/Inspector Signature: Date: , �1d1(J15_
Continued

Facility Number: Date of Inspection
Required Records & Documents , ,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes JLJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes V(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V1 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JVNo
VrNo
❑ 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
0140
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes VNo. ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 9 NA ❑ NE
Other Issues �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes ; ��D}},,NNo A [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes A No 7❑ 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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Pf
No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ElYes //// No ❑ NA ❑ NE
Additional Comments and/or Drawings:.. "
14vawo 70 Z-0c. zj r-11-Vee
12129104

Facility Number: 3 1 — Date of Inspection ' l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
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? es ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 20
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ff-No,
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type SQA(—fti
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes 5
5<
14. a) Does the facility lack adequate acreage for Iand application? ❑ YesFN
p�
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes 0
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 6 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes io
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 o
Air Quality representative immediately-
Cuents (cetfet' €� gt�esi�on�#)`F�plauu art�t BLS aaswers9andloralry recoameeadatra nr sny utter couuuents. P ,�;
aU se d ca►vtns: ut better ern s�a#tous _.us traaaics asry) ❑ Field Copy ❑Final Notes
GM rP3u6 c,,c;,(Ut 100 GIUSS ;a— LAGOv�J wr-Au.S. 50MC
Reviewer/Inspector Name x`�'
__� ..
Reviewer/Inspector Signature: Date:
I2112103 Continued

a
r - Division ofWater Q'uahty
°t vrsron of Soii and�Water_Canservation `
�x
Type of Visit Qj Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 17 Time: L ! Printed on: 7/21/2000
Facility Number
1 Not O erational O Below Threshold
Permitted E/Ceer`tiitied © Conditionally Certified [3 Registered Date Last Operated or Above Threshold
Farm Name: ...!�.!._N.Q!Ot�............... 1�............................. County: ipL.N �,.
...............................
Owner Name:..... R -/........ 1z<l1�F. Phone No: .....................................
Facility Contact: .............................................................................. Title:........- Phone No:
Mailing Address: .............. ....................... ........
..................
Onsite Representative:..:.�'/!1 F-...... Integrator:.. "�.,.r..............................................
Certified Operator:........ ...........................................
Location 'of Farm:
Operator Certification Number: ........ -................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C 69 Longitude �• �9 «
o - Design , Current.
Design Current Design Cur_ rent
_..- ._ ' ` Po iilatioa .
Poultry Ca aci Po ulatioa Cattle :: , .,.
_': Po tioa
Wean to Feeder
❑ Layer ❑ Dairy
= Feeder to Finish p
❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
Other
Farrow to Finish
Total Deli ' Ca a
�`.
Gilts
Y._ Boars
TotalSSLW-'
..:R m sfnbei. f,agpp� ;
;. Subsurface Drains Present
Lagoon Area
P Spray Field Area
;.:
❑ No Liquid Waste Management System
�r
Hang Ponds / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes {9No
Discharge originated ac ❑ 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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �YNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesINo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................
Freeboard (inches): 3
S/00 Continued on back

Facility Number: —3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ONo
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
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
..,,
7. Do any of the structures need maintenance/improvement?
El Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)ZfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
2 No
/X]No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence over application? ❑ xcessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�No
oof
12. Crop type �JD
13. Do the receiving crops differ with thse designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�io
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
Y—N
b) Does the facility need a wettable acre determination?
El 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
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�No
2l. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes PNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �No
24. Does facility require a follow-up visit by same agency? ❑ Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes /E�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�.:
Comments (refer.toquestran#} Explairany9Y);S'atiswers¢andlor anyromme©dattons nr anyo#her commentsA.
Field Copy ❑ Final Notes
4 8e
0av-r G �q �o �ORK DN r- _5-�J��z/vG- SUE l�2 �,41`�SS Cep LJ
(LAC ao^�), QtJn1E2 / p5 .��iQEAD
f�� J41A FP-CF,
Reviewer/inspector Name I .
Reviewer/inspector Signature:
05103101
Date:
Continued

Facility Number: 3 3 Date of Inspection 3� /j�///) 2 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 ;ZNo
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) T
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )dNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings'
J
5100

ivision of Wager Quality A
Q Division o€ Soil and-WaterCbriservahon
Other,Agency
=.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit .Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ® Time: ® Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold
FarmName: ...... y... ......................................................................
Owner Name:
Facility Contact:
MailingAddress: .......................................................................
Onsite Representative:..
Certified Operator:.._..
Location of Farm:
............................................ Phone No:..................................
.....................................................
Title:................................................................ Phone No:
............................................................................................. ..........................
........ Integrator:..1� Z' ....................................................
........ Operator Certification Number: ..........................................
[]Swine []Poultry []Cattle []Horse Latitude �` �° ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish CO ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other r
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars EE Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
h. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. II' 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
9140
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
1$ No
1
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
01No
Structure I Structure 2 Structure 3 . Structure 4 Structure 5
Structure 6
Identifier: ........................................................................................ .
Freeboard (inches): Q
5100
Continued
on back

Facility Number. t. — Date of Inspection 7/21/2000
Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Wo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P<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 maintenancelimprovement? ❑ 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? ,ryes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;R�No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes WNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1jj:fNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VNo
b) Does the facility need a wettable acre determination? ❑ Yes ,k!fNo
c) This facility is pended for a wettable acre determination? ❑ Yes & No
15. Does the receiving crop need improvement? ❑ Yes )f No
16. Is there a lack of adequate waste application equipment? ❑ Yes ,TNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes jb�'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 J917No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ,A '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 ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes VNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes A�No
24. Does facility require a follow-up visit by same agency? []Yes 4 o,
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes JE No
K'd.yioiafions;ot- deficiencies •were hOtpd- during this;visit; • Yoo witl -i-eoeiye Rio fufft ;
rorrespo deice. about this visit. • • • .
Comtnents-,(refer to question #): Explain any YES answers and/or aipy recommendations or'any other comments:
Use drawings of facRi. to better explain situations • .
l ty P _ r (iise addttlonalpages;as necessary)
r g rr, p �Q�jO `�'�P
Reviewer/Inspector Name - • - _ � .-
Reviewer/Inspector Signature: �� Date:•-0 ( $/pp

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 ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours?
0 Yes
lie"o
28_
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
fo
roads, building structure, and/or public property)
5
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�Fo
�`
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
�qNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
k No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
KNo
tjonComments: 2ndVOr Fa Ugs::
42��Ir-56A -'Vt' ('CJ
(3vei,4
5100

i
IS Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ISLRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 40 Time, ] �� Printed on: 7/21/2000
3 ? 3 8
0 Not operational 0 Below Threshold
JO Permitted [3 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: .........:...!..dG�... .r�.....(...°................................................................ County:. Y.._,.!'1.................................. .......................
..� y..
OwnerName: .............V �.'.'.. .1......9'61e.S..........................:.............................. Phone No:.......................................-......-........-...............................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: .........................-..........-..........-...--.-................................-........................-..............................-........................................... ..........................
Onsite Rep resentative:•...--J-e r'.r ...-�.k.-. 2`5........................................ Integrator:.. ,gf'I`o.1!.•................ ................. I....................
Certified Operator: ......................-........ .. Operator Certification Number:............
Location of Farm:
Swine 11 Poultry 171 Cattle fl Morse Latitude • C 1; Longitude ' 6 «
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
Feeder to Finish
- If 170
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 1111 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originates[ at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed; was the conveyance man-made-? ❑ Yes No
h- If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes f'No
c. If discharge is observed- what is the estimated flow in gal/min'? h /q
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 8 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 1KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P4 No
Structure I Structure 2 Structure Structure 4 Structure S Structure 6
IdentiFier: ...........�..............................................••----.--........---..........-......-...-.....-...-......................................--........-..--....--..-......................................-.
Feeehoard (inches): 73's
5100 Continued on back

Facili6,Number: Datc of 111spection 8 00 Printed on: 7/21/2000
�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 [I PAN [I Hydraulic Overload
12. Crop type _ liI / Aeq-f
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?
yiUatidiis;or• deficiencies were holed• during this;visit' • Yoik will-k&6ye do further • ..
correspondence. aN k this .visit,
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
raGi 1 4 and rccor'd-c mre L./e. II kerb.
❑ Yes 0 No
❑ Yes JgNo
❑ Yes No
❑ Yes No
❑ Yes j4No
❑ Yes ff No
❑ Yes 6No
❑ Yes [K No
❑ Yes jN No
❑ Yes ETNo
❑ Yes 9No
❑ Yes � No
❑ Yes % No
❑ Yes A� No
❑ Yes id No
❑ Yes No
❑ Yes No
El Yes No
i
❑ Yes 0 No
❑ Yes E�No
❑ Yes An No
❑ Yes N No
Reviewer/Inspector Name .5 4o ►•t e L-j A 6144 4 ; f
Reviewer/Inspector Signature: Date:

` Facility Number: 3r —388 Date of Inspection QD
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 KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes W 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 ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 2rNo
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? OYes ❑ No
itiosa omnients an or. _rawings - _
3123/99

Division of Soil and Water Conservation - Operation Review - -
[3 Division of Soiland,Water Coaserr+at,on :Compliance Inspection x
- Division of Water QualityCompliance Ins_ pectron_
M OzOther Agency, Operation Review yE
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number $$ Date of Inspection 2 9
Time of Inspection /5F = 24 hr. (hh:mm)
XPermitted)2(Certified ❑ Conditionally Certified © Registered [3 Not O erational Date Last Operated:
Farm Name: ........ A&J-0.O.Y..... c , County:.......... .9f. I�.l ...............
Owner Name:..
Facility Contact:
Mailing Address:
Onsite Representative:.., ..,, ... .....
............................. I......... Phone No: ......................................
.......-
Title: ................................................................ Phone No: ........ I..........................................
........................................................................................................................... ..........................
....................................... Integrator:....... t P` t?�-�.1.i....,t..�
Certified Operator:................................................................................................................ Operator Certification Number......
Location of Farm:
Latitude ���°��� Longitude
Design Current,,"' -. Design Current
Swine ,Capacity Po ulation Poultry_ Capacity .Population Cattle
❑ Wean to Feeder
eeder to Finish
7,160
❑ Farrow to Wean
=; ❑ Farrow to Feeder
❑ Farrow to Finish
_; ❑ Gilts,
❑ Boars
Design Current
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area I[] Spray Feld Area
Holden& onds s /Solid Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischargc 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:
Freeboard (inches): ......... ��.fr...-.-.........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ONO
❑ Yes ENo
❑ Yes 7&0
❑ Yes EfNo
❑ Yes eNo
❑ Yes PA'o
❑ Yes [5*No
Structure 6
............................
❑ Yes J'No
Continued on back
3/23/99

Fc•
acility Number: 3 — 3 Date (if Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or h
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �2<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Applicatipn
10. Are there any buffers that need maintenance/improvement? ❑ Yes /;70
11. Is there evidence of over application? p Excessive Ponding ❑ PAN El Yes
12_ Crop type Sv Y i3Z Gv 0 -CA rr-
13. Do the receiving crops differ with4 ose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes;afio
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ?fNo
b) Does the facility need a wettable acre determination?
❑ Yes �' o
c) This facility is pended for a wettable acre determination?
❑ Yes ONo
15.
Does the receiving crop need improvement?
❑ Yes 2�iqo
16.
Is there a lack of adequate waste application equipment?
❑ Yes .�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ONo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes No
(ie/ WIJP, checklists, design, maps, etc.)
❑ ,
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes O 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 J�2No
21
Fail to notify regional DWQ of emergency situations as required by General Permit?
dNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
. ❑ Yes 2i0
24.
Does facility require a follow-up visit by same agency?
❑ Yes VN o
21.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZrNo
.........................................................
��id-061afioris'or dgficiendes •mere hofpd• during this:visit: • Yoir will •reeeive iio flurther
•- �cori-es� oric�eirce:ahorutithis:visit:-:•:-:•:•:-:-:•:•:-:•:•:•:•:•:•:•:•:•:�:-:�:-:-:-:•:-:-: -:-:•:•:•:-:-:-:
Comments (referto question_#):`Explain any YES answers and/or any recommendations ions -or any'other comments:
Use drawings of facihty:to-better explain sit"66ns (use additEonal pages as necessary) - W
T _ to ,
Reviewer/Inspector Name �_� u- f j� ,nj: _ # U,f4r q l 1 -
Reviewer/Inspector Signature: le� r _ _ Date: 1p,
3/23/99

Facility Number: ?.�% — Date of lizspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below (:]Yes ;2'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 j2'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
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 Z"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 E<No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O NNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
SIDivision of Water Quality
Routine O Complaint O Follow-up of DW2 ins ection O Follow-ue of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered Certified 0 Applied for Permit © Permitted j] Not Operational Date Last Operated:
Farm Name: V ... f tG Count../..:�:....I................ I..... .......................
.................................r(,_,.................-----........................ y:.....
Owner Name:...... 1�,. �, ..k.Q4AM. ......... Phone No: i,6� ��.................................................
Facility Contact: `r.P .............. ........ TitIc: cry. - .... Phone No:
Mailing Address: ....Z 3..7..........,�...............C'......... Z. rC.......................... ....................................... _t..
Onsite Representative:,. g 1�i1 .........................
ry............................................................... Inte rator:.. �i�... .c.�LJ..........
Certified Operator;..-..` .��/.................. ... P.......s............. ...... Operator Certification Number:.....................
....................
Location of Farm:
Latitude ' "
Design Cup
Srnne Capacity Popr
❑ Wean to Feeder
EW Feeder to Finish
zi a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes J4 No
❑ Yes UtNo
❑ Yes Ea No
❑ Yes [Z No
r
❑ Yes .( No
❑ Yes No
❑ Yes Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenance/improvement?
C. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes 19 No
❑ Yes P No
❑ Yes tM No

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes -19-No
Structures (Lagoons.11olding Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &fNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft).......?2.r...'�.........................
10. Is seepage observed from any of the structures? ❑ Yes 0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes RNo
12. Do any of the structures need maintenancelimprovement? ,Yes ❑ No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes El No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ANo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
�- (-S 5. Cr
15. Crop type .:..................•----.-----•................ : ........(.................. ......................... ...........................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0-No.vitilations-or' ddicieiuies.were-hated-during this.visit:- You41ll receive-n' '14rttiei~ : -
correspOdde O. d oiit-this:visit.: .
I Z. trti. + v
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes N No
❑ Yes Q No
❑ Yes No
❑ Yes No
❑ Yes MNo
❑ Yes 4KI No
❑ Yes fnNo
Qt/ rt 2 p L L V — �I'�f !�/±� �. /1 h r /v cQ% G, '1 � . `S. 7/25/97
Reviewer/Inspector Name�.lr.,. .. _ .,...fie . =4 .. s �. ._.. 1, ....
Reviewer/Inspector Signature:
Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
IQ Koutine 0 Complaint 0 Follow-up of DWQ ins action O Follow-up of DSWC review 0 Other
Date of Inspection I6
Facility Number { Time of Inspection �--�� p l24 hr. (hh:mm)
(] Registered 0 Certified © Applied for Permit 10 Permitted JE3 Not Opera Date Last Operated:
FarmName:..........i!'..0 ...Ci �5:V.............r .1....................................................... County:......h ....................................................
Owner Name: ....... .t.� ... .................... Phone No:...L�1.4..� `..�.�.............................................
Facility Contact: St�rt Title: Phone No: �`I 71 l.........ZW.cs...................... ........0Id..,1%.k..................y.................... �.. �.�........i....�....................
Mailing Address: ...Z .tom........i{"......N......4kE1l...Z-....... �1[L�u.e.........11r1.r...............................8.ti.g......
................ ...... ... .
Onsite Representative: :.............. II
p J�!�Y.' ......� Q.....2S
..............----.................---...-----...----.... Integrator: ........._�Y.Y.'Q.1[S......................................................
Certified Operator ......... se.xyl.....Kn... '.Itx�A(-S........................................................ Operator Certification Number,........ 24.32.................
Location of Farm: I
1 ...... i .... ....lh� ..........!±�...... sl.fil�!.x.:..r1Vr1^......f�iV......prl..... ......- YYI..................... �
......a........ (IdA......................................................................................................... .......................... ..................... .......................................................
.
Latitude • 4 ©64 Longitude ©• ©4 ®41
General
1. Are there any buffers that need maintenance/improvement?
i
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-mad0
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in -al/min?
A. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
M Yes EP No
❑ Yes- ® No
❑ Yes ® No
❑ Yes 14 No
t,l 14-
❑ Yes (R No
❑ Yes [19 No
❑ Yes ® No
❑ Yes No
❑ Yes to No
❑ Yes 0 No
Continued on back

Facility Number: 3 —�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2 Structure 3
Identifier:
Freeboard(ft): ...............3: .......................................... .............
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
❑ Yes 04 No
❑ Yes ® No
Structure 6
............................................................................................................
❑ Yes 14 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............R-17j a[cax-........................................................... W."f........ ....................................................... ...............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWW)?
❑ Yes
W No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
1A No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
( No
22.
Does record keeping need improvement?
1p Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
53 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No .
® No.violations,or. delciencie's.were nated-during this:visit Yoit:will ree�n ce'i'vo14rther�
:•:•cbrrespQndencealiout.this:visit:-:�; : - -:� :.;.::.:,::.-_;.,_,-
Comrnents (refer:to question #) Explain€anyYES answers andlor any=recommendatrons or"any her`com¢ nent s.-
n -
Ue 'expiarn sitations(uadditioapaesasnecessary)g
{ Buttu s S F�ou�� b,c �tik[ e4oh(� ihl�S
•
5
tt A !
tZ- ywc ociu t j`r+ps d bt reseeded. E1�sior amtc�& arm jhrur wL\ty t) Ould �i Cit�[.rJ olt-* Gt.y
2-2. Efuwycv 0.ckior, OJ im;evVi 6e- i, L"V- € e3 OJA
-�li�Gu.�+
7/25/97
, n
Reviewer/Inspector Name i `x
Reviewer/Inspector Signature_,. �_ l Date;