310399_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(IvU-0 I6��W
� i'vi'sion of Water Resources
Facility Number Il - ® OO Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gr!koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15 Arrival Time: T%g 7 Departure Time: o County: ty4-.1t Region: 7
Farm Name: t" i I1 iM rn {iK Owner Email:
Owner Name: } I SOS f Li-�/ Phone:
Mailing Address:
Physical Address:
Facility Contact: C.40 Ha 49C4l'"NTitle:
Onsite Representative: I
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: jV4_lfici
Certification Number: l%-t
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder
I
lNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
q
z
Design Current
D Ploult , C•_a aci P,aP
Dairy Heifer
Dry Cow
Non-Dalry
Farrow to Finish
I
11-ayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes EZLN&--0 NA ❑ NE
❑ Yes
❑ No
Ea-blA
❑ NE
❑ Yes
[:]No
[ -KA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [�FGA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes D-I�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes F6 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciEi "Number:. g - Date of Inspection:
Z'
W ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[jES fO ❑ 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): e3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0<0 ❑ 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
/
®mo 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?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
ElYes
VNo❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3No ❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
[3io ❑ 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): ( ' tM/ )
13. Soil Type(s): kat Uy 1/l If-TJ (Jl e_ p" f o—t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®,Flo
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
L21no
❑ NA
❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]"vo
❑ 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
Ef No
❑ NA
❑ NE
Reguired 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
[fNo
❑ 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 [20'Po
❑ 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 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 21412015 Continued

Facili 'Number: - Date of Inspection. .
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ego ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [BIN o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [TIN' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes CENo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EINo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ 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
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ef-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
[I -No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I -No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any addiitionalrecommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 16x�
C
Reviewer/Inspector Signature:
Page 3 of 3
- q'lO -3'Dg-- 6gs(
Phone: v Q— q3 - 33
Date: 1
21412015

(Type of Visit: eFCom ance Inspection O Operation Review U Structure Evaluation CU Technical Assistance
isit: RoutI
Reason for Vine 0 Complaint O Follow-up_ 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / % /rz,
Ct / Tiitle:
Onsite Representative: k L� 1^ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: j 1p
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder I
Fe r to Finish
Wet Poultty
Layer
INon-Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Arrow to Wean
2 4 U
lt ,
Design
Ca aci_
Current
P,o
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
113eef Brood Cow
Other
Other 7 F
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ErNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
eo^
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili6j Number: - 3 Date of Inspection: �n b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
E Q 1"" ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes fo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E: o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 0"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
To❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VTNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesEYN-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 ❑ 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 Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes j�N
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: Zio
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Uf'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes O—No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [3'RA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
ffNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.0"No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
�iQo
[] NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Na -
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
rNo
❑ NA
❑ NE
Reviewer/Inspector Signature: `� Date: 2—
Page 3 of 3 21412014

- ivi'sian ofVl�ater Resources
Macinumber -11 39 1 - I PgisiogitSoil and NYater Conservation
Other Agency
Type of Visit: ompli -Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
4.
Date of Visit: t' Arrival Time: O Departure Time: 3 nt County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
Layer
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
sign
D .rult , Ca acity
Current
P.o P.
D Cow
Non -Dairy
Farrow to Finish
Layers
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?
❑ Yes [ o ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
�N�o[:]
g
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesN
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued ! l

Ocility 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):j---
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [DNo ❑ 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 []3"'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M—No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ['i`lo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E !"o ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
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 E3No ❑ 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 To ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []'No D 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?
D Yes
; ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
��
ff/t ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
3No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑( N� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F tciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes To ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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
LJ No
❑ NA
❑ NE
❑ Yes
❑ No
Efr-A
❑ NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes [3-go ❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
I__I N
❑ NA
❑ NE
r❑
N❑
NA
NA
❑ NE
❑ NE
Comments.(refer to question #): Explain any YES answers andlor'any additional recommendations,or any other.comments:-
Use drawings of facility to better explain situations (use additional pages as necessary).
aC,or-J 5 (00A_JC on�_
oA i l�k_ A9 t rr► j of C e -.a �i,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: f(o 7 `? G 73�c1
Date: r'I
21412015

Type of Visit: 0 C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
� r. u� i r iw�� ■ r
Date of Visit: ArrivalTime:1 IDSO I Departure Time:® County: Region:
Farm Name: f (L,Uri^� f L i_ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: jt� Rl
8
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: q p �;-7
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
jNon-Layer I
Dog Calf
Dairy Heifer
Feeder to Finish
Desiirrent
Dr, P,oul Ca a,v ,
Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility .yumber: '� j - Z�q Date of Inspection: i
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M/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 environmento threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E4o ❑ 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 [3 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VlNo ❑ 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?
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
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Inspections
❑ 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 21412014 Continued
V
o ❑ NA ❑ NE
VN
❑ NA ❑ NE
❑ NA ❑ NE
[� ❑ NA ❑ NE
No ❑ NA ❑ NE
[�N ❑NA ❑NE
V�To ❑ NA ❑ NE

Facility N mber: 31 -38 IDateof Inspection; �S
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
o NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
No NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge
levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
ZO NA NE
Other Issues
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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
N NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Yes
Zf No NA NE
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 reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Yes
Yes
Yes
NA NE
NA NE
NA 0 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).
DwJE 8 (lei 1 Iq 36(6R.E Us$c c c uIJ , # EXJCj rR A),,s`r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
•JO+ t,j F� 04�_A,L
Phone: 0_U — pu
Date: T 4
Z/4/Z I4

Mr-dMoov
Type of Visit: Q Corppliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 9 U Arrival Time: Departure Time: County: I}_PLx- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Do VG A l K7r/4S _ Integrator:
Phone:
Certified Operator: Certification Number: 99536
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
to Finish
Design Current
Capacity Pop.
Wet PMile-SIAGAren
La er
Pop.
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
IrWean
Feeder to Finish
1) P,oul
Layers
Design
Ca aci_
Current
P,o ,
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean{
Farrow to Feeder
Farrow to Finish
j l
2L{ 1
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other_JMLJOther
Turke s
Turke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes j�No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection: g 4iS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 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: L-A &m
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C2rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dt4o
❑ 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 L_I No
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [�, o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 4o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31- Date of Inspection: Ck hj 111
24. Oid the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
CJ l ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
WNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
�To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
&1 o ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ "No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O/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
o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ 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
WNo ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
use drawings of fadlity to better'exnlain situations fuse additional Dages as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 1 1 ?16 _ 1
Date: a Iq 13
2/4/2 11

Type of Visit: d Co npliance Inspection O Operation Review Q 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: 1 Z Arrival Time: { Departure Time: County: a jP (2AA_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: k 0()C t UUF(MA13
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
to Feeder
Farrow to Finish
Crrent
Design u
i
Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - q Date of Inspection: '1 tt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: L.A
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
❑ Yes
Structure 5
[Z/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Observed Freeboard (in): 60
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 [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 "No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes C2(No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ❑] o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo
❑ 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 [1To ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes B10 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 [2-No ❑ NA ❑ NE
❑ Yes C2-go ❑ NA ❑ NE
[:]Yes []"N'o ❑ NA ❑ NE
❑ Yes [3'�o ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [D.,IQo ❑ 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 [_r No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E;To ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Ds ection: Z-
24! Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [E�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Ala ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes /o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [3
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes /❑No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ®No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [:J�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2/No
❑ NA ❑ NE
Comments (refer to question ff): 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:
Date:
21412011

d-Division of Water Quality '
FaciLty Number. " ( O Division of Soil and Water Conservation,";
i
Type of Visit 46Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q fcoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d t Arrival Time: Departure Time: County: �r'��JV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
5
Facility Contact: Title: Phone No:
Onsite Representative: _LIUICT41 1/V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = i Longitude: = o = ' =
' Desi n
Current= Desi r Current
g
Desn. arren t
- g q
rSwine Capacity Pipulati©n Wet Poultry *Capacity Population
Celt Capacity opulati
1P on
.. . _ .. m_.
„_.... Al -
El Wean to Finish
❑ La er
` El Dairy Cow
❑ Wean to Feeder
. ❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
�
❑Dai Heifer
Farrow to Wean 1
" DPoult ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑Beef Stocker
❑Gilts
�' ❑ Non -Layers
o Beef Feeder
❑
❑ Pullets
El Boars
❑ Beef Brood Cow
❑ Turkeys
Other �°»^ "' Y ❑ Turkey Puultsa
❑Other
❑ 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dIN111
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Fa �lity Number:11 — (q Date of Inspection C)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: LA6v&�
❑ Yes No ❑ NA ❑ NE
El Yes ❑No El NA El NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �2 /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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N, ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes � Co El 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 UINo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VI No ❑ NA Cl NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes Zo El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNp- ❑ NA [I NE
❑ Yes No ❑ NA ❑ NE
Comments (refer.ta 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.}: t P
•
Reviewer/inspector Name
j erg :- ( Ib -„; z-: Phone: Qtb
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 ' Continued

LFacility Number: 2. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain InspectioneNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
11J N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IrJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F�— Noo
[3 NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
EI'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
,�,
[a o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
to
❑ 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
040
❑ NA
❑ NE
as
Additional Commenfs.and/or Drawings:
Page 3 of 3 12128104

`", Facili'ty Nu
k
Type of Visit
Reason for Visit
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Apliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Arrival Time: % Departure Time: County:
Facility Contact: /� Title:
V Onsite Representative: qu� %q't.&j6 J
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [=o =! =!! Longitude: 0o =! =
Design Currentiiiiiii
Design Current
Design
C►urreut
Swine
Capacity Popu` lation
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑Dai Calf
❑ Wean to Feeder ❑Non -La er
❑ Feeder to Finish
❑Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
y P
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection d
Waste Collection & Treatment
(� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
1
ill No ❑ NA ❑ NE
(iet 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
JNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
VN ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to ❑ NA [IN E
maintenance/improvement?
/No
l l . Is there evidence of incorrect 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 Area
l2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 7NN
❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Ye: �No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [/o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 6No ❑ NA ❑ NE
1) rXkAV CIE r,✓ C6
Reviewer/Inspector Name I `J& AA:t 1 Phone: 67 f
Reviewer/inspector Signature: Date: // /
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
.Required Records &Documents /
E� 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 L] No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U4
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,[,, //No
L j' o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�J No
❑ NA
❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
^El
NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El
WN
❑ 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
f 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
❑ NA
❑NE
General Permit? (ie/ discharge, freeboard problems, over application)32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
��/�Nq,
o
El
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Addinonal'Comments and/or Drawings:
4
Page 3 of 3 12128104

FA
• Division of Water Quality
==Facilfflyumber �j _ �jcj� 0 Division of Soil Md Water Conservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: t \fit s7 6 Arrival Time: Departure Time: County: U Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 1eENDAU_ Hl1MM4d Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E= o E__1 I =1 p Longitude: = ° = 6 = «
gn Current
Design
C►urrentrenSwine
Imspcity Population
Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean 2 f
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
El Beef Feeder
F013oars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other I
Number of Structures:
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facil4y Number: Date of Inspection It a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o
❑ NA ElNE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes No
❑ NA ❑ NE
through a waste management or closure plan?
th at, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7No
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl 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
maintenancehmprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes9'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes � o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WN o
❑ NA
❑ NE
Zo.) 1) e 0RT wuP Vj"T" N
C_ t1ic1' r sv -r
Reviewer/Inspector Name I S { Phone:
Reviewer/Inspector Signature: Date: i v
72/2MInd Continued

Facility Number: — 3 Date of Inspection a
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 al components of the CAWMP readily available? if yes, check
❑Yes
❑ No
❑ NA
El NE
the appropiate box. D WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
VINo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�No
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El0 Yes
o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[�Vo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
bNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PKNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

V Division of Water Quality
'1Faeility Number Q Division of Soil and Water Conservation
- O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 FoltOW up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: It tom{ J 1 Arrival Time: Departure Departure Time: County: L'1L1.14.! _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: kk-sopau A�fl'i1 Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 e [= I = Longitude: = ° = ` =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑X Farrow to Wean
1-411
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & 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 Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes tJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ef No
❑ NA
❑ NE
Cl Yes ENo ❑ NA ❑ NE
12128104 Continued

Facility.Number: — Date of Inspection t`l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L-A Gaa IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '-11
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 IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L`L No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir7yes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? P 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 L/J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement? ��,,��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes C2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
IS. 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 acre determination?❑ Yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dZo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ 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):
` ) DIV.6, WALL' tvEE.bS S01,AE Co\JfCF . WCrRJt_. 096 At c) 04Dc,u►%4E,oiErj
Q ,j u,J 6
Puar As 3i_5
%-+4 G-o-J p ES.iGl�I .
Reviewer/Inspector Name jowo Pgrta+lL-L\_ Phone: to 14 b 3
Reviewer/Inspector Signature: 0 J Date: s S
12128104 Continued

Facility Number: 3 ­311 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 readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists Design ❑Maps ❑Other
ElYes D No ❑ NA ElNE
19/yes: ❑ No ElNA ElNE
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
Cade
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
{J 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
L' I No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYe
WNo
El 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
[-INAEl
NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
�lLl/No
iJ 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
�2o
❑ 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
aN.
❑ 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
❑ N9
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
El
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

j i r
Type of Visit 0
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
xRoutine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: I W, Departure Time: County: ���%N Region:
Xe
Farm Name: /Wvd/_nP/_� J64R/]A Owner Email:
J /
Owner Name: iQ G !l iPiif SS VC�57,4 7,�5 L!i i!i Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Trams Onsite Representative: 49V16 o�jtie,, /f_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O =' =] Longitude: = o
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
Current Design Current
Population C•attte Capacity Population
❑ Wean to Finish 10 Layer
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
pry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
Farrow to Wean
El Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Gilts El Non-Layers
❑ Pullets
❑ Boars El Turkeys
Ot e 10 Turkey Poults
❑ Other 1E1 Other
[IBeef Brood Co
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 V1 No ❑ NA ❑ NE
❑Yes
❑No
[I NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
'0
ONo
❑ NA
❑ NE
Page I of 3 12128104 Continued

r
r
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?: An
Designed Freeboard (in): ,5
Observed Freeboard (in): 13
Structure 4
❑ Yes VNo
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
to
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.) I
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
u
Se, /dI��s
i
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1Z
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(11
Uf 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):
Fn1 Q�CDQ aT� ST�i �T �n/J Sro r° cI ;
/CFI- c,rc.f1 � ��''� � �N s7��D � ��t1�z�✓E`
Reviewer/Inspector Name �~ �� Phone:�—
Reviewer/inspector Signature: Date:
Page 2 of 3 � 12128104 Continued

Facility Number: ' -- Date of Inspection 'Y`5
Required Records & Documents
I9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No El NA El NE
the appropriate box. ElWUp ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes]
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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/11
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
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
1
TV
Page 3 of 3 12128104

PLAN OF ACTION(Poa) FOR HIGH FREEBOARD AT ANIMAL FACILITIES NOV ZI?OS
Facility Number: AWS310399 County: Duplin
Facility Name: Triumph Farm
Certified Operator Name: Kendall Huffman Operator Number: 16819
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level v�l
in the lagoon to the bottom of the spillway for lagoons with spillways.
Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4 Lagoon 5
Lagoon Name/ID: _Triumph
Spillway(Y or N): no
Level(inches): 18
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures.
Five and 30 day Plans of Action are attached. Hydraulic and agronomic balances are
within acceptable ranges.
XXXX Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A
30 day Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Bolume and PAN content of waste
to be pumped and hauled is reflected in section Ill tables. Included within this plan is a list
of the proposed sites with related facility numbers, number of acres and receiving crop
information. Contact and secure approval from the DWQ prior to transfer of waste to a site
not covered in the facility's CAWMP.
Operation will be partially or fully depopulated.
*Attach a complete schedule with corresponding animal units and dates fro depopulation
*if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: 11/20/2006
I hereby certify that I have reviewed the information listed above and included within the
attached Plan of Action, and to the best of my knowledge and ability, the information is
accurate and correct.
A 3 L; Yl I on Phone: �If0 v��f I.35-7
Facility Owner/Manager (print)
Q Date: Od
Facility Owner/Manager (signature)

�1
II. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YRJ24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1. Structure ID: Triumph line m = 699.2 lb PAN
n. 699.2 lb PAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD. DO NOT LIST FIELDS TO WHICH PAN CANNOT BE APPLIED DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining IRR
t TOTAL PAN
u. application window
2 PAN balance
BALANCE FOR
(iblacre)
FIELD (lbs.)
column r x s
AW 11-15
Wheat
36.42
104.00
3787.7
Se -Apr
AW 16-18
Wheat
1
16.01
96.00
1
1537.0
1 Se - Apr
AW 19-21
Small Grain Overseed
11.93
50.00
596.5
Oct - Mar
'State current crop ending application date or next crop application beginning date for available
receiving crops during 30 day draw down period.
v. Total PAN available for all fields (sum of column t) = 5921.1 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) = 699.2 lb. PAN
x. Crop's remaining PAN balance (line v from section Ill) = 5921.1 lb. PAN
y. Overall PAN balance (w - x) = -5222 Ib. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here including pump and
haul, depopulation, herd reduction, etc. For pump & haul and herd reduction options, recalculate new PAN
based on new information. If new fields are to be included as an option for lowering lagoon level, add these
fields to the PAN balance table and recalculate the overall PAN balance. If animal waste is to be hauled to
another permitted facility, provide information regarding the herd population and lagoon freeboard levels at the
NARRATIVE:
Irrigation onto existing spray fields will continue as weather and field conditions permit. Additional land is
available for pumping if needed. Application will be done with an aerway drag hose system. The WUP reflects
the use of this equipment.
PoA (30 Day) 2121 /00

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
1. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/Identifier (ID): Trium h
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker 18.0 inches
b. designed 25 yr./24 hr. storm & structural freeboard 19.0 inches
c. line b - line a (inches in red zone) = 1.0 inches
d. top of dike surface area according to design
(area at below structural freeboard elevation) 159216 ft2
e. line d12 x line d x 7.48 gallons/ft' 99245 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design 255571 ft3
h. current herd # 2000 - certified herd #1 2000
actual waste produced = current herd # x line g = 255571 ft'
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 daysAine f=
4. Total PAN to be land applied during draw down period
I. current waste analysis dated 1 10/16/2Q06
m. ((lines e + k)/1000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
1ft3
u9625o ft3
438604 gallons
1.30 Ibs/1000 gal.
699.2 Ibs. PAN
PoA (30 Day) 2/21/00

F
IType of Visit of Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7 D Arrival Time: � � Departure Time: County:
Farm Name: Owner Email:
Owner Name:RZ Phone: _
flailing Address:
Physical Address:
Region: r �D
Facility Contact: Title: phone Na:
Onsite Representative: ,11f _f}/L 4F�d )0P4 �A1- erator:
Certified Operator: rl�LiJ�. L. /� T5 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= e [= 4 = Longitude: = ° = i = {!
MW_1esign
Cent
y.
Destgn; Current rD40
estgn' CurrenM�rS.
-s »'r` •. d __.g �y`Swine,Capaypalatcnf'�'P^ Capactty,Poplat�on Cattle Capacity Paplatian
,
❑ Layer 1 ❑ Dairy Cow
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -La et
❑ Dairy Calf
❑ Feeder to Finish
MAIN,`
L oul
ray PtT ,
r.
❑ Dairy Heifei
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Layers
❑Non -Layers
E ❑ Pullets
❑ Turkeys
❑ Gilts
❑ Boars
❑ Beef Brood Co
s xax
Other e,
... a
.� a�,� •�{, w,'t., . �.
Number of�5tructures: L
❑ Turkey Puuets
I
❑ Other ❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes ;�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PfNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
ElNA
ElNE
other than from a discharge?
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
❑ NA ❑ NE
El NA El NE
Struc ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes !Z No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.) ,�(
6. Are there structures on -site which are not properly addressed and/or managed El Yes I[J No ❑ NA El NE
through a waste management or closure plan? /
❑ Yes 0 No
❑ Yes [:]No
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 ElNA [INE
8_ Do any of the stuctures lack adequate markers as required by the permit? ElYes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes Id No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10No ❑ 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
❑ Outsi of AcCceptable Crop Window �❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �, jJ$ (/t//��i4T r¢ �`" 4
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo ❑ NA ❑ NE
10No ❑NA ❑NE
0No
❑ NA
❑ NE
PNo
❑ NA
❑ NE
[;�No
❑ NA
❑ NE
>��r-..ti-._:.., _�_:�_,. .:,a-. ��n,.«.,..- ---aces. �rce S, �x�. _ r_.'�. - F; � ... :�.-'.. z.p .�:w�. :_ _3.,+.>.!3r...�w ,..'Y.:rD sr..®.� � ,...�r!er.✓�s'�t '3a r
VrV G:9G�o� GcJH�c /�,E,E p G�PAS� Dvi,Cf1 G/_`;
Zj SioC�2�G f'F�� 4-% So ztl
A, Ap,"-5
Reviewer/Inspector Name ICE T? Phone: ! /0
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 3 — Date of Inspection f1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ 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 )eNE
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
XNo
❑ NA
❑ NE
Addittanal Cotiiuietitsings - _ _ .�
�/tr
94©
a0,0XIV, _SPa" yF7oce6 s "Pok�do
12128104

s e
Uther j
7:777 7 '777
7M
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit PyRoutine O Complaint O Follow up O Emergency Notification O Other El Denied Access
Facility Number 31 Date of Visit. D=Time: t7
0 Not Operational Q Below Threshold
0 Permitted Q Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .�__.� .... _.
FarmName: ..............J 9'1!V!............................._................_......._. County: ...... Yl�Qrr..... ....................... ..._............
Owner Name: .............. .. _ ........ __ __....... Phone No: .� ._. _...... _.. �......._.
Mailing Address:
Facilitv Contact: .............. ................... _.... ......... __..._- Title: Phone No:
Onsite Representative:... [ F 1... 4..6 ........... ....... _...._.... Integrator: ........... �W.._................
Certified Operator:..... ................................._...._......__............................ Operator Certification Number: ......... ........................ ..._._.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & L& Longitude • 4 64
i DesYgn Carreat ' �, DQg_ n Curren# P > Design Content .
, --
Swiae ,, _� �'Ca act _ Po-ulaiion... Poultry_ 1 - - i -' a t Pop ulatron�-s�Cattie�< ` _ __Ca act E-Po "itlahon
_ ❑Layer =: ❑Dairy
-JONan-Layer.° ❑Non -Dairy
_ x r
❑ Other
•
.,;.. ^x 5
rK 10 D�.S1�IlCapac.><ty_
-G-_
-s
To#aI SSLW
�rNumber of Lagoons e
_xga
Q Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Z,Qt1D
MIS,
Farrow to Finish
Gilts
Bows
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min"?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... .....i................--- •--------_--------------..._.-........................ ............
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection f v
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes /No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Downy stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes VNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground /❑+ �C,o"p�per and/or Zinc
12. Crop type �� (G u _97t&-rd 6tl& J1..5661)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �'No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? El�dNoYes
15. Does the receiving crop need improvement? ❑ Yes �o
16. Is there a lack of adequate waste application equipment? [IYes PNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes fidNo
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes )2fNo
Air Quality representative immediately.
tedrawrn of faccili to,bet#er srtua�oas. asetzonal es as necessa )�
(� ❑Field Copy�� ❑�F� u�al�rrl
�"� �j"��'��
e � -' �� , -�: � �. , ` � .< ���"� � -� � -� � Notes}= _�
r
�j6Rl�'tddR Y�E t.D Nr�� �E CJ wOriKE D N AN6 P'( spaagr-E-0,
�pzn�� Ate �►� r� rf! K�°�
r,arA is tNG �.c. +Mfl�
Reviewer p actor Name 4-- - .
GF
_ y � _
Reviewer/Inspector Signature: Date: !
12112103 1 1 Continued

Facility Number: 3 ._ Date of Inspection 1$
It Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes)ZNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [�No
❑ Waste Application [I Freeboard ❑ Waste Analysis [I Soil Sampling
`
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ';� No
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes �1�io
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes ❑ I10
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes J'No
28. Does facility require a follow-up visit by same agency?
❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PFNO
f
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 31 3 q- date of visit: Time: t o= I S
Not O erational Seiow Threshold
O Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: -Tr ' v "•^ P Fa, ^^ County:
Owner Name: _ 'r i V,,..t p l-• %j S S Q i e 1 L 1< G Phone No:
Mailing Address:
Facility Contact- Title: Phone No:
Onsite Representative: , ..,_! �'r'� `� �.q Integrator: ✓� n'�-1 �"1
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• 0 " Longitude ' �•
Design Current Current Design ,_xCurrent
WSKtne._:..
_Ca acitvPo "nlat,onPotsitr-_.._-.�: C - Cattle ��-_-�.Cs`acat�-=Po utatron _= acity . Po elation
❑ Wean to Feeder
❑La er❑Dairy
ElFeeder to Finish
= Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
!'
❑ Farrow to Feeder
{ Other
❑ Farrow to Finish
t Total DesignCadw.psrtt
❑ Gilts
y .
❑ Boars
aLSSLW
wNnmber of L.agoods � .,.,
i ❑Subsurface Drains Present ❑ La oou Area ❑ S rav Field Area EZ
HoldiagaPonds /.So1sd Traps
A ❑ No Liquid Waste management Svstem
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes _'B�qo
Waste Cgllection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J2-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches): 3
0510310.7 Continued

Facility Dumber: ,3 ) — 311411
Date of Inspection lO 3i Z
S. Are there any immediate threats to the integrity of any of the structures observed?� (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Poonding ❑ PAN El Hydraulic Overload
12. Crop type f +" rn v ct C,. a �. r, Ll �.1 n .1 c� 1_ X-" c,,) i 6 YR--h. _d i e rseC_4 I (1 a rr W k
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?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) i
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 ONo
❑ Yes ONo
❑ Yes �ffNo
❑ Yes ❑'No
❑ Yes ErNO
❑ Yes ETNo
❑}}Yes 0No
�7i S,-qr,j
❑ Yes No
❑ Yes ;!rNo
❑ Yes ZNo
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes 21 No
❑'Yes A:sNo
❑ Yes EfNo
❑ Yes ZNo
❑ Yes 0 No
[]Yes )2rNo
❑ Yes 9No
❑ Yes ,❑ No
❑ Yes '2rNo
[:]Yes J;3No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,{refer to question #): E iplsrn any YES answers antlfvr.aay recommendations or any Mher comEuenis.; -
_ �6
Use drawings of-fact7i to.beEter laua� sttgations ' ase additional a es
g n { p g as tteeessary) _
Nw� ?❑ Field Com
—
❑ Final Notes
.
s Amrrw r f VEYy L,)ene,j,
Are Ver7
well keje4. --ryie s�„-,;r,c �,�1l.&rF A,✓e� q�ai �a5ao js
we1>I
r., o., V% ; c, v ,r^e A , T 1, p ) �, g d o +n Iv- e e b o A rot ' -5 Ia kct4 14 sh o t, _ Id b e
->te� L1�e�,r- rke"C y .s a ngeo( +
e-c gnbl sL,
%e. ✓►, u d n, a ►� ra 1oD/rt i G v� O� T e b e'er ri-t -r; e
l Gi 4 e
11'e,s flares 40 4k;j f`;e+d
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

acilit} Number: 31 —31111 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
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 permanenthemporary cover?
❑ Yes ❑ No
❑ Yes 'O'No
❑ Yes P"..'40
❑ Yes ONO
❑ Yes ZNo
❑ Yes ONO
❑ Yes ❑ No
Additional Comments and/or.Drawings: - -'
o-10 e ff ov > S
ad c� o✓dtpr Are evade i rirNat grloY'cc t-a4eOf Al sv, sa--,el
was done "L-, q rOVJ
O5103101

w; Drrision of Water Quality`-
,
Q Devtsion of Sot! anti Water Canset vatton
A
Other Ageucy.:
Type of Visit Inspection Q Operation Review O Lagoon Evaluation
IReason for Visit 1011outine . Q Complaint Q Follow. up O Emergency Notification Q Other ❑ Denied Access I
Date Ur Visit: I S-3 1101 1 'rune: 1 9 • 3 C= Printed on: 7/21/2000
Facility Number 1 3 J
Q Not Operational Q Below Threshold
© Permitted © Certified [3 Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
Farm .............. Name: 1 � M FA O-Ms County:...P.v�.I..'.?........................................................
.................................................................................................................
Owner Name: PLC �...................................... Phone No:.......................................................................................
Facility Contact:
Title:
MailingAddress: ........................ ............ .......... .......... ............ ...............
Onsite Representative:... o,�' , m oo r-c
....I............................................
Certified Operator:
Location 'of Farm:
Phone No:
.... ................. ................................................................. I.. ..........................
Integrator:.13ro� ✓n +J 6-P ►-�cl
Operator Certification Number:.......
Swirte ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 44 Longitude �• 4 C�6d
Wean to Feeder
Feeder to Finish.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
3edgn ' Current Design Current Design Current
tt ei Po ulation Poultry Capacity Population Cattle Ca aci. .. Po Wation
❑ Layer I 1 1[:] Dairy
❑ Non -Layer I 1[:3lNon-Dairyl______
O OD a ❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area 10 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 [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. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................... .................................. ................. .. ... .......... .. ........................ ............................................
Freeboard (inches): 369
5100
❑ Yes )21"No
❑ Yes �No
❑ Yes �Ao
❑ Yes 'O No
❑ Yes Q"No
❑ Yes P110
❑ Yeso
Structure
Continued on back

Facility Number: — 3 Date of Inspection Printed on: 7/21/2000
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type IR ^►Vet -IJ `�\-f sn' t II Gr-t1.1. 66,- L,JkXC")q, S�746egnS-
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?
Re uired 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?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iet 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?
(iel 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?
l7: ilN,O-AOtigris'et- dCeie d,t-Wire hoed, 0&ing this:vsit: • Y60 'Will eegve no turthe- -
:.
. correspondence:about:this'visit_'-'
❑ Yes �No
❑ Yes ) ` No
❑ Yes JyNo
❑ Yes /2f No
ElYes )21"No
❑ Yes IffNo
❑ Yes ,21'No
❑ Yes j2rf'o
❑ Yes ,F,�rNo
UrYes ❑ No
❑ Yes_0No
❑ Yes ] No
❑ Yes &No
❑ Yes Jallo
❑ Yes'ONo
❑ Yes".,dNo
❑ Yes 16No
❑ Yes ❑'No
❑ Yes VNo
[:]Yes VNo
�1er cAc,'lr4716rojaf J(5)vu; receDrd5 OIL Melt �«J,J. !- _/,J
is) War- 1, r(/Mpio✓e 4 p-eo^i,4e be,r"v,,4c, ,y—q p( 1''Li OI/eASOf L6/-mVdr,,� 1,'el
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: ,� I3 UPI 5100

Facility Number: Date of Inspection f , Prinied on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '121No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes "EfNo
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 2fNo
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 /EfNo
31. Do the animals feed storage bins fail to have appropriate cover? [] Yes Pilo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

/>
Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
ty Number
Date of Visit-, 4 d 'Time: � Printed on: 7/21/2000
Facili31 � 9
Q Not Operational O Below Threshold
Permitted © Certified [3Conditionally Certified [3Registered Date Last Operated or Above Threshold: .....................
Farm Name: A i h" 1 Not r"'n Counts': aR + Y1
.................................................j...............i.............................................. �1... j..1...-....................................
OwnerName: ............96 ..In .... Phone No:.......................................................................................
..... ..............................
Facility Contact:
.. Title: .11 ............................................................. Phone No:....
:Mailing Address: ............... ................................................................................................................................................................................. ..........................
Onsite Representative:-a1-7 pi eo re Integrator: .U->7/J q-- t
'
--,,,,........................................................................................................................................
Certified Operator: ................................................... . ........................................................... Operator Certification Number:.--................
Location of Farm:
It
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��° Longitude ram• ��' ���
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I JE1 Dairy
❑ Feeder to Finish JE3 Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ZQ eD ZOe p ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagsinn Area ID Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, Was the conveyance man-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 gallinin'?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............1.1 ........-...................... ....................... ....................................................................................................
Freeboard (inches): L11
5100
❑ Yes ',gNo
❑ Yes f�WNo
❑ YNo
h�
❑ Yes No
❑ Yes 19 No
❑ Yes J'No
❑ Yes 19 No
Structure 6
Continued on back

,v FaciCrty Number: ,T) rate of Inspection ) Q4 Printed on 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ;'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Yes 15No
12. Crop type Ce ✓` rt t } bs So �j b e,qh S, Be r"yd of 14b , -rno, 6 rA i n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes jg'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? (:1 Yes PfNo
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes J'No
R_eguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ElYes Z 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 9 No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Oyes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes DjrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes ;j'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
24. Does facility require a follow-up visit by same agency'? ❑ Yes 'gNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes -'No
.... vi. .. .jr. . .deficiencies •were rtbted d&i&t fhis:visitti- Y:otr will•reeeiye fio futther • : •
correspondence: about, this visit .:.:.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
I jvv- �',QQ rer►ieve nonber-r-tudti Ve9c�a�ro>1 4eorw\ ber.�udei �C eV
etp& &eW4; es�a�li.s� beer►-lv�a.i�e ave AA la•�1e.5jrl,,�, r66.-
o GK, wtere speA yl^ Ajoell lime 4o f�, e ar --4'ie-Uf gCGP1V;nj
-�� so �'-/cs� a� so6, A s
7-— �d� -vjv xc; I o►tit� Ve9e�q-�e �ctr"e A���r �Jr1 Iq�pvn a.� {ie1d 3-�
�� .••R� ; V S-�-dtr� i s � .
1,1. U.Se ar reofir;1do 6e.5; n•rt i+tig r"47N ,*i141AGe 1-10 1 wvt4e, PArl a"t�i(rJQ-�'�• cj
Gal! +n

I
Faetiity Number: Date of Inspection [ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 5$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 V No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2TNo
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 NfNo
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 CgNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZ No
32. Do the flush tanks lack a submerged fill pipe or a perinanent/temporary cover? ❑ Yes J4No
Additional.'Comments and/orDrawings:
M. zlon4 'l veA .
Be S u the b (15 C 019rrT ed 4 e A IVA4 q r1 A J y s,'s- On
5100

- V.
f3 Division of Soil and WaterrConservaftion ^Operation Review
Q Division of Soil aiid WaterConservat�on _Compliance°Inspection =
- - )2—!Division—of Water Quality Compliance Inspection T r _
�:Otler Agency, Operation lReiview' p
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-uUof DSWC review Q Other
Facility Number 3 Date of Inspection 7 t
Time of Inspeclion T 24 hr. (hh:mm)
XPerwittedCertified 0 Conditionally Certified [3 Registered Not O erational Date Last Operated.
?011 ff �t
Farm Name: ........ N...-1... '1 _.....FAe_.-A_s ...................... County:.........De-Lk d.............---
....................................... .
Owner Name:
Facility Contact: .............................................................................. Title:
FlailingAddress:..........................................................................................
Onsite Representative: M b
...........................................................................
Certified Operator:.. ....................... .........
Location of Farm:
Phone No:...........
.................................. I...... Phone No:
p.................................................... ...... I...................
....................... Integrator:.....f'. �?. .$... �' �.....L %,",xj ... ................... ......
........... Operator Certification Number: ..................
............................................................................................................................................................................................................................................................... w
Latitude 0 6 64 Longitude • =° 11
` Design Current: , Design- , Current Design Current
Swine------. Capacity Population— - Poultry Ca achy_ Population Cattle ,- .. Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
[] Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Fa
jTow to Wean
arrow to Feeder ❑ Other =
'?�o�
Farrow to Finish Total Design" Capacity
❑ Gilts
❑ Boars '.. Total SSLW
Number of Lagoons- ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding.Ponds / Solid Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �To
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JZNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes O'No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 2 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes,&No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
h
Freeboard (inches): ..........1-.3
.......I............... ._....................... ........ ............. ... ............ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,es
seepage, etc.)
3/23/99 Continued on ack

Facility Number: — 3 Date of Inspection
6. Are there structures on -site which are not property 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 maintenarice/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
5-7AIr-
7 /g
❑ Yes XNo
❑ Yes �No
❑ Yes /No
❑ Yes �No
Cl Yes VNo
J ❑Yes �to
Goa;d
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?
0; 10 yiolafiQris;or deficiencies were noted• during tbis;visit:-:Y:oik will-TebO*ci iiti further ; ;
.. ,correspontience abotit this .visit« ... ... .... .. .. .. ...
❑ Yes VNo
❑ Yes 2rNo
❑ Yes ja'No
❑ Yes V(No
❑ Yes )2�No
❑ Yes ONO
❑ Yes [?'No
❑ Yes 0 No
PKYes ❑ No
❑ Yes 01N10
❑ Yes W o
❑ Yes No
❑ YesNo
❑ Yes ZNo
❑ Yes LPw
Comments (refer to,question #):-'-Explain any YES answers aud/or-any recommendations or: any other coimn nfs .W
Use;drawings -of faciiity to'better explain situations: (use additional pages as necessary) -_
-
�g) rPk7�&Ak r%C_0 F4V_-= t_i Ti E-S AAUS r- ire A Wcvt r-t- r R4 A,A-0 C-0G
✓�'�T r� aR-�tti(� E1 I�� VJ> ✓LL. e:]Q-�.Ar-f i z,� AP��� [,4�i cf rJ l��C�� D
r.1o_ �1 T - SPa-`GCHQ 5� c_gzAuaA �FU46 z�b .
s} c�-^t�i� A`� $ E SPaT' �1�:F1•a S C.;,a.tg: p�1�s���� SAR�i rf(* 4�+�
Reviewer/Inspector Name a" �.. z. w .�
Reviewer/Inspector Signature:-,�..,... y, _ �� tj,� ~ Date: 7 fill"
3/23199

r
Facility Number:.�f* — 3 F Elate of Inspection /9
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
MYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
O/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
INO
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
[io
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
VNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ZNo
AAditional . omrtients an: or- .rawings:'I AJ
Ss-Av_ ikw..,. FA��; Qf� 4�.A�5 t l3�tr �o'T fl--�aD
3/23/99

Devtsion of Soil and Water Conservation ❑Other Agency0 3
� �j Divtston of water Quality
Routine O Complaint O Follow-uR of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
Registered Certified [3 Applied for Permit 11 Permitted 10 Not Opera tionalNhA
Date Last Operated:Farm Name:.... �-:�:..M51+�... ``.:rr..--...--�++.,,.. County: ..... ........................................ I......................
Owner Name :........ _....................... ........ ..... i Tl ............ Phone No: �... .
Facility Contact: .............Llsmn .......I &Q ................. .... Title: ..................................... Phone No: ... (afo�29� r �. ............
Mailing Address:......... D.s1I .....altf5p r. ...! �.:.. d.�.:Y.e 3G
ra... t................................................ �..1�.1 s.......................Y.".....:�.......
i
Onsite Representative: ...........�1. u..'...... RW.1............................................................ Integrator: .......Ey 0 �,.S..............................................
Certified Operator;............................................................................................................... Operator Certification Number,............................
Location of Farm:
Q.r.....k�uC........ .... af..... ? ..t�I.4.r....l.... 1�.1�......e � ....a ......�....lna�....................................................................................I.._...........
........................... -------.------......- .. . ...---...-----....... ............ .........
Latitude 0 6 C LG Longitude ' 0' 49
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes W 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? I ❑ 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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [%) No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fait to have a certified operator. in responsible charge?
❑ Yes
1P No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaQoons.11oldine Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (ft): ..........1,3 ................
10. Is seepage observed from any of the structures? ❑ Yes SR No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes [A No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
19 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
§6 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
............. .
Crop type r�............. T............... Mf.:............................ ......................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
1P No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
R) No
18.
Does the receiving crop need improvement?
0 Yes
MPNo
19.
Is there a lack of available waste application equipment?
❑ Yes
W No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ERNo ,
21.
Did Reviewei/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
22.
Does record keeping need improvement?
Vj 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
Im No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EA No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[9 No
0, No:viailatioits�or d&cieneie's:were'noted-during this'.visit.- You:rvill rece'ive•iio'f&iher-:
correspondence oboiA this:vWt:, .::
12•�-6nhnU4 ¢. -k-o �t�1'lc���0. da-c LJG.�1- LQIX' p�KC. ualk SY 'Aj b'__ ftX00�e(A- t�Yt7SfOn
( berm Ggt4S Oe� l` ]} , I J
a S ON Jew 6`.4 W��l �� 6e- -stwvW �3 t ��LLO�`{F rtue-ded,
i2_ caafY'_ 1�N1.i 'S ou d 6e {A11e e" " 1 ft.ccAs. ►N-L cor r_j cma,-
7/25/97
Reviewer/lnspector Name Fy 4 Ag 'r vt w� a . t s.
Reviewer/Inspector Signature: Date:

❑ DSWC Animal Feedlot Operation Review
BDWQ Animal Feedlot Operation Site Inspection
Wtoutine O Cornelaint Q Follow-up of DI Q inspection O Follow-up of DS1i'C review O Other 1
Date of Inspection p
Facility Number
Time of Inspection = L 24 hr. (hh:mm)
© Registered © Certified © Applied for Permit E Permitted 113 Not Operational Date Last Operated:
Farm Name: ....... County: ... � ..........��..�
Oxvner Name:....... .................................0....f4... Ihone \o:.(...i.11..Q.....a.....` 0193.11(.°
aL
Facility Contact: a..�1.�rt.....t3.p.�r.�.......................... Title:................................................................ Phone
MailiMailin Address _ Ln � Z 3
ng Address .. .........L�..,..1..�.......5� .,,� j,,��-...-...................:...........W.-;�........�..1.i...v:,e,.........►��..�................... �...6.5
Onsite Representative: ... a,o-k........ .a. r.Q.r................................................ Integrator: ... �..Yo..�N..>n ....................................................
Certified Operator; ...................................... ........... . Operator Certification Number, ..........................................
Location of Farm:
<?.ra....�.�.�..�Y+. .... .�.. p ....5.:..1......;...��..c-a.x..Y,M1a.... .... ..... .1.,..........rn.�...�......
�a.s.�...a .....�.K..�r..st�t.�r.
vu�$ tr►.-...-�.�.1-aQ `--.......... :...................................................... .................................................................. ...............................
..........................................
Latitude �' �1 44 Longitude �• �4 44
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
Design Current Design... Current,
Poultry Capacity Population Cattle Capacity; Population.
❑ Layer =1 10 Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I&Subsurface Drains Present JIULagoon Area i❑ Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
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 Ed No
b. If di:char c is observed, dill it reach Surface Water? (If yes, notify DWQ) ❑ Yes KNo
P c. If discharge is observed, what it the estimated flow in gal/min?Mal
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
RNo
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
ELYes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design`?
❑ Yes
19 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
®.No
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes $5 No
Structures f>Lagoons.Ilolding Ponds. Flush Pits. etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ®.No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .....3.�.............
Freeboard(lt)..............................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes CKNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? KYes ❑ No
12. Do any of the structures need maintenance/improvement? PKYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
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 ...5. .y----------------------------------
I ....
� ............................ ........
v+1..!�L�.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.violatitins or deficiencies werenoted during this.visit.- You.will receive no ftirther'
correspondence shout this.
visit:
ornu ents (refer to question #): R Explatn;,any YES answet's and/or
Jse drawings o facility to better explain situations (Use additional
S v T M t.: t, I- to U (�Z' ✓vt OLM,
11 . 12-, C. 0 ;rrL G & 2Ary f It ,n K � c�,l a s y. ,,,,t a.. 1, L
t-o.q o "Ja. t 1 . LJ
4 1J s i c .t a J�
❑ Yes RNo
❑ Yes 10 No
......................................
❑ Yes
5 No
❑ Yes
@-No
❑ Yes
12 No
❑ Yes
No
KYes
❑ No
❑ Yes
KNo
❑ Yes
IELNo
❑ Yes MNo
❑ Yes R No
❑ Yes KNo
1 V I s it- {
J_; i*-'14 .
CL"'L e-e'v� -e- t u_ i-4__ cY C I
a^---�Pr0, of tloae+�-
7/25/97
Reviewer/Inspector Name f 1
Reviewer/Inspector Signature t . ,. rt� _ r Date: 1 13 / 0 9-7__

•
Site Requires Immediate Attention:
Facility No. 31 Sqq
DNISION OF ENVIRONMENTAL MANAGE?vIENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: I / —1 -5 , 1995 � rn
Time. 10. q z?
FarmNameJOwner: _ - f'A6N1--`�_W
Mailing Address:
6S
County: s/yl' �► _ _ _ -
Integrator ,rOc e�✓l5 O � ef'geo '• 4' - Phone: S'3 - 34 Uzi
On Site Representative: v VY\ is D V e— Phone: 8' f
Physical AddressJLocadon: , A � + s �t(-1 -S / rLe
Type of Operation: Swine _X_ Poultry Cattle r i �PecPi�
Design Capacity: 2004r?[a_� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude. Longitude: 77 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 Foot + 7 inches) 19 or No Actual Freeboard: 2,`Ft. - Inches
Was any seepage observed -from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
j n
Crop(s) being utilized:; .N 119
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? � or No "
100 Feet from Wells? 0 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 IViap Blue Line? Yes or T&
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orvg 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 oro
r�ti f i_. . - ;
Inspector Name. - Signature
c:: Facility Assessment Unit Us4 .attachments if Needed_