310394_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

- ivi'sion ofWater Resources
Facility Number - ® ® Division or,Soil and Water Conservation
I � Other Ag�y
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: z �w , Arrival Time: 0:0 Departure Time: County:
Farm Name: F (i Owner Email:
Owner Name: 'lz'( W4 t j Phone:
Mailing Address:
Physical Address:
Facility Contact: L, ) S Title:
Onsite Representative: t {
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: W (J —S
Region: C v' I
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
C•apaeity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design C«urrent
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy
Wean to Feeder
Non -La er
Dairy
Feeder to Finish
er
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�� 50
'aC70
Dr,. P,oultr,
Layers
Design
Ca aci
C►urgent
P,a
Non -Dairy
erGilts
Non -La ers
rBoars
Pullets
d Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
l . 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 water "eg � T
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 operatU 6 7 2017
3. Were there any observable adverse impacts or potential adv impacts to the waters
er
of the State other than from a discharge? QAerati ali Sergio of
Wilmition
ngton Regional Office
Page 1 of 3
❑ Yes
❑"go
❑ NA
❑ NE
[:]Yes
❑ No
�NA
❑ NE
❑ Yes
[:]No
dNA
❑ NE
[:]Yes [-]No
❑ Yes ETNo
❑ Yes dNo
[3"'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
21412015 Continued

Facility Number: - 'yq jDate of Inspection:
Waste Collection & Treatment
4i'ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-N6 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ( so
5. Are.there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑g;:W ❑ 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
[a' Il�o
❑ 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?
[ fes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t
[R'Ro
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3'WIo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E3"'No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _z __ Ame' 4
13. Soil Type(s): /y-tk-
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�f<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3"'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
E2"'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ["No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: .2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED-1_ ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J d ❑ 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 C3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E� 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 PI -No ❑ NA ❑ NE
Comments�(refer to question °#} Ezjil to aiiy DES answersanci7o ny addlfiOnal recommendations,or any. otherfcorrii gent& 717111
Use drawn s .of," to better explam'situafidiW{use additional=pQiWAs_,nee essary). ..I_.
C,7_),A -[�
4V�7 -- 'F_t; " (o v` CU v, 0'L L)U,9-N -� k.'t k'j
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0—No ❑ NA ❑ NE
[:]Yes E'No ❑ NA ❑ NE
❑ Yes [oXo' ❑ NA ❑ NE
❑ Yes [:�M ❑ NA ❑ NE
Phoneit V- �f 33- ,3 3
Date: �_
21412015

Type of Visit: JOTompliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region: z�!
Farm Name: �4���� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: aLki R,." I/
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: 17106
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
FFeeder
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
Da' Calf
to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry $oul C•_a aci P,o P.
Layers
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream lmoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2No
❑ 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
ff 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
Z No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
e- o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Wo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilitv Number: - cV (J I IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2fNo ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
];No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[—]Yes
FNo
❑ 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
'P
eNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VN0
lo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code.
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: Q �,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z�j No
25. Is jhe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j-J-No
the appropriate box(es) below. TT
❑ 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:
❑NA ❑NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
rjj No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
VNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
JZ No
❑ NA
ONE
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
[6 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
Ej 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
[Z(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
CZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No
❑ NA
❑ NE
Comments (refer to question•#): 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).
. k,V-117,1 d_ C�YG{� %GC7 �0466i
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
1 06vi ✓i
Phone:
Date: l�
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: G Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: a4�- &Z&aC_L_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region: f 1
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design C*urrent Design
Wet Poultry C►apacity Pop. Cattle Capacity
ILayer I Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry P,QuItr. C•_a acit P,o -
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke §
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (galtons)?
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 ,allo ❑ NA ❑ NE
❑ Yes J'No
❑ Yes .01No
❑ Yes 0 No
❑ Yes o
❑ Yes ] No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facifi Number: jDate of Inspection: Z
Waste ColleStion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
- Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L? No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ONo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes EfNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
D Yes J'No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes P3'I<To ❑ 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 P 40 ❑ 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 f3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .f!f'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Q110
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J o
❑ NA
❑ NE
Re uired Records & Documents
19. Did facility fail have Certificate Coverage Permit
the to the of & readily available?
❑ Yes 0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes Lr&o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,E]"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [—],No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - ( Date of inspection: 4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
16
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j2fNo ❑ 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?
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 J No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
[:]Yes PrNo ❑ NA ❑ NE
❑ Yes j2fNo ❑ NA ❑ NE
❑ Yes F
,.erNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes _0"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes i2rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations use additional pages as necessary).
6J 3 z
�r s� 2
loll 11ye
h y
V rq U
c z
Ice
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2420114

Type of Visit: OCompliance Io'sPection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ':Okoutiae., =O;Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date'of Visit::. Arrival Time: q;� Departure Time: County: QM
Farb Name: Email:
�• Owner ail:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: K= �V " & T"
Back-up Operator:
Phone:
Integrator:
Certification Number: 1`1 I b1
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet PouI nj Capacity Pop.
La er
Design
Cattle C►apacity
Da' Cow
Current
Pop.
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
ll r P,oult . Ca aci P,o ,
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes PrNo ❑ NA ❑ NE
[:]Yes
[]No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
oNo
❑ 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 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Wo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes �no ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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 /05'No ❑ NA ❑ NE
IS. 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 DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �TNo
[]Yes No
❑ NA ❑ NE
❑ 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. ❑ YesZfersNo
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yesg�No
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: -
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes ;'�io
�''
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes TTNo
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 JZ�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes VfNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
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
0No
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
;?fNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
rNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
23 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1Z No
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/inspector Name: �u���-;vt _ � Phone:
Reviewer/Inspector Signature: ��� Date:
Page 3 of 3 21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: : y5 County:
Farm Name: X—I &jCpqS :an C, Owner Email: �
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: CI���,�
Certified Operator: V. Q�
Integrator:
Region:
Certification Number: \11 1 b1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design
Capaeity
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
NA I Farrow to Wean
a
Design
Current
Dg Cow
Farrow to Feeder
D , P,oul_ . Ca acity P,oINon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [] No
[:]Yes ❑-No
[:]Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

i -
Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a 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
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E'No
❑ 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
ffNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VfNo
❑ 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
V1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
kTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;�rNo
❑ NA
0 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 VNo ❑ NA 0 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 Zf No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EfNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes O No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J�T No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes to No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[a NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [;]�No ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
❑ Yes Z No DNA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes VNo
[:]Yes [;]'No
❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1
Date:-��1�..
21412011

(Type of Visit: (D Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance 1
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: L
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: ® Departure Time: County: 1 Region:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1162,0
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3 O
D . PoouIt .
Layers
Design
Ca aci
Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes fX
oNA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
Page I of 3 21412011 Continued

>-acid Number: - '319 jDate of Inspection: (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2/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: LACeZ,0 (.A&60j� 2--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2L 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r7f No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
o ❑ NA
7. Do any of the structures need maintenance or improvement? ❑ YesWNo
❑ 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 dNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes f;40
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ao
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes No 0 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectio;IN
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IF_acitity-Number: j - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
c
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
fNo
❑ NA
LINE
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
E/No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
WNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
MIN o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
ID/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gNo
❑ 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 situatians.(use additional pages as necessary).
Reviewer/Inspector Name: �JW F446C L
Phone: 71d " 73SA
Reviewer/Inspector Signature:
Date:
j}
L
Page 3 of 3
24,1201

Type of Visit: 0 Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D Arrival Time: Departure Time: 9 3x County: -r Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 7A7P=CK �-USS EL�� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Vean to Finish
La er
Vean to Feeder
Non-L,
eederto Finish
arrow to Wean
arrow to Feeder
arrow to Finish
13510
0.
D P P��
Layers
iiits
Non-L
oars
Pul lets
Other I 1 101 I Other
Latitude:
Poults
Certification Number:
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?
Longitude:
Cow
ow
Calf
alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ ❑ NA ❑ NE
[:]Yes WNo
NA ❑NE
❑Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Ds ection: !�
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: ( pwj ?i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ —?It
5. Are there any immediate threats to the integrity of any of the structures observed?
EYes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
WNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
❑ NA
❑ NE
maintenance or improvement?
VN_o
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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
N
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA [3NE
25. & the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tNo ❑ 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?
01"Y'es
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:)Yes
FZ/No ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[] ❑ NA ❑ NE
and report mortality rates that were higher than normal?
WNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E/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
Ej No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E � ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
�N/o
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments::;::;,
Use drawings of facility to better explain situations (use additional pages as necessary). „w
2jv) KEEP SPY gFv�V55f 01C, CA" turf!
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: R1011 v
Date: 10131
214/2011

(Type of Visit: Q Cop'ipliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: 1 Arrival Time: IOZ,S Departure Time: County: ;p/ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: HQECMA� Integrator:
Certified Operator:
Phone:
Certification Number: 11711
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine C*apacity
Wean to Finish
Current Design Current
Pap. Wet Poultry Capacity Pop.
Layer
Non -La er
a i Design Curren#
D , P,oult . C•_a aci P,o ,
ILayers
Non -Layer
Pullets
Design C►urgent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Dai Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Farrow to Wean 24 it
Farrow to Feeder
Non-Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes En No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
❑ Yes
[:]Yes CJ No
❑ NA ❑ NE
[DNA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: 31 - Date of Inspection: 1� i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
n
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6-o-6 �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
j��
(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 ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes yl�o
❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes F/N o ❑ NA ❑ NE
❑ Yes w ❑ NA ❑ NE
❑ Yes yNo ❑ NA ❑ NE
❑ Yes C ❑ NA ❑ NE
❑ Yes �rNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
_Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �,o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D4o ❑ NA ❑ NE
❑ NA ❑ NE
8. Do any of the structures sack 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 A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes ❑o ❑ NA ❑ NE
maintenance or improvement? WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Page 2 of 3 21412011 Continued
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes yl�o
❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes F/N o ❑ NA ❑ NE
❑ Yes w ❑ NA ❑ NE
❑ Yes yNo ❑ NA ❑ NE
❑ Yes C ❑ NA ❑ NE
❑ Yes �rNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
_Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �,o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D4o ❑ NA ❑ NE
❑ NA ❑ NE
8. Do any of the structures sack 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 A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes ❑o ❑ NA ❑ NE
maintenance or improvement? WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Page 2 of 3 21412011 Continued
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
_Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �,o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D4o ❑ NA ❑ NE
❑ NA ❑ NE
8. Do any of the structures sack 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 A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes ❑o ❑ NA ❑ NE
maintenance or improvement? WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Page 2 of 3 21412011 Continued

Facility Number: - g Date of Inspection: 17—ItIl,
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 EyNo ❑ 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 FZINo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Ca/No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: �jb j/ jj P✓ M1J f:(A Phone: C%
Reviewer/Inspector Signature: Date: i2
J( 111
Page 3 of 3 21412011

Division of Water Quality
==I=Eacilityumber 1 0 Division of Soil and Water Conservation
Other Agency
zM1
Type of Visit or"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
t( Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /UFO Departure Time: County: �P� - Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Ppmt�14- r%/S'fC��-t
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = = « Longitude: F-1 o =, 0 "
Design Curren
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
El Feeder to Finish
❑ DairyHeifer
29 Farrow to Wean 1 b l lZs
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other.
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
❑ Wean to Finish
❑ La er
❑Non
❑ Wean to Feeder
Discharges &Stream Impacts
I. Is any discharge observed from any part of the operation?
El Yes
21No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
[-I Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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)
El Yes
�
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: 31 Date of Inspection l
_r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: LAC:odj-) t&J (X01>Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑Yes C� o ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 f ❑ NA ElNE
ElYes 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 [dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 WYes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ld o ❑ NA ❑ NE
maintenance/improvement? J
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes U/No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IJ o
El NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
'Comments°(referAo gnesttori #): 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):
q,) R�&r_ge_u & Pump + EDJ ?o �?XE D, ��a�}} UbCsoory M��(c EIS IJEF9 �3E �CP�IGEO
FZEOW A16 1� Bf kj 'r 3irCf, A4,W U_ �.is3. -, Sc o PLAv�eco OCC -F66 Gar
Ar► r,"PM.(wT 14'69_ SO/6. 4'14f rt AAIALy5 r-C F) & o0,,1E To (ff Ieat-. Y(W PL*KPZ #LX-
rl ) A. C D JJCca/ 6 C f PE Kr-�{TT,
3 , j '3,) DAYS To 6—Er ?APC9-i✓d2 k ,r
Reviewer/Inspector Name f rr Phone: 7/o %G =i
Reviewer/Inspector Signature: Date:
Page 2 of 3 f 12128104 Continued

J*
facility Number: ) t Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA;Design
'P readily available? If yes, check
the appropriate box. ElWUP El Checklists ❑ Maps ❑ Other
Q Yes ❑ No ❑ NA ❑ NE
13"Yes ❑ No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, ZWaste
the appropriate box below. �es ❑ No ❑ NA ❑ NE
El Waste Application El Weekly Freeboard Analysis ❑ soil alysis ❑ Waste Transfers ❑ ual Certification
LQ Rainfall [Mocking ElCrop 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 O'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,_�No El NA [I NE
26. Did the facility fail to have an actively certified operator in charge? ElLH Yes "No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes jJ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ld 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 EfNo ❑ 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 E 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 2 No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ElYes ❑ No ❑ NA ❑ NE
Additional Comments andloreDrawin s
g_
IAcrow 065Z Ail `
12128104

Type of Visit i[-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i2 rcoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time: �� eparture Time: County: /vL Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Maiting Address:
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: = o =' = Longitude: = o =' =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
ElLa er
El Daia Cow
❑ Wean to Feeder
I ElNon-Laer
❑ Dairy Calf
❑ Feeder to Finish El Dairy Heifer
El Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets ❑Beef Feeder
❑ Boars ❑ Beef Brood Cowl
❑ Turke s
OLUC ID Turkey Poults
❑ Other F
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;�Mo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
UNo
❑ NA
❑ NE
[]Yes JO'No ❑ NA ❑ NE
12128104 Continued

Facility.Number: —3ZY Date of Inspection W;�111
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Pio
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ,fNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� �3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes .I 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 oNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes )'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes dNo
❑ 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 Z-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZI—No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes )�fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes /ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ff No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
C.i "mmentsa refer to; uestion°# E:x lain an YES answers and/or an recommenttahons or any other comments.
'Uk'drawingi�of facilky�to better explain situatiooa (use -addrtional pages as necessary)
Reviewer/Inspector Name �✓�/ Phone:
Reviewer/Inspector Signature: Date: cf:17150116
12128104

V ci$ty Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [j(Yes -*No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yicld ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Z�No
❑ NA
❑ NE
[:]Yes P�lo
❑ NA
❑ NE
❑ Yes ,�TNo
❑ NA
❑ NE
[:]Yes eNo
❑ NA
❑ NE
❑ Yes TNo
❑ NA
❑ NE
❑ Yes IQ No
❑ NA
❑ NE
❑ Yes �No
❑ Yes 4E No
❑ Yes ZfNo
❑ Yes gNo
❑ Yes VNo
❑ Yes JJ No
IV( _p4l� W s y
sul2 ,,� off• 1�Se 5��� /��
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

Type of Visit j(X'ompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 016outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' ) Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: /' Title: Phone No:
Onsite Representative: trt �F f� 4 Integrator: /"#T
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
Longitude: =
0
Region:
Deslgn
Swine Capacity
Current
Population
Wet Poultry
Design
Capacity
Current
UDUlftiO31
Design Current
apacity Population
❑ Wean to Finish
JEJ Layer
❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer I
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish ❑ La ers
Non -Layers
❑ Gilts
❑ Boars Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
I ❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
l . Is any discharge observed from any part of t operation?
i +
i Discharge originated at: I Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Die discharge reach waters of the State? (If yes, notify DWQ)
`t 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 �INo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,?rNo
❑ NA
❑ NE
❑ Yes
Q'Nfo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / 'Z
Spillway? :
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '[:�No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g90 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ 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):
+ ,r e c o r des Laois
Reviewer/inspector Name Phone: /P —
Reviewer/Inspector Signature: Date: G
12128104 Continued

j Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
VYes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
7fNo
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
(KNo
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
❑ Yes
?"o
❑ NA
❑ NE
❑ Yes
;No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Additipnal;Comments andlor,Dr�wmgs�,g ,
rJ
Yee S �,, s � a�n 4 dot
b ri L!
r e.,Jc, 5-e^ c1f ryv- a cc f the �-•
co, pie, le,
Page 3 of 3 12128104

-� Division of Water Quality
Facility Number 3�M
3/ O Division of Soil and Water Conservation
--- _- O Other Agency
Type of Visit (2rCompliance 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: G 7 Arrival Time: Q C/ Departure Time: County: Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/;
Title:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = i Longitude: = ° = 1
Design Current,. Design Current' Design Curreif°
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacityi .Population.'
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
�) U SoO Fe e a r [- 6r,
OVA so vV"-
5 04. life (_urd 5 fv,4-- � G ,r �y r l L
Reviewer/Inspector Name I Lad Phone:
Reviewerlinspector Signature: Date:
Page 2 of 3 12128104 Continued

Flicility Number: % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ W UP El 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 oil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional: Comments and/or Drawings:
0,73 0
0- 6-7 0> 0
�r 15 -
//\������
�- r
����.�
sG. c e r CA_,4, 4/ (cct�. k ��
Page 3 of 3 e V p ,."_ _}_3 . { J' t 4e, cZ j G 6 c—e 1C iL— 12128104
" 5 { a kA e,-z i 4_.G v 4. i - r "v'- F-r/. d- sir'* , , h ,

3'7
Type of Visit )OT'ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 a Departure Time: County: !/h
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
geeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Pho a No:
Integrator: /;1
Operator Cert/icatio"'n—Number:
Back-up Certification Number:
Region: 6-,.f [,,
Latitude: 0 e 0 i Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
h ❑ La er
II' ❑ Non -La et
Other
-❑ Other--- — -
Dry Poultry
❑ Layers
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
2Mo
[]NA
❑ NE
❑ Yes
Z_No
❑ NA
❑ NE
12128104 Continued

Facility Number: —3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LaNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ ^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E] 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 RNo ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No El NA El NE
maintenance or improvement? ((
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �TNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of//Wind Drift ElApplication Outside of Area
L�612. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/�" No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P/ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3,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):
za:JOon -:7- @ 02 1ACAVY. f'l&ls e 51cle 0604
a Celt �� �a�ad� eeCee�s��e6��
Reviewer/inspector Name Phone: —7 _
Reviewer/Inspector Signature: r% Date: /Y
Page 2 of 3 I /28/04 Continued

Facility Number: 3 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ]2'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 El Checklists El Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P'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
a No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
j FTNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
ONA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
P NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UNo
❑ 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
(�rNo
❑ 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
[3"No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Addltioo9-Ciiiments and/or Drawings:.
� f
7 z Cj�
an t 5tis (eCer 14��
Be s u r-e- +o p k"f � ( 0 \t'V_d -Go I- i' S
��e�czz6 cQ
.6 Lkse- w a S �-
5'6m4".
'SPfatq -ri2th- ClT2 in good shape.,
12128104

Type of Visit &Gmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance \
Reason for Visit _1Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
y Date of Visit:Tn�Arrival Time: : O Departure Time: County: Region:Farm Name:r >�%_ _,,�ia�, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator• G!✓i�
AV 40ir
Operator Certification Number:
Back-up Certification Number:
Latitude: [::] o ='
= Longitude: = o [=] ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
1 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 Plgo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
21�o
❑ NA
❑ NE
12128104 Continued

Facility Number: — q Date of Inspection
Reauif d Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑fio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check .E31es ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists gn ❑ Maps
Desi p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J2 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 2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 21 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
PNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ❑"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
JaNE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J:allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ice' 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 D-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 ,Q'go
❑ 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 .EI-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes .2<o
❑ NA
❑ NE
Additional;Ccmi nents:andlor.Drawings
'10 0��Ooy-' C". C Uf C>—'Zooy ",
�aI Wct' �P_f C ��5 a��LSV\ C" tcY»YnaC�
- f-wt,�kr -G-ec,��oaccl +0 r'LVFr(7v"j C"
Srcu6 -C; P�d r- G
l2/2&04

Facility Number: Date of Inspection !� D
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes , rNo ❑ 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): p
Observed Freeboard (in): p2 D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Pr'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 ETNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 7No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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?
❑ Yesl-ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes eFFNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes _E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,0116
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JC�-No
❑ NA
❑ NE
'Comments (refer to gaeshon,#) �Egplain atiy YES`answeri►�andLor,�any.�recommendahons�or any�other comments�� •, t ° � _'
'IJse�draw►n s.offacili["yto betteresn�lain "situations: use,addthon"aI a eras necessa ��� 's�'�Y�,�����*?!~;��;' � � �,�;
.--e :.... ...�, g _ _ ,.,_`y,. �.x _ - _-_� r. .. .. �,°., ...�(i 3:-. .. nen .'i`a�S..�ai�_i:�x�°yv"°Yx %'`i...-��i #. ;.r .'�'�ti.•i�:Y ��'-.%: .s.,,f?r"�ri :t"kl�': b'�u'b�3i�1
Reviewer/Inspector Name fPL1f�� �� Phone:
Reviewer/Inspector Signature: Date: d�
12128104 Continued

Type of Visit (Zi Corpipliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit OF Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility'Niimber
Date of visit: �o + Time:
j
Q Not O eratiolial Q Below Threshold
0 Permitted p Certified {�© TConditionail Certified 0 Registered Date Last Operated or Above Threshold: ........
Farm Name: ....._.. �. ! _ .1 K. A6... !...:� R County:...
Owner Name:
Phone No:
Marling Address: — ----- ---------------- —..------------ .._
Facility Contact: ......... .' j...._............ ..............._......._... Title:.._ .. _ ..... .W. _ ._....._.. .... Phone No:
Onsite Representative: ---• �---'�`� ---
� EEO __.. Integrator:
--
.............................
—
Certified Operator:---------- ........... ..._....._ .. ._ ....._ .........W ....--- Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 64 Longitude 0 4 14
Discharees & Stream Imaacts 1
1. Is any discharge observed from any part of the operation? ❑ Yes En No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2/No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes LJ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier• 1 2—
Freeboard (inches): 2_ 1 i
12112103 Continued

Facility Numb SL3L=1 Date of Inspection ZI Otl
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 maintenancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenancermprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype d9 E CM t4DA ( G -J- N) 5C-r a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV W)?
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional
Air Quality representative immediately.
❑ Yes U(No
❑ Yes E340
L'(Yes ❑ No
❑ Yes �No
❑ Yes L No
❑ Yes 7No
❑ Yes
❑ Yes Ef No
❑ Yes
❑ Yes LrNo
❑ Yes ❑Tio
❑ Yes To
❑ Yes 0
❑ Yes No
❑ Yes
❑ YesN7
❑ Yes No
mComuaents (refer torqueshoa #) Eapls ra aay YF.S-answers aadfor any recommendanons or�other comments:
. .__.= ro
Use draivtngs o ih.__ ty to better explains at ( additronal pigs a necessary)• ❑Reid Copy ❑Final Notes
A C6 4wh PER.M1:—r N E t=b '(o $( 1.J.! ? ij ZC CAILDS ,
23.) LAic wo svcE Ai4ALes:L5 5151a3 tom.
L,AG400 2- NEE 0 REPL.AC.E L4,� VEL &AVGx E (YA+dSJG
WE-rt aaC.E ALIC:ES po+�E
�� StaA�E
BER.r,�►�pA 46AY F:.rEt,bIT
�nn� WE�� Cpl�•oV �CE�E� �
T
Reviewer/InspectorName t►�21S:Z..l:W�"_,
U52
Reviewer/Inspector Signature: Date: 6 LZI
12112103 1 Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLTP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If es, check the appropriate box below.
❑ Waste Application [I Freeboard Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32_ Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
EYes ❑ No
❑ Y No
es ❑ No
❑ Yes No
❑ Yes U<0
❑ Yes [To
❑ Yes h10
Yes N(V
❑ Yes Q lv0
❑ Yes f !V o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
12112103

Type of Visit (4kCompiiance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit O—Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 15 Certified [3 Conditionally Certified 0 Registered
Farm Name: ,4a „_ 41e-he z _Le.
Owner Name:
tt
Mailing Address:
Time:
Date Last Operated orAboveThreshold:
County: //aDhh
Phone No:
Facility Contact: Title: Phone No: `
Onsite Representative: r/ /'�% �r Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ' '
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes X No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f
Freeboard (inches): Zig 3JT
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes IQ No
❑ Yes RNo
❑ Yes ®,No
Structure 6
Continued

J
Facility Number: 31
Date of Inspection ? z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
El Yes pNo
❑ Yes E[No
❑ Yes fallo
❑ Yes 5& No
❑ Yes ® No
Waste Aunlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes W No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 1':;;rNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes tgLNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes U:No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
q No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
54 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
94No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JZNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ER No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®'No
00 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,,- _ a b
Comments (refer t question% plain any YESnifnswers and/or any recommendations or any other comments. R
Use, awtags of facility to b.etter,explain situations:.{use additional pages ag neces§aryj
h ❑Field Copy ❑Final Notes
.D
ff�� `
/!/OfG ` �P -140 cl L�ly c ZkgAon ��h S
/
AA/[ 0I pO�ji i'G �� S�C�'rOh�,/
/
Age/f� CI <� O�� t/k6'1 76-' 1
Reviewer/Inspector Name ,��
Reviewer/Inspector Signature: Date: �3 d
05103101 "1M1,�7f 5--✓ pa -ec)— Z05--
Continued

i
.s
Facility Number: P 3 Date of Inspection 7 3 Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �INo
❑ Yes &No
❑ Yes allo
❑ Yes 2�No
❑ Yes tlNo
❑ Yes &No
❑ Yes RNo
Additional Comments and/or Dri4ingsc'
05103101
05103101

'Division of Water Quality _
Q Division of Soil and Water Canseryation
_ Q:Other Agency _
E
f Visit Compliance Inspection O Operation Review O Lagoon Evaluation
n for Visit,,12(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
I- - j 1;6 Facility Number
Date of visit: d ! 'time: Printed on: 7/21/2000
3/ 3�7
Not Operational O Below Threshold
Permitted © Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name: r M �
I..:.Q�!... G' �7 P��l ...... �?.............. �t1G.............................. _2gipp.. �t+'?
U...........................................
OwnerName:...........f�e -r.... ........................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: .... / n �q� ' etd . Integrator:.Mvr, +L
.......................................................................................
Certified Operator: ................................... ............... ............................................................. Operator Certification Number: ........................... I..............
Location 'of Farm:
Dt Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Design Current
ire Cannaty Poanlation
to Feeder
r to Finish
w to Weanw
to Feeder
U
w to Finish
Design Current Design Current
Poultry Capacity Population Cattle Ca -ci Pt ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
t.; Subsurface Drains Present LaArea
111�iEabecof LagoE►� ' �--
2 $aWmg Poems C Solid Traps:" ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Lagoon ❑ Spray Field [I 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. Dries discharge bypass a lagoon system'? (If yes, notify DWQ)
Spray Field Area
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
❑ Yes Y!rNo
❑ Yes 9(No
❑ Yeyys�� Z] No
`I A
❑ Yes 121�No
❑ Yes PNo
❑ Yes , dNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )21"No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... I ... .............................................................................................................. .
�7...................................
Freeboard (.inches): 23 J , �
5100 Continued on back

Faciliiy, Number: 31 — 3 Date of Inspection l Printed on: 7/21/2000
Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 11allo
(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 )ZrNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste_ Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes YrNo
11. Is there evidence of over applications? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes . 'No
12. Crop type 1ffe1'n L,6(4 H,;oy4 61,av-1?l Sr-,ci11 6ect;j,
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
e) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes'ONo
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 PNo
19.
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)
Oyes No
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes f'No
21.
Did the facility fail to have a actively certified operator in cbarge?
❑ Yes ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ,01No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 'Q*'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Oyes ❑ No
Io yiol i1Qns:olr d�#iciet�ries wtere h6 ed diNFrig hjs:visit: Yoj>f will-reoive do further • . .
correspotidence: about. this :visit: ' ....... . .. _
ents (refer to nquestian #): Explain ---any:
AL
1Q - fieeo( 4o 4ctke we;v4e sJQrti�l{e-�a{ 'vici[ S:s e y (-,Odq t
0+•lGf V52 C� LnICcS�e plv.G�( !'"SGiC�GC Gvr-i�L (Or ��e S �o� Gq�GtJ�citGtli
Q fiZcG s��'Z Ice- ^I.f. lake 5,,; sc,%t,01aJCS0 OP )eCL571 e�✓�y,
Kj e-,i sry S SO; 1 ,-A " / /¢ I �lA t/ e receA*lNeeat
6 eeh Sevit , � W P; b tl4 4in A ✓ r-1k �0 I
appt c6j o,1j 4owcird 4he be,�vdA -fo have A eebecvot recorAf
a�q Iable Fa. ;,15�aecj,'M, keep etj jea.S-F ortie ueq,eartvecordfAvc( )able
7
Reviewer/Inspector Name /ie
Reviewer/Inspector Signature: Date: 0 S/pp

Facility Number: Date of Inspection �lL /L`f Printed on: 10/26/2000
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 -240
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesXNo
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 f:�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Commentsan or.Drawings: a
ZS . ��U` v10� �cf�D(..� 5��,-� �,QI; C�iG� t,�,��L✓��a�' �'l0l'2 ?�q� _ �
So lb s . on s^'�t l t �ra+ r . S►�a l ! ray"►� ha rl o o f bean '�Q'�`°'`�i
iS ,.ti iQra L� fS p�'?f.t re/ytpre�;+� ��Gvld b�
)t�rv�pvQ/( ��,] �/j/'•i� � a� ¢.aG� lj 2qr _
��0{ aYP j��ca��ons
57albs.
4vw t 6( bermv,dq Au3vsf 31,
3 t+ � I P1 � n 6 sna r' � -f �E�� �fHtt2 /•e�h�i � rf; vict
rn �� r ✓are �[ ✓� °� M cl-, n of Td e,,c ce ed ,
5100
Mi

FA
Im ttoutme V Complaint V IPollow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number ,3 ( 3 Date of Inspection Z 9 00
Time of Inspection 1 124 hr. (hh:mm)
12 Permitted Q Certified 13 Conditionally Certified 13 Registered Not O erational Date Last Operated: P ..........................
Farm Name. K¢n 13G 1'r l¢ ID� > a�M.InL•........._........................ County: V %,h
.................................................................. .........
Owner Name:......_!�:�n %q r ...�..t.0........................................... Phone No:..................................................................-------------
............................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: „!� e_n�. O. ............. Integrator:... rQ'l / q + r S
r.....................................................
Certified Operator: ................................................
............................................................. Operator Certification Number:..........................................
Location of Farm:
6ak4 0, / s"'liles Not
Latitude =• 01 =11 Longitude =• =' =11
- _ Design Current -
.; Ca acit populationp
❑ Wean to Feeder
.
❑ Feeder to Finish
29 Farrow to Wean
13 S0
1411
❑ Farrow to Feeder
F1 Farrow to Finish
Number of Lagoons
Holding Ponds / Solid Traps
Poultry
_ _rgn- urgent
Cattle -- .Canacity "Ponulation�
❑ Other
Total Design Capacity:,:
❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts '
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 1
Freeboard (inches):.........;7_�{........................._� ,/
...................................................................................................................................
5. Are there any immediatethreats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IN No
seepage, etc.)
3/23/99 Continued on back
❑ Yes 0 No
❑ Yes ® No
❑ Yes ® No
n �a
❑ Yes gf No
❑ Yes ® No
❑ Yes ® No
❑ Yes 10 No
Structure 6

Facility Number: 3 +—,3G�(1{ Date of Inspection Iz, 21OQ
ii 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 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? B Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 21 No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes N No
12. Crop type 6efmvAa A,,q S;�1) (;ra;ei
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
,Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RrNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
(9 Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
® Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
13Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24.
Does facility require a follow-up visit by same agency?
N Yes
❑ No
25_
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
yiolatigris:or de#iciendbx5 •►here pQted. cl4rririg ihis.visit' • Y:oe� �vlil•reeeiye do fuirtber;
icorresp6iidence. about. this visit:
Comments "(refer- to question #): ;Explain any =YES: answers and/or.any recommendations:orany other coihi
Use drawings of -facility Wbetter &p1aJn"s'it'ua"'tio*nsi (use additional pages asinecessary} _ r
T7. Ci}on4 i+i u e, erfo,'4S 4o e54ctt 1; s veGJe4.,v4iojt art G) e ke w,1l1S � atyo0 y
4o 1preve-Y4 ._For to erostovl.
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-&r-#- n /ecard 5. T w;! I 5ertd r-�kL, s o iOLie.y, r
Reviewer/Inspector Name o� ;�,a Z t., a
Reviewer/Inspector Signature: _� �,t�� � _ Date: 4 2.9 OQ

Fagility Number: Date of Inspection DQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
JA No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
JR Yes
❑ No
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
0 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? - 0 Yes ❑ No
Ndditional:omments and/orrawings:.
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�` .. 3 Division of Soil and-Water-T6asei vation ,•,Operation Renew
t . [3Division of Soiland Water Conservation µCompliance Inspection t
Diivision of Water aii
Qu ty Compliance Inspection
11
Other Agency Opel ninon Review -; =
Routine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number ISDate of Inspection
Time of Inspection 124 hr. (hh:mm)
Permitted Certified r] Conditionally Certified © Registered [3 Not Operationalte last Operated:
Farm Name: ......... . E �.. VA! -4,t: � .... County:... -��.�L...................................al........
Owner Name: ...........
..Iti vL e..........-......j J-G ( ...1. ....................... Phone No:.-.._-. �l �L!]...�fs �.. !.. .lP.. ..................
Facility Contact: .......h Q.. .! `t .....1 7..� Tit] e:........ �WY�P�Y ............................... Phone No: ��.�D�.�.S�.'....�.�.4.5..
Mailing Address: �.e $ t i ` S l-rpi5rdu %j/� f '✓ �i �� J C
.......IhS .. tf..ld!................................ ..... ..-....-......'..�.f.. r....... !... r....-.. J....%f..r.. ..........S.fP.. ]...
Onsite Representative: ......`i �P�YLf1 .........:....'..4.�`:! ..�.:.�................. Integrator: ......... �L.•r............................................................
....
Certified Operator:.......�L,4Y1;�.'-...................��`�i.�.�............... Operator Certification Number:.................... 41..............
Location of Farm:
Latitude Longitude �• �� ���
Design
Current` :- Design- Current Design Current
•Caftle�
., -
Swine 'Capacity
.... ...
''`'Poult
Population iv Ca acity Population _ Capacity Population '-v:
❑ Wean to Feeder
" ❑Layer ❑ Dairy
Feeder to Finish
== ❑ Non -Layer ❑ Non -Dairy
j$ Farrow to Wean 1360
= ,
El Farrow to Feeder
= ❑Other
- ❑ Farrow to Finish
w
Tofal Design Capacity. -
.' [ Gilts
❑ Boars
_
- ; ' -Total SSLW
Number of:Lagoons-.
❑Subsurface Drains PresentJ10Lagoon Area JLJSpray Field Area
°Holding -Ponds / Solid Traps
E� ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues 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
ClYes KNo
❑ Yes q No
❑ Yes A No
❑ Yes ANo
❑ Yes KNo
❑ Yes KNo
❑ Yes ANo
Structure 5 Structure 6
Identifier:
Freeboard(inches): ........ .......................... 3.�......................................................--........................ ...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
...................................
❑ Yes x No
Continued on back

Facility Number:.,3 —3G Date of Inspection
a=-j=
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10- Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNO
9Yes ❑ No
❑ Yes gNo
❑ YesXNo
❑ Yes XNo
❑ Yes 9-No
❑ Yes 14No
❑ Yes []No
❑ Yes [-)No
,-Yes ❑ No
❑ Yes [�(No
❑ Yes �No
❑ Yes KNo
❑ Yes k1No
,Yes ❑ No
❑ Yes ONO
❑ Yes &�No
❑ Yes 6No
❑ Yes �qNo
❑ Yes IRNo
❑ Yes gNo
V''N'd'-6 afibris:or iief cie diie were poled• der 'ing this:visit: • Y:ott will �eceiye po further
correspondence. AauA this .visit. .................. ........... . . . .... .
Comments (refer to gdistion #).:wExplain any YES answers and/or any recommendations araany other comments
Use drawings of facilely to -better explain situations (use.additional_pages as necessary)
i,Li. ?t,drd- -�Y vc4abje� r_Vcre&5 ds�u�► � �.
� 9• LAtCkA t_ Sai l a"Pl 1tJ"s4-0— $6. uxt� Wee�1� tC��r.r� rt�ord� 145e Keep TA; -"&Q
rj
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Wi►tier. �J
Reviewer/Inspector Name
Reviewer/Inspector Signature: �}GG Date:
J�� (�I`,J"!5 ' 3�� z ZS`' 3/23/99

Facility Number:,;? Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below . 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 VNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
j�'N0
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
VNo
Additional..Comments-and/6r rs wings
L
3/23/99

Division of Soil and Water Conservation [ Other Agency
0] Division of Water Quality
J%Routine Q Complaint Q Follow-up' 6f DWQ inspection Q Follow-up of DSWC review O Other
Facility Number
Date of Inspection (r go
-�- q
Time of Inspection 13: tXJ 24 hr. (hh:mm)
13 Registered acertsed 13 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
Farm Name: t ........ .FtP.IO....._ k.Y^/^``....lfv..c..................................... County:....:.hyph.n................_............................................
OwnerName: ........................- VAi! LV............................................. Phone No:.... ........................................
.................
Facility Contact:
Title: ................................................................ Phone No:
Mailing Address: .... Z3..y....!�!L
..S.ummN
gtYl.C.ti.....��?SSkotnd.....tut .:...........................M{:...b.Li.�1tc'.......n.........................._ ...........
Onsite Representative:...r......... L41.......... .DO.;Ir A.Q...................................................... Integrator: .........tA.0I.........................................................
Certified Operator;............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude �•,�' �" Longitude �• �' �"
Design -Current „ ;-,. Design Current _ Design-- -Current,, f
Swme Capacity,Population Poalfry "Capacity Population `Cattle' Capacity sPopulation "'
' ❑ Wean to Feeder 10 Layer 1 ❑ Dairy I.a
❑ Feeder to Finish ILI Non -Layer , ` ❑ Non -Dairy
Farrow to Wean
0
„y ❑ Farrow to Feeder , ❑ Other ,
V ❑ Farrow to Finish Total De"sign Capacity,
❑ Gilts
❑Boars Total SSLW
Numbenof Lagoons / Holding Pon' I0 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
m r u t. ' JE1 No Liquid Waste Management System `
r,.
General
1-. Are there any buffers that need maintenance/improvement? ❑ Yes y No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
P0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
(9 No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
❑ Yes
(A No
- - maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
1P No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
10 No
7/25/97
Continued on back

FacFtyumher: 3 1 —3o,�
i
-
8.
Are there lagoons or storage ponds on site which need to be properly closed'?
❑ Yes
No
Structures (Lagoons.I1olding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
] No
Structure I Structure ? Structure 3 Structure 4 Structure 5
Structure
h
Identifier . ...............i........ Z....:..............
Freeboard (ft}: L
10.
is seepage observed from any of the structures?
❑ Ye;
(No
t 1-
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
J�A No
12.
Do any of the structures need maintenance/improvement?
00 Yes
El No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify D`VQ)
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
K No
(1f in excess of WMP, runoff entering waters of the State, notify DWQ)
15.
for
Crop type .......................i��� U .ST...........St ....�-f:asv.................................................-.......... .
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
W No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18.
Does the receiving crop need improvement?
—5QYes
❑ 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 Reviewedlnspector fail to discuss review/inspection with on -site representative'?
F1 Yes
O No
22.
Does record keeping need improvement?
%Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
&No
[j No.violations or deficiencies were noted -during' this.visit.- You4ill receive no further
correspondence about this.visit:-
Cotntnents"(refer.to question #) Explain any YES answers and/or any recommendations or any, other commen s. f -
Usedraivings of-facEhty tti better eXplairi situations. (tise additional pages as necescarv)
r".---:.
d;14 vic.,tls e Ipoo,\t �,ou e I resee C -Fees
�i,oc.� he nemoved �^on� d kul,s}w 409
rlA{Stu tva • _n�.7�e olS 5 �0 t enwved 1
�e
"kodj t""Ot" J• a f s- Ova Lkrn -9 2 S�i7v�0
f� �&MEA ,r rel�
ln6e ,.
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amow-
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Dwa( 17 , ; [�; � Ie h Ec#F 1��
7I25/97
Reviewer/Inspector \ame
Reviewer/Inspector Signature: Date: o

Mft
Division of Soil and Water Conservation ❑ Other Agency k
Division of Water Quality F ,
M-M
O Routine O Complaint ' O Follow-u 'of DWQ ins ectioW O Follow-up of DSWC review 00ther
Date of Inspection
Facility Number 3
Time bf Inspection ; !�p 24 hr. (hh:mm)
Registered PiCertified [3 Applied for Permit Permitted [3 Not O erational . Date Last Operated: ..........................
Farm Name: r/ I� �.Gl,rGt7�
...........�.dc�:....�oz:.1....fair.�:........!n.-�-......................................:...... County:......u4L�.9.............................................................
�l.
Owner Name: ---...----... � .'' �.k =....................................................... Phone No:.. � °�.� -. L .fie .......................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:.... ?.. ........ ........ ............................................ ... a .�1oS......
Onsite Representative . ............ t................. Integrator:....,A&g.16
Certified Operator:............................................................... Operator Certification Number:...................
Location of Farm:
Qxf.....5ai.1. ...Inf "�.......�.1 .sv....s+......... ....1 ...t......d'7t C>4.. CS......!?....5 ..........---...............------.......................................................
....... ---- -- ........ ..... ........I........ .... .......................... _ .. ... .........
Latitude a 4 " Longitude 0• ` "
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
2. Is any discharge observed from any part of the operation?
11 Yes
❑ No
Discharge originated at: ❑ Lagoon' 51 Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
IM No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
iM 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
fu No
3. Is there evidence of past discharge from any part of the operation?
5byes
❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
❑ No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
10 Yes
❑ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97
Continued on back

Facility N umber: — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures (LaLvoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:
Freeboardtft):............................................ ...........................................................................................................................................................................
10.' is seepage observed from any of the structures?. ❑ Yes ❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...................................................................................................................... .............................................................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violations or deft ciencies.were- noted- during' this;visit..You.will receive no further
correspondence about -this:visit:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5)Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
go Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Co66b`khts;(refer to question`#): Explain any'VES agswers and/or any recommeit laiions or any, other comrnents
Use drawings of facility to better�explaiu situations (rise additional pages as.necessarv) -
I
7I25I97
Reviewer/Inspector Name
Reviewer/Inspector Signature:—
v
Date:

. ...... .. ..
DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
F Facility Number Time of Inspection H� 24 hr. (hh:m
E3 Registered ElCertified [3 Applied for Permit [3 Permitted [3 Not Operational I Date Last Operated:..
Farm Name: I& . . ........ -
, Count C- v..--V-,a.T..t.,,,. . ...... ...................
. ....... ................................. J-0.
Owner Name: ........... T
..................................... Phone No: ... 0.11.) .... Ca. ..................
FacilityContact: ................................... ................................ Title: ................................................................ Phone No: ...................................................
Mailing Address: ....... ...... N ......... M. ?-g '4S
P", jtAc ... .......... ....... ..........................
Onsite Representative:... .:7 .VIntegrator-.,M.,.V-..T-
It :�l '............................................... Certified ........... ..................... operator Certification er ...................
Location of Farm:
............ ............ ........................ ......... - ........................... ................................................
Latitude E"]; �Ll Longitude
I
Design Current
Swine Capacity Population
0 Wean to Feeder
0 Feeder to Finish
19 Farrow to Wean
1-2_5 0
0 Farrow to Feeder
El Farrow to Finish
0 Gilts
F-1 Boars
Design Current
Poultry Capacity Population Cattle,
El Layer El Dairy
ILI Non -Layer 10 Non-Dairyl
JE1 Other
Total Design Capacity
Total SSLW
-A
............
Number of Lagoons Holding P Numb ands, 10 Subsurface Drains Present I[] Lagoon Area 10 Spray Field AE!aj....
JE1 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'!
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made'
b, If discharge observed, did it reach Surface Water? (Ifyes. notify DWQ)
. cle I is I I e
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass 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?
7/25/97
0 Yes P No
El Yes El No
[I Yes
El No
El Yes
El No
rJ j4t>,
❑ Yes
0 No
El Yes
9) No
El Yes 91 No
0 Yes 0 No
[I Yes 0 No
[I Yes C![No
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lazoons,floldinz fonds Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier
Freeboard (ft):.............r..i.............. ...........
.:..�....
10. is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 0 No
tKI Yes ❑ No
Structure 5 Structure 6
12, Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15. Crop typei'i,rvY. V.tl. .......................... _......._......_..... ...........................................
lb. 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?
❑ Yes ® No
❑ Yes
® No
X1 Yes
❑ No
❑ Yes
JQ No
❑ Yes
21No
❑ Yes
KNo
91 Yes
❑ No
® Yes
❑ No
❑ Yes
19 No
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
❑ Yes
56 No
® Yes
❑ No
❑ Yes
9 No
0, No'. viola' or deficiencies.were noted -during' this:visit- .You•:wil1 receive no ftirther
correspondence about this: visit:
.
Comments (refer to question #3 - IJxplain any YES anstivers and/or any recommendatigpsvnr any other comments
Userdrawings of: facility tg bette++r, explain situations. (use additional, pages of nnecei s V_V} , J
I ".S S0-qOD+•�. .$�^'0 V`••y- Y.Q- 0 VYH F..�-0. :.� M- i•�L 14
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lo
2 .+r-�,.v 1 Z cA�rv..�-a,r iS r�-a f �rr•� �-a•L,.�..a1�'�! U�v-` ��--r1� !�- {•, [. �. �i t 1her [� .ai � 1.-w ti-b,. lac j' 1
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7 i a �—¢ v a�
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r•
aec o� �2k+�tr�"`uI ,_..
wer nsoectnr Name
Reviewer/Inspector Signature: r� __I , „ , r I", `H-0 �1�, • �,_ a �� Date:
Ft61

•
Site Requires Immediate Attention:
Facility No. 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address:
County: FJLG
Integrator rL
On Site Representative C?b'U Cr C-7, .
Physical Address/Location:
Type of Operation: Swine . Poultry Cattle
Design Capacity:
Number of Animals on Site: `oz b a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:6�10 Longitude: 6 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foat + 7 inches) Yet or No Actual Freeboard: Ft. Inches
Was -any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or To
Is adequate land available for spray? G or No Is the cover crop adequate? e or No •1
Crop(s) being utilized:
Does the facility meet-SCS minimum setback criteria? 200 Feet from Dwellings?&e or No"
100 Feet from Wells? �e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(@§
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or I
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Na If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
i