310417_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental W4

type of Visit: omplia ce inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gr9outine Q Com laint ❑ Follow-up Q Referral Q Emergency ❑ Other Q Denied Access
Date of Visit:
Farm Name:
Arrival Time: r Departure Time: County: I Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: _
Facility Contact: Title: Phone:
Onsite Representative: c rj r 6-9k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Certification Number: T 9
Certification Number:
Latitude: Longitude:
Design eurrent
Swine Capacity pap.
Wean to Finish
Wean to Feeder
I
Design Current
Wet Poultry Capacity I?ap.
Layer
INon-Laver
Design Current
Cattle Capacity Pup.
airy Cow
Dairy Calf
Feder to Finish
Design Current
Dai Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Dr. 1'.oult FTMC. aeI PAJON
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
urkeys
Turkey Poults
10ther
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 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 6No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
[2NA ❑NE
❑Yes ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-N_o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier-
Spillway?. -
Designed Freeboard (in):
`{
Observed Freeboard (in): yJ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[:I 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
4 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
[2-'ice
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3'-Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�*o
❑ NA
❑ NE
maintenance or im rovement?
p
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
���N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C5No
❑ 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
gNo
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rainfall Inspections Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes N C] 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

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the per t?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑'No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
EfNo D NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑'NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o ❑ NA ❑ NE
❑Yes 0' 0 ❑NA ❑NE
❑ Yes EJ I�o �❑ NA ❑ NE
❑ Yes [T'No ❑ NA ❑ NE
❑ Yes ❑-I o ❑ NA ❑ NE
❑ Yes [3-<o__[3 NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Gbmtnents.; (referito;gpestian #); Explain ariy YES answers;andlur.: Any;additional:recbmsnendiiitibias ur any other:, camrrients .
Use drawings:af facility ', ett e_xplain.sit'uatIoris {ase_additional`pages as necessary):
Reviewer/inspector Name: Of-~ I �'P, `h tj
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7if
Date: J
214J 01

DlVi5iDn of Writer Resources
Facility Number - EM .❑ Division of Sail and Water Conservation
❑ Other Agency
Type of Visit: Ciance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
leason for Visit: aRoutine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: t Arrival Time: 9 Departure Time: © County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _ Cr1 � f � A ._n__ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
W n to Feeder
tAfeeder to Finish Co
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: 1 7 r 7
Certification Number:
Design Current
!'Vet Poultry Capacity Pop.
Laver
Non -La er
Design Current
ury routtry
Layers
Non -Layers
Pullets
Turkcys
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?
h. 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dair
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes La No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
D Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ NA
❑ N E
❑ Yes
5Z�'
❑ NA
❑ NE
Page ! of3 21412015 Continued

Facial Number: °7 1 - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ N ❑ 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
o �] NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FfNo ❑ 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
ETNo, ❑ NA
NE
maintenance or improvement?
Waste Ammlicatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or Improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes Vo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes [3 N ❑ NA ❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes L' J N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes U No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili 'Number: 3t t zp I Date of Inspection.
pg-
2k Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0--No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 "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 N❑ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No l :.l NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
�No
❑ NA
E] 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
d No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Reviewer/Inspector Signature: -.tom Date:
Page 3 of 3 21412015

LIE
�zen $r4s UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
• y REGION 4
o q ATLANTA FEDERAL CENTER
Fyrgc �eaz+a�or $1 FORSYTW STREET
ATLANTA, GEORGIA 30303-8960
CERTIFIED MAIL 7015 1730 0001 8044 2555
RETURN RECEIPT REQUESTED
Mr. Claro Stroud
Claro Stroud Farm
961 E. Wards Bridge Road
Kenansville, North Carolina 28349
Re: Claro Stroud Farm
NC Swine Waste Management System General Permit (AWG10000)
Certificate of Coverage No.:AWS310417
Dear Mr. Stroud:
On March 26, 2015, the U.S. Environmental Protection Agency Region 4 and the North Carolina
Deppartment of Environment and Natural Resources performed a Compliance Evaluation Inspection
(CEI) on the Claro Stroud Farm (Facility). The results of the EPA's CEI are summarized in the enclosed
report.
The EPA's participation in this inspection was to evaluate the Facility's compliance with the
requirements of Section 402 of the Clean Water Act, 33 U.S.C. § 1342, the regulations promulgated
thereunder at 40 Code of Federal Regulations Part 122.23.
Enclosed is a document, the U.S. FPA Small Business Resources -Information Sheet, to assist you in
tinderstanding the compliance assistance resources and tools available to you.
If you have specific questions or need additional information, please contact Mr. Don M. Joe at
[phone],
Enclosures
cc: Mr. John Farnell
NCDENR
Ms. Christine Lawson
NCDENR
Sincerely,
Stormwater & Residuals Enforcement Section
NPDES Permitting & Enforcement Branch
RECEIVEDINCDENR/ R
MAR U 7 2016
Water Quality Regional
Operations Section
Wilmington Regional Office
Internet Address (URL) • http://www,epa.gav
RecycIad/Recyclable • Printed with Vegetable Oil Based Inks on Recycled Paper (Minimum 30% Postconsumer)

United States Environmental Protection Agency
Washington, D.C. 20460
Water Compliance Inspection Report
Section A: National Data System Codin i.e. PC5
Transaction Code NPDES yrlmolday Inspection Type Inspector Fee Type
N AWS310417 2015/03/25 J = 3
Remarks
Inspection Work Days Facility Self -Monitoring Evaluation Rating BI QA ---Reserved---- Reserved -------------
Section B: Facility Data
Name and Location of Facility Inspected
Entry TimelDate
Permit Effective Date
Claro Stroud Farm
12:30AM. 3/28/2015
10/01/2014
961E Wards Bridge Road
Kenansville, NC 2B349
Exit Time/Date
Permit Expiration Date
01:45PM.3/2612015
09/30/2019
Names] of 0n-Site Representatives)/Title(s)/Phone and Fax Number(s)
Clay S. Stroud, Operator, [phone]
Other Facility Data (e.g., SIC NRtCS, and other
descriptive rnformafionj
NAILS: 11220
Name, Address of Responsible OfficiaVritlelPhone and Fax Number
Claro Stroud
Claro Stroud Farm
961 E Wards Bridgge Road
Kenansville, INC 2t3349
Section C: Areas Evaluated During Ins ection Check only,those areas evaluated
X
Permit
X
Self -Monitoring Program
Pretreatment MS4
X
Records/Reports
Compliance Schedules
Pollution Prevention
X
X
Facility Site Review
Laboratory
Stormwater
X
Effluent/Receiving Waters
Operations & Maintenance
Combined Sewer Overflow
Flow Measurement
Sludge Handling/Disposal
Sanitary Sewer Overflow
- Section D. Summary of Findings/Comments
Attach additional sheets of na► -ative and checklists, includinR Single Event Violation cartes, as necessa
SEV Codes SEV Description
❑ W ❑ ❑ ❑ ❑
Name(s) and Signature(s) of Inspector
Agency/OfficelPhone and fax Numbers
Date
USEPA Region 4/Water Protection Division:0
Clean Water Enforcement Branch
La��
Stormwater & Residuals Enforcement Section
Don M Joe, Environmental Engineer
Ph: [phone] Fax: [phone]
Signature of Management 0 A Reviewer
Agency/OfrlcelPhone and Fax Numbers
Date
1
USEPA Region 4/Water Prate ctlon Division
![ !
C.f
Clean Water Enforcement Branch����
Stormwater & Residuals Enforcement Section
Daniel J. O'Lone, Section Chief
Ph: [phone] Fax: [phone]
EPA Form 3560.3 (Rev 1-09) Prrvioue edrtbm as ob�olsto.

NPDES CAFO Water Compliance Inspection Report
Date: 03/26/2015
Weather Conditions: Clear
State Inspectors): John Farrell, Environmental Engineer, NCDENR
Entry Time: 12:30pm
A
Facility Name Claro Stroud Farm
Latitude/Longitude 35' 1' 24.96"N 7.7" 53' 39.84"W
Type of Operation Swine
Number of Animals 1,860 Feeder to Finish
Permitted
Number of Animals in Confinement 1,760 X 45 days or more
Animals have direct contact with Waters X no ❑ yes, explain
Nearest Waters ❑ 303(d) listed, for
Goshen Swam
25-year, 24 hour rainfall amount for this location 7.5 inches
Description of Facility
This facility has three swine houses and a waste lagoon. The facility can house 1,860 swine with
the waste storage capacities of approximately 180 days (231ft x 196ft x 8ft, approx. 2,553,043
gallons).
7Permitmber AWS310417 ❑ individual X general
X copy available on site
Date Issued October 1, 2014
Expiration Date September 30, 2019
Number of Animals the Facility is permitted for 1,860 Feeder to Finish
Compliance Schedule X no 0 yes, provide a brief description

Facility has NMP X yes X copy available on site
❑ copy maintained at farm office at another location
❑ no X the Facility has a nutrient budget
❑ the Facility has an environmental management plan
Includes Maps of Production and Land Application Areas X yes ❑ no
a RECORD KEEPING
Inspections of Waste Storage System X yes ❑ no ❑ some, explain
Liquid Systems, Freeboard Records
X
❑
yes ❑ no ❑ some, explain
not a liquid system
Inspection of Storm Water Controls
❑
yes
❑
no
❑
some, explain NIA
Rainfall
X
yes
❑
no
❑
some, explain
Records of Manure Transferred Off Site
❑
yes
❑
no
❑
some, explain NIA
Records of Land Application of Manure
X
yes
❑
no
❑
some, explain
Maintenance Records
i.e. equipment calibrations
X yes ❑
07/15/2014
no
❑
some, explain
Annual Reports
❑
yes
❑
no
❑
some, explain NIA
Emergency Response Plan
X
yes
❑
no
Soil Sample(s)
Manure Samples
X yes ❑ no ❑ some, explain
X yes ❑ no ❑ some, explain
3

Manure Storage Structure(s)
❑ holding pond
❑ lagoon
❑
concrete structure
❑
under house structure
❑
manure pack house
❑
manure lot
❑
composting
❑
other
X clay lined
❑ aerobic digestion
❑ clay lined
❑ concrete slab
Description of Storage. Structure(s)
The manure is stored in an anaerobic lagoon
❑ synthetic lining
X anaerobic digestion
❑ synthetic lining
❑ tarp/cover
Designed to NRCS or State Required Standards X yes
❑ no
❑ do not know
Visual Inspection of Structure
Structure(s) appears to be maintained to state standards
X
yes
❑
no' ❑ concerns, explain
Structure(s) appears to be stable
X
yes
❑
no ❑ concerns, explain
Rain gauge installed and maintained
X
yes
❑
no ❑ monitor rainfall by
Structure(s) maintain liquid waste
Banks are maintained
Marker is present to gauge freeboard
Adequate freeboard eased on NmP or state standards
X yes
X yes
X yes
X yes
❑
❑
❑
❑
no
no
no
no
Comments
4

MANURE7. ► ■GEMENT (UTILIZATION
OF
Manure Transferred Off Site ❑ yes
X no
❑ some, explain
The Facility is following state approved ❑ yes
protocols for transfer of manure
❑ no
❑ some, explain N/A
NMP Calculated Application Rates and X yes
Areas for Application
❑ no
Manure is Land Applied on Farm X yes
❑ no
❑ some, explain
Description of Land Application System
The facility has 22.52 acres'for land application and applying waste water with irrigation reel.
The Facility has Adequate Land Available
X yes
❑ no
Facility has a schedule for Land Application and is
following the schedule
❑ yes X no ❑ some, explain
Apply as needed
Facility has appropriate setbacks and buffers
X yes
❑ no ❑ some, explain
Visual Inspection of Land Application Areas
Field Identification
Crop Growing_Permit:
BMPs 1 Buffers
Concerns
P1 - P6
Bermuda grass
25 ft.
Mortality Management According to the NMP
❑ burial
❑ incineration
X rendering
❑ composting
NMP gives specifies location for mortality management
❑ yes ❑ no . NIA
NMP specifies management required 0 yes 0 no NIA

Visual Inspection of Mortality Site
Mortality Management On Site
❑ burial
❑ incineration
X rendering
❑ composting
Facility is Managing Mortality According to the NMP ❑ yes ❑ no NIA
Comments
Shared an animal dead box with Steward Stroud
Farm.
NMP addresses the storage, handling and management of all chemicals ❑ yes X no
Chemicals stored on site
❑ fertilizer
❑ herbicides
❑ pesticides
❑ cleaning supplies
❑ fuel
❑ veterinary
❑ other
Method of Disposal of Chemicals
No chemical stored/used on site
Visual Inspection of Chemical Storage
Facility is managing chemicals according to the ❑ yes 0 no NIA
NMP
Comments
No chemical storedlused on site
r•7

No discharge observed during the inspection.
Exit Time: 01:

AWS310427 Claro Stroud Farm
Photo # 1 Facility aerial map

AW5310417 Claro Stroud Farm
Photo q 4 Lagoon has adequate freeboard of 33 inches (Based on the 25
yrs., 24 hrs. rainfall amount for this location, facility is required to maintain
at least 14.5 inches of freeboard)

AW5310417 Claro Stroud Farm
Photo # 5 2014 Waste Analysis Report

(Type of Visit: (3'Coce Inspection Q Operation Review p Structure Evaluation t) 'Technical Assistance
Reason for Visit: outlne Q Complaint p Follow-up Q Referral Q Emergency Q Other p Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
C to, 4 'jk( -�. t,- J_
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: rf 730�
Certification Number:
Longitude:
F
Design Current
Ucsign
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
@attle
Capacity
Pop.
Wein to Finish
can to Feeder
Layer
11 iNon-Layer
I
Dairy Cow
Dairy Cal f
Feeder to Finish
! O tog 9
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P.oult .
Layers
Design
Ca acit
Current
1Po
Dji Cow
Non-Dairys.
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Puuets
Other
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 P' to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑N❑
❑NA
❑NE
[:]Yes ❑ No ❑ NA ONE
❑ Yes J No ❑ NA ❑ NE
❑ Yes F!!�No [DNA ❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
•
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Na [] NA ❑ NE
[:]Yes P'" ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ET'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. [:]Yes ZfNo ❑ 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
C3 No
❑ NA
❑ NE
15,
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑/
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
-
—❑
NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, cheek
❑ Yes
eNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 LJZo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � ❑ NA ❑ NE
Page 2 of 221412015 Continued

Facility Plumber: jDate of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
24. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;1*6- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�KAA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes t < ❑ NA ❑ NE
❑ Yes E2< ❑ NA ❑ NE
❑ Yes ❑-Ko— ❑ NA ❑ NE
❑ Yes
[3-fqo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
[] YesFI-No
❑ NA
❑ NE
Reviewer/Inspector Signature: 62�Date:
Page 3 of 3 21412015

Type of Visit: U70utine
Hance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Q Complaint Q Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: 1340
Arrival Time: �G= Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: cl_A�yfD&2un _ Integrator:
-72 Certified Operator: Certification Number: I
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
La er
Wean to Feeder
on
Feeder to Finish
Farrow to Wean
t7
Farrow to Feeder
Farrow to Finish
Gilts
eNon-L
Boars
Poults
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
El 1 other I I JZ1 _ I Other I
Discharees and 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 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?
❑ YesVNo
No
❑ NA
❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21417014 Continued

Facility 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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
• Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Zv
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
❑ NA
[3NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environm;Ivo
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? ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding [3Hydraulic Overload ❑ Frozen Ground [3Heavy 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): J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fN o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CyNo ❑ 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 Yo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes 7No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
gNo
o 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ 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?
24. 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, Freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ 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 reviewlinspcction with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes I 2I No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
VNo ❑ NA ❑ NE
/o ❑NA ❑NE
❑'No ❑ NA ❑ NE
IComments (refer to.question, #):;.Explain ;any, YES answers: and/or; any. additional. recommendations or.. "any other:cnmtrients:� .s' x :
IJse drawings of facility ta.better explain situations (use:additional,pages aslnecessat yj.
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
101
Phone 9 /0 T4, ^ -? 3 gy
Date: 3 /;1- 6 / I ,-
214C1U1

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: gRoutine Q Complaint Q Follow-up 0 Referral ❑ Emergency D Other Q Denied Access
Date of Vlsit: Arrival Time: Departure Time: County: DIJ6- Region:
Farm Name: tea, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: CL- Vdj
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: r7 3,95coat
, Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop,
Wet Poultry
Capacity
Pop:
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Deslgn
Current
Dry Cow
Farrow to Feeder
Or• Poultr.
Ca aci
P,o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,Turkey
Poults
Other
Other
Discharees and Stream 1mnacts
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 P"No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes Q No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

►/
Facility Number: -41 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ 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: f
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(i,e,, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0No ❑ 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 E:�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes XfNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) iiiiii�����-
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 4 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 4No (DNA ❑ 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.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
8,No
❑ NA
❑ NE
❑ Yes
�No
NA
❑ NE
❑ Yes V1 No ❑ NA ❑ NE
[:]Yes �fNo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo
❑ 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 jd No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facillty Number: It, - L.1 jrj IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes pfflVo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
�] Yes
P No
❑ NA
❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 2j No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
�] NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: `at4e\ Phone: c`� -3M-Xz o
Reviewer/Inspector Signature: _ ,�.,��-- Date:
Page 3 of 3 21412014

Division of Water Quality
Facility Number-IJ - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 9:NAfAl
Departure Time: [1�
County:
Farm Name Cl a„
o s+,"
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator:
jy
�i
■ �
�
Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ther, .
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Laver
Non -Layer
Design Current
Dry Poultry Capacity' Poo.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
other
Discharacs and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure [] Application Field ❑ Other:
a, Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Z No ❑ NA ❑ NE
[] Yes 0 No
Yes [:]No
Yes No
Yes No
[� Yes E2-No
NA NE
NA [] NE
NA ONE
�NA NE
NA NE
Page I of 3 21412011 Continued

li acili ' Number: IDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0'+No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: � �1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
;2 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
Po
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FrNo
❑ 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
,EfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
JZ 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
;ZrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;?No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
<' ❑ Yes
No
❑ NA
❑ NE
Regu_ired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes 0 No
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 9 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes VrNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Fail ure 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 ;6 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes VrNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes XNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Zf No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZI No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gT No
❑ NA
❑ NE
Comments (refer to question #); Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facilityto better explain sitttatlons (use additional Rages as necessar }.PW
Reviewer/inspector Name:
Reviewer/Inspector Signature: AAAA
Page 3 of 3
Phone: P-52 O L'"b
Date: W 3
21412011
1�

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: rcompliam Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ARoutine Q Complaint 4 Follow-up ❑ Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: Q� County:j L>LAQi uN Region:
Farm Name: Ce-paCa Srn Owner Email:
at I 01M tcaa U to (H
Owner Name: La�-C'3 �T2fJI.�L� Phone:
Mailing Address: "I r {ii V�]�-1 QGl C &/1/M5U 1 "LLG lve 4&3
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:Integrator:
c
Certified Operator: Certification Number: 3
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
"Layer
on -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkcy Poults
other
Discharues and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes KNo ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: i
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ 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: C,otSN
Spillway?:
Designed Freeboard (in): 1g.5
Observed Freeboard (in):
5. Are there any inunediate threats to the integrity of any of the structures observed? ❑ Yes No [3NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0,'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 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? Ift
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.]
Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc..)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): c
13. Soil Type(s): �U ►J
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
�4 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
tN
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists 0 Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tA No
❑ Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑Xste Transfers
0 Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections El Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes No
❑ NA ❑ NE
❑ Weather Code
[] Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: --C' i. - Ll 1 Date of Insnection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes No
❑ NA
❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
]�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
0
❑ 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:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): 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),
rangy C" D (519
5 U,AD& E ex�P caw
NG �
m�I,gC, S I SCE C1 f 11
Reviewer/Inspector Name:
Reviewer/Inspector signature:
Page 3 of 3
r
— /Vo ftC)C_1 3 S //Vc- & / P// /
C.XNOON E oli'�
s
Phone:
Date:
2/4a011

Division of Water Quality
Fa 'ility Number ?j' Q Division of Sail and Water Conservation
Q Other Agency
Type of Visit Acompliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit �(Routine 0 Complaint Q Follow up i) Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: tL! Ur r Arrival Time: Departure Time: County: Region:
Farm Name: <fZ-Pf2C> S7R-0LXD POZO-] Owner Email:
4 to - -o� (4try N
Owner Name: ��L> 7f�o�� Phone:gx0 =—rlqlo -i 39 5 Cw*)
Mailing Address: `7 (01 E: ��� S'IR-1� !r—� �1�%� 5„1 LLB, ��'�► IT�
Physical Address:
Facility Contact: �1 Title:
L,
Onsite Representative: �Q'1 i S . _ � l _..
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: [], ,
Operator Certification Number:�0
Back-up Certification Number:
Latitude: 0 U 0 I= 11 Longitude: = c 0 6= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ gther
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? (Ifyes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
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
k No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Puke 1 of 3 12128104 Continued

Facilitydumber: -7,) — L�
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_,I Structure 2 Structure 3 Structure 4
Identifier: ccy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
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
*N❑
[IYes ❑ No
Structure 5
❑ NA ❑ NE
El NA El NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
{Not applicable to roofed pits, dry stacks and/or wet stacks}
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement? A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Pondiing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or iU lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &(E LL 4) C<3W SG 1,_')�►EAT S
13. Soil type(s)
14. Do the receiving crops differ From those designated in the CAWMP?
❑ Yes
No
k
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application'?
❑ Yes
N❑
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Comments '(refer ;to question'
;13xplaln any. YES ansWers andlor�any. recommendations ur pny.6tNer comments:;
Use drawings'nf facility to�hetter: explain situations. {use addit[onal,page's as `nece"scary):. r ,, i r
T
Reviewer/Ins ctor Name Phone:
>� Nr' 1 6-
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. El WUP [] Checklists
0 Design ❑Maps ❑ ether
21, Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis [] Soil Analysis ❑/ste Transfers ❑>inual Certification
0 Rainfall ❑ Stocking 0 Crap Yield El 120 Minute Inspections 0 Monthly and[" Rain Inspections [] Weather Code
22. Did the facility fail to install and maintain a rain gauger? ❑ Yes bNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ yes XNo ❑ 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
0No
ElNA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
X NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
tNo
❑ 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
t..q..,, a" • is ,
"•Y •i �.. yi-S•.lw 4t
Additiiiiial:iiEurririienls`andlor Dr'ttwln s ,? € "v'• x..:: :Y,, ..>€; e.is t � f ,, i Am
, 11
A
)C)/ 9ho r.a
Page 3 oo3 12/28104

Typo of Visit • Compliance Inspection o Operation Review Q Structure Evaluation o Technical Assistance
Reason for Visit 0Routine o Complaint o Follow up o Referral ❑ Emergency o Other ❑ Denied Access
Date of Visit: �It) Arrival Time: Departure Time: County: L/A( Region:
Farm Name: CLoacs S- ack&DF-pern Owner Email:
CLraaa S cz4ut] qio-aq("-aoUtoCW)
Owner Name: ► phone: x � 'a
Mailing Address: `iYt � � 5 '1�� I fl C KGN4qSU 1 t_LF A/C o%'S'R— d
Physical Address:
Facility Contact:
Onsite Representative: CAA- 1 S
Certified Operator: CL=6_kA C
Back-up Operator:
Title:
Phone No:
Integrator:
aol0
Operator Certification Number: F-B o S
Back-up Certification Number:
Location of Farm: Latitude: = ❑ ❑ I 0 11 Longitude: = ❑ ❑ 1 0 11
llcsign Current
Design Current
Design Current
Swine Capacity Population
Vet Poultry Eapaeity Population
Cattle Capacity Population
Wean to Finish
❑ La er
ElDai Cow
Wean to Feeder
❑ Non -La er
Dai Calf
Feeder to Finish k
Dair Heiicr
Farrow to Wean
ElDr Cow
[[rE:l Farrow to Feeder
Non -Dairy
Farrow to Finish
Ej La ers
Beef Stocker
Gilts
❑ Non -La ers❑El
Beef Feeder
Boars
Pullets
ElBeef Brood CoTurke
s
ther
❑ Other
'f'urke Poults
Other
Numbe► of Structures:
Discharge__s & Stream Impacts
1, Is any discharge observed from any part of the operation?
[]Yes
)ANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
INo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JNo
❑ NA
❑ NE
other than from a discharge'?
121,28104
Continued

Facility Number:
Date of Inspection f1
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: %4 ooAl
Spillway?:
Designed Freeboard (in): 19. S
Observed Freeboard (in): ?j 1
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 anchor managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes 0No ❑NA ❑NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify )DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes X.No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? X
11. is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes �(No
❑ NA ElNE
❑ Excessive Ponding [IHydraulic 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 IX No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes )n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes V No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes V No ❑ NA ❑ NE
A.
C..ornmenls"(refer: to questlori #]:..explain any YilS'answers;.and/ormny recommendations or..apy other corttments., 1
Use drawings: of facility to better explain situations'' use additional pagesku"s riecessary�j�� � a' � � � a�
.. ( .. s� z_ _ .,,. �. :,.sae• . Ps' `3g•& �3 :f. � ._o; 31
W _ R6
�, {: —=tea :: �-9(0 Reviewer/Inspector Name "j;..5 ;;.';::. a%.r `.k;'.P Phone �1CJ
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection ®1
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes
XNo
❑ NA
❑ NE
the appropriate box. [] WUP ❑ Checklists ❑ Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
)4 No
❑ NA
❑ NE
G Waste Application ❑ Weekly Freeboard 0 Waste Analysis [3 Soil Analysis ❑ Waste Transfers ❑ V ual Certification
[] Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and i"
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
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? [ie/ discharge, freeboard problems, over application]
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
AddI gs:
12/2&V4
12/2&V4

jType of Visit Compliance Inspectlon Q Operation Review Q Structure Evaluation Q Technical Assistance
IReason for Visit &Routine O Complalnt Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time:
Time: ®rDeparture Time: �� County: Region:
Farm Name: C P Q(U2> S 1"' �11�-m Owner Email:
Owner Name: T N�s Phone:
Mailing Address: • wabs G 1�-�3 ►�N� V j�~�-'E .I a6 ,'7 �—
Physical Address:
Facility Contact: Title:
Onsite Representative: r--(-A�-TI >
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e 0 & ❑ Longitude: 0 ° = 6 0
ii
Deslgp Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ID Non -La er
❑ Dairy Calf
Feeder to Finish
I4
rj(j
❑ Dairy Heifer
❑ Farrow to Wean
❑ry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef' Stocker
❑ Gilts
❑
Non-ts ers
❑ Beef Feeder
❑ Boars
Pullets
❑Beef Broad Cow
❑
Turkeys
Other
❑
Turkey PouIts
Number of Structures:
❑
Other
❑ Other
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? (Il'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 any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: + — 1
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?
f ,Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA6ocytl
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in). y d
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 arc not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �*o ❑ NA ❑ NE
El Yes ❑No El NA ❑NE
Structure 5 Structure 6
❑ Yes )0 No ❑ NA ❑ NE
❑ Yes ;QNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 4 No ❑ NA ❑ NE
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes [(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �6e[Z P AUt GQqW S G% ( 6
13.
Soil type(s) A u�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PQ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
;qNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
jq No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Reviewer/inspector Name F, Phone: 8 • 9 6o—
Reviewerllnspector Signature: Date: QQ 3
Page 2 of 3 12128104 Continued

FAII1 y Number: `,�j —�� hate of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IXNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
0 Design [] Maps ❑Other
2I. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard [] Waste Analysis [] Soil Analysis ❑ kste Transfers ❑ onual Certification
D Rainfall [] Stocking Cl Crop Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1,No
❑ NA
❑ NE
23.
1Fselected, 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
�ZkNA
❑ 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 oFdead animals within 24 hours and/or document
❑ Yes
A 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
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LmfNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
-`T Facility Number 3 l Q Division of Soil and Water Conservation
a Other Agency°
Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit P Routine Q Complaint Q Fallow up D Referral a Emergency Q Other ❑ Denied Access
Date of Visit: I I 3 d% 1 Arrival Time: Departure Time: L.� County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: , �l.t� l S �i L�Ctu') _
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Latitude: o Longitude: °
Design Current Design . Current Design. Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population .:.
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish 600
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
::;Other.. .
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
Nan-L.
Pullets
Turke
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
Dai Heifei
❑
Dry Cow
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of tire State
other than from a discharge?
u
❑ Yes Cq No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
[I NE
❑Yes
[I No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
12128104 Continued

Facility Number: l - t j =}- Date of Inspection T�d
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: LAC-,OCY11
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L43
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 4 No ❑ NA ❑ N E
El Yes ❑N❑ El NA El NE
Structure 5 Structure 6
❑Yes ®No El NA ❑NE
❑ Yes [—%No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 5No ❑ 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) ��55
9. Does any part of the waste management system other than the waste structures require El Yes fy No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need ❑ Yes R1 No ❑ NA ❑ NE
main ten ance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Da No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 d% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name IM A N DA G 91 AIES QLIM JP4R"Ef-(­ Phone: T!L1 6-3119'?
Reviewer/Inspector Signature: Date:
17179laA ra"01"flad

Facility Number:3 1 Date of Inspection r D�
Required Records &_D_ocuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes E,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q 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 91 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes E� No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[E[No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LQ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E[No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes MNo El NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
2� 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
,o No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
X1 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit o Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Jy U Arrival Time: ,� Departure Time: �a� ounty: G� Region:
Farm Name: L- Owner Email:
Owner Name:.. -�� .� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �%Y� Integrator: V'rT
Certified Operator: 6A-Lf — =- ST a, r - Operator Certification Number -
Back -up Operator: Back-up Certification Number:
Location of Farm: 0 ° 0 ` 0 " g = ° 0' = "
Latitude: Longitude:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
A 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
ko
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
oNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r
Facility Number:, — Date of inspection 3 d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
a
Designed Freeboard (in):
f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XZNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes IgNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes gNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes �No ❑ NA
❑ NE
maintenance/improvement?
/
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ONo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of
Area
12.
Crop types] �.,�jYi ,Q ���� 6,
13.
Soil type(s)
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ff No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes ONo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes A!f No ❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes )�rNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes 'R'No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendatlons'.or any: other comments:::
Use drawings of facility to better explain situations. (use additional a es: as necessa
g tY P P g ry}:
,
'.
rr) o v,C• 6 /5;e &
Reviewer/Inspector Name
!Phone:
Reviewer/Inspector Signature:
Date:
Pagel of 3 12128104 Continued

Facility Number: — Date of Inspection 3 d
Rertuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes XNo ❑ 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
XNo.
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JdNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
=No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
o
XN
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspec(ion with an on -site representative?
Cl Yes)21TNo
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
•n04/ d 1"earn
vorv. � c4, lU�� � �-✓f
���� �'2 '�� r -
AL
Ale— SEr/F_LlFL L i��
Qrl��q c Aelyi s
GCJ� �� rf �� �,9-�►��►�.
Page 3 of 3 12128104

7'.
Type of Visit A Compliance inspection Q operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 6 Routine Q Complaint Q Follow up Q Referral a Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �County: 4am-60-2�
L
an ill
Farm Name: �1 Owner Email:
Owner Name: CGD ��I!'IJIrGi Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
J
Phone No:
Integrator: y
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I =14 Longitude: o
958 �+�os 9401ado MO.
Region: WI/CV
Design Current
Swine Eapacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Eattie *apace city Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
❑ Dai Heifer
Farrow to Wean
Ilry Poultry
❑ D Cow
❑ Farrow to Feeder
Non-DairY
❑ Farrow to Finish
Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La era
El Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
Beef Brood Co
Other
❑ Other
�"urke Pouets
❑Other
Number of Structures:
Discharp_es & 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 0No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes 0No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
1212"4
Continued

r .
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )Z(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?: _ O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No El NA ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9fNo ❑ 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? II
Waste Avollcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XfNo ❑ NA LINE
maintenance/improvement?
1 l , is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > I0% or t0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) �f III1f3 61,40)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP7 ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes No ❑ NA ❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NF
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes ZNo ❑ NA ❑ NE
Comments (refer to question 4): 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):
CSC :J,PO
Tv
Reviewer/Inspector Name
Phone: f4
Reviewerlinspector Signature:
Page 2 of
Date:
12128704 Continued

F...
Facility Number: I — Date of Inspection D
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp 0 Checklists ❑ Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;iNo ❑ 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
L�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
WNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IVNo
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
VNo
❑ 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
P
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or drawings:
�ZS) 14t- A/F.--_>n tleO �0,145 8tv" Ce' 2 00�,
Page 3 of 3 IZ28/04

Type of Visit J6Compllance
Inspection
Q Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit 1"
Routine Q Complaint
Q Follow up ❑ Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure'l'ime: PCounty: ISRegion:
Farm Name: Owner Email:
Owner Name: t� 1D �r��u ---- - -- - - - _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �l%IQ���] �IQOclId
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
f� r
Integrator: ll s
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = f = Longitude: = ° = & j
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
MTurkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed !'rom any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Daia Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: FE
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 VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NF
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes '10No ❑NA ❑NE
❑ Yes ;YNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — pate of Inspection i I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 91No ❑ 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?: /yO
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes r 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 16 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
m a i nten anc e/i m pro v eme nt?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. XY
es ❑ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
,OPAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 10 Evidence of Wind Drift Application Outside of Area �
12. Crop type(s) 244V') � f �I. Cf� 10ow 43 ,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �LL No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
i Ja :.,.�-'�: �: :.•�e�: .�". •: i�q�pp'yF�
Comm is {refer,Ito`questlon{#) Esplaln;any_YfS`answers and�or ny recomrttendations r any other.commcnts.
Use drawings vf`faeility,;to lietter"explaiq situation`s {use dditlonalYpag as ne essuryJ:
�U� �� TdGz L�3 ro LG � ��•A��r.+� Aw �%PeAJ -r �� � WUA�
Name Reviewer/Ins ector " Phone; 4-
p
Reviewerfinspector Signature: Date:
I2128104 Continued

Facility Number: 5 flute of Inspection J�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'P�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ElNA ElNE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste 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?
❑ Yes
)z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Cl Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ Na
0 NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[21 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours andlor 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? (iel discharge, freeboard problems, over applicat ian)
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
VfNo
❑ NA
❑ NE
�%� RQF'SF y�T �: SFalL4.. 'ri'Y 4�':i'L+... •�b:a�,.. �k' ' .�'�• ...�� ��T. - i'��'°''
Additional Comments Andlgr��Drawin
9j) 612, (7lizot 64e-r-oAz) ��o 71 2:wrt/ 4f:�If'lj
r �,�,✓f �,��� o� COP'l 0/- In
12128104

Type of Visit 'Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit R"'Routine ❑ Complaint ❑ Follow up ❑ Emergency Notification a Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
,JdPernAUed�Certifieed. `0 Conditionally Certified r�p0 Registered Date Last Operated or Above reshold: .............. ..........
Farm Name : ............. ... -:!-��....0 i .....��'1..................................... Cannty:..........��.IP�• ..................... .......................
OwnerName: .. ......................... ...................... .... . ....................... . ... ........................ . ........... Phone No:... gib..-..ZR�a....... / 3 9 j .......................
Mailing Address:
FacilityContact:............................,..•..J........................................... Title:................................................................ Phone No:...................................................
Onsite Representative: ........... ca. .I....... i !a ......... .................... ...................... Integrator:. _. .. � � I'/, ................. ..................... .....-
Cerfified Operator: .... . .. . ............................ . .... ......
Location of Farm:
Operator Certification Number:,...... ............. »...................
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 46 Longitude ' ° 44
Current' € J Design Current
5wirie Poult „ , . ,
Ca atx ... Po : tion "o :... ..- - - Y.. !Ca act Po ulatian
❑
Wean to Feeder ❑Layer
r;
eeder to Finish o i, ❑Nan -Layer
❑ Farrow to Wean
h O
❑ ter Farrow to Feeder ❑ _
Farrow to Finish
Gilts
❑ Boars ry'� [ " �' i.•` f . .
Numbear aaf Lagoons ;
t ?,Wr%1dina Pnnde I .Cntid Ti-ana
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?
,� `; . r, ;; ii ,fl,;,^ i Desiga ;• ,','? ;Current _ ',;
Pobulation
9 Jp Non -Dairy I
It ; �;ki�;.�E.�r•,p.:r,q�� '€ � t.l'ii'� », ,.I,.,._ ,.,n°� :: ,a.:.iF.
• ,.l__ ;p ;:� . ,i L; i �•'.71' i. ilk
JJ � iY
�n .Capacity' 1 {.
otii ssLw.3 r
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 gallnun?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
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
Stru�ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ......................................... ...... ........ »................ ........ ... .................. I ..... ....... ................................... ..•................................
Freeboard (inches): 3 7i
12112103 Continued
Numbear aaf Lagoons ;
t ?,Wr%1dina Pnnde I .Cntid Ti-ana
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?
,� `; . r, ;; ii ,fl,;,^ i Desiga ;• ,','? ;Current _ ',;
Pobulation
9 Jp Non -Dairy I
It ; �;ki�;.�E.�r•,p.:r,q�� '€ � t.l'ii'� », ,.I,.,._ ,.,n°� :: ,a.:.iF.
• ,.l__ ;p ;:� . ,i L; i �•'.71' i. ilk
JJ � iY
�n .Capacity' 1 {.
otii ssLw.3 r
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 gallnun?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
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
Stru�ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ......................................... ...... ........ »................ ........ ... .................. I ..... ....... ................................... ..•................................
Freeboard (inches): 3 7i
12112103 Continued

Facility Number: — Date of Inspection
' 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
o
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yesr/NNo
elevation markings?
Waste_A"Aication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below.
❑Yes
7No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (14)J G -
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
b) Does the facility need a wettable acre determination?
❑ Yes
N
c) This facility is pended for a wettable acre determination?
❑ Yes
a
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
idN0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 17 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0O
19. Is there any evidence of wind drift during land application? (i,e. residue on neighboring vegetation, asphalt, ❑ Yes 10
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Yes o
Air Quality representative immediately.
.,�, ... .. .. .. .::.... .. ,.�,. �.i..•�r.. -.�..� .,..r ... ..:.-...-r. -..yal��i'.�".e 'S.".:-..: ryn..";:::"'4.. �:...»:..:: .,....?'.. '.:Aw:s:': � :.!p":yh .;'- ° �•I-� .�i1nH lt::!
b:1 {
Gomnaents {re%t,tosquestion #): 3F.xplain any,rYF.S answers and.... y racommcAdations.ar aoy otlter.cominents: '; iri, � .,: , l,t ,1.1�;. .
�:
Use drawings. :.£aclhiy to: baker, explain situations. use` Wditivrial:puges as necessary �_ ❑ pield Cop [FinalNot j
iS "hIM
AJ9tJ wL)e FAR.. Q4A 4)6 CjaAtt �s� �� to w IMA r1r6 f p6AI)-r,
-«r-; s is r ura:,ir,�"1 � m: " 7#' n El I.
Reviewer/Inspector Name" ; (�:' : a..i �:; �
i�:.
.,:�:,'
.ItiJ�i a .�i� �;:.-:.,� w..� f.,
3x ._..e ....-. Y,s.�...�.:........ _ .._•w'.u. ' ..� _ ._�..���r�:�:�,:�.: , fir: �.
Reviewer/Inspector Signature: Date:
12112103 ' Continued

Facility Number: —Cp 'j Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & GeneraI Permit or other Permit readily available? ❑ Yes PC
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W[]P, checklists, design, maps, etc.) ❑ Yes ;/No�
23. Does record keeping need improvement? If yes, check the appropriate box below. El Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes dNq
L.J
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes��No_
28. Does facility require a follow-up visit by same agency? ❑ Yes FNo
'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
NPI3ES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
MNIO
31.
If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute inspections ❑ Annual Certification Form
,12112103

Type of Visit p Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine d Complaint Q Follow up Q Emergency Notification a Other ❑ Denied Access
Facility Number Date of Visit: ENot
ime:
er tion 1 0 Below Threshold
Permitted 0 Certified 0 Conditionally Certified © Registered pate Last Operated or Above Threshold:
Farm Name: L County: z2(Jl94,s�_ _ �Q
Owner Name: d fa,S�r� " _ Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:olm „ .,...,--
Certified Operator:
Location of Farm:
hone No:
Integrator: '
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 6 iG Longitude • 9 46
U Wean to Feeder
I
JU Layer I 1 11 JLJ Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
' 01
Other
Total Design Capacity
. Total SS[,W
El Farrow to Wean
Farrow to Feeder
"
p
'
Farrow to Finish
❑ Gilts
Boar
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area
S ra Field Area
Holding fonds 1 Solid Traps ❑ No Li uid Waste Management System
Discharges & Si[eam ImRacts
I. 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)
[ 1 Yes [1 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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Yes ❑ No
ed-
Oes ;eho
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
toNo
Structure fi
Identifier:
Freeboard (inches): 3
05103101
Continued

Facility Number: hate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? {'ic/�treees, 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?
S. 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?
aste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? , ❑ Execssive Ponding
12, Crop type
13. Do the receiving crops differ with those ddsignated in the Certi
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?
n PAN n 14vdmidic
RegpiLed 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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
{ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
❑ Yes No
Cl Yes VNo
❑ Yes &4o
■
ElYes ko
❑ Yes F(No
El Yes tVNo
❑ Yes P] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,{No
❑ Yes ,L■,.I No
❑ Yes JJVTNo
❑ Yes No
❑ Yes XNo
❑ Yes No
❑ Yes ;No
❑ Yes �J l
❑ Yes //�_/]
o
❑ Yes
o
❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.: .. .::-.:... ... •. oF: .'.�� .x�1-u-..: '. .... �. .. . -.:.. .. :..:.:...� :.�_.,.:1•.� eek�•"i.:.RC'"r'.':::. ": :rF-•: ..w.::: v.":: r-':.:( :. � .. ..�..-v.• . ,ti ..u:.-�
Comments {refer to yucstion #]. •.Iaarpla[n any YES answcrs;andlvr any recommcndationtioiany other.comments....•,-
Vsedrawings of Facility to hotter explain situations. [use additional pages as necessary}: Field Copy ❑Final Notes
CvZDEnI�� �Ff .'�..9C�-,�I�►e��. F•PDrr] �v�.l u�E rPl�i�►�C� �P�;
ReviewerlInspector Name
Reviewer/Inspector Signature: Date:
05103101 V� 1 Continued

•
Facility Number: Date of lnspection Printed on: 7/21/2000
Odur Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes jINo
Iiquid level of lagoon or storage pond with no agitation'? I/�I
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes 2 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VN❑
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 XNO
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 ZNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IR(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an or Drawings:
9
4v5 L�opfvAel<6< 9
J
5/00

�:a
.
,;
;, F
t,
r
ttall;bi d and ater Couneaiioiir
4 vision v
rv
.. ,,, �........x.........::.:.:..:.
�:.0 Other Agency
Type of Visit %9 Compliance inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit )gRcutine D Complaint o Follow up p Emergency Notification Q Other ❑ Denied Access
Date of Visit:
Facility Number
'Permitted [] Certified 0 Conditionally Certified [3 Registered
Farm Name: rQ Av
.... �.........................`.....d.... � .►-...........................................
Owner Name:.......... I.ard.,'—'r.4rv!N..............................................................
Facility Contact:
Title:
19 Not Operational 2 Below Threshold
Date Last Operated or Above Threshold: .••......................
County:.. .. W�!.'1...........................................................
PhoneNo:.......................................................................................
PhoneNo: ...................................................
MailingAddress:..................................................................................................................................................n....................................................... ....................:.....
Qnsite Representative:.C.t.ar..s.................. .............................................. Integrator: L.�i....r o .........................................................
Certified Operator:
Location'of Farm:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �_ �" Longitude
Design Current Design Current. Design Currehf!",,
Swine Capacity Population Poultry Ca aci .,.Po ulation Cattle ''
Ca ati Po atiorti
❑ Wean to Feeder 1 10 Layer 10 Dairy ,r
4
Feeder to Finish j (oO 1 10 Non -Layer 10 Non -Dairy
is
❑ Farrow to Wean e „
❑ Farrow to Feeder ❑ Other
;r
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons FZ Subsurface Drains Present ❑ Lagoon Area Spray )Field Area '
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & 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 ® No
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? �1R
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? Iff Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IgNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 StrlletUrc 3 Structure 4
Identifier: .............. I..........I...... .......................................................... ..............................................
Freeboard {inches): 3�
5100
❑ Yes X No
Structure 5 Structure b
Continued on buck

Facility Nwunber: 3 j — j 9 ❑ate of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J9 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 10 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 J9 No
8. Does any part of the waste management system other than waste structures require maintenance/itnprovement? ❑ Yes SNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Apoli_cation
10• Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type i h f e•r Art n V11 , Su ► 44ne r A,1 n V a , 16tr^ t.dAl J�A 94V �, Swr.o
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PfNo
14. a) Does thefacility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes :gNo
c) This facility is pended for a wettable acre determination? ❑ Yes Of No
15. Does the receiving crop need improvement?
I6. 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`? (ic/ 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. )~ail 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?
! fi�5'Qi� �eeFe��� ►+ire �e g 5:vst; Yoh�R �'ii' �o1r
corres oridenC .about this visit.. .
[:]Yes A No
❑ Yes 19No
❑ Yes No
❑ Yes % No
❑ Yes JW No
❑ Yes )0 No
❑ Yes ONO
❑ Yes PfNo
❑ Yes ONo
❑ Yes PjNo
❑ Yes No
Com netiits (refer to question #):..ExpltJffn any YES answers and/or. any-recommeodatiosm o r4nrother",'0 i lai
Use drawings offacUlty to better explain situations. (use.eddidonal pages as necessary):. _',::1::, . a . N' r;k ew e
(/y� .
i�cs�]e7r'?ded �o r►'Ir'• clafo S4rb�'I a�[fe� f kQt1Ul�s Hk Qv[�"rlviue
I;-` Wask is rin
6Ve r4r(,,W L'60 aUse"A e 1 av19
►�icd ave,-�rjow F iPe . 'Per/-�'a �rw� roLl 421 he
Q;,%4e,3A#Ae_e on i ,p ir,, 4 f V f er' -+ t)4v#'e aGGV Pr"e+4 Ce � .
i J
Reviewer/Inspector Name
Reviewer/Inspector Signature:
.71
Date: ZAZ b16J5/00

Facility dumber: art — Date of Inspection .12-61011 Printed on: 1/9/2001
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
J9 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
• p No
28,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
`� No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
m No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
'Yes
❑ No
nna ntnmett an ar Drawings: :: gi — ita1€:a4°.
5/00

sion of Soil and Water.Co6servition •Operation°Review ,. }; tad _ ks � t��,`
;" :'•:!; ' Clbivisivn of Soil and Water GbnservationY- Compliance Inspeetion LL
e' I ' F � s hs 151 F J�
Yr y w^ .:..:;', r�ixSI 1, ppp
.x. .. :'..:.. <r... ..
Division of.Water.Quality - Compliauc iispertivri :i: C;...
............:.... q
Vl W 4 is 1 .r' ..hSl�'
�.Otber. A enc . = U etrsitivn Re a :ii...: s1.s:,''.. rul�..11,
J%Routine Q Complaint Q_Hollow-ue oFDWQ inspection Q Follow-up of DSWC review a Other .� J
Facility Number / / Date of lnspection
Time of Inspection 7 : / 24 hr. (hh:mm)
Permitted ;4 Certified C1 Conditionally Certified ©Registered Not D erational Date Last Operated:
Farm Name: 1'P..................: aird. -....... ..... r0.f .................... County: ............ DNfq.ip.............................................
�a
OwnerName; ...... �.8. t Q............................. "'U.40.4.......................................... Phone No:.............................................
Facility Contact:....Nax-op............... � I........... Title :......... 12A".IK.-.................................. Phone No:...................................................
Mailing Address:....................
.....................1............
I`1.....,......
...Integrator:
Onsite Representative :
,
......................................
.....,-......�c.YrDIS........................................
Certified Operator:.........
�...................:........
............. ............
Operator Certification Number:..........................................
Location of Form -
Latitude ' +' Longitude 0 4 «
Design Current, Design Current i i !' Design, • �iCurrent
Swine Capacity Population Poultry Capacity Population Cattle , _Co- aci `.Po ulativa
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I 1 1[:] Non -Dairy
Farrow to Wean
❑er Oth
❑ Farrow to Feeder
j
❑ Farrow to Finish Total Design Capacity, e
❑ Gilts
❑ soars Total SKW ';
Number of Lagoons IM Subsurface Drains Present ❑ Lago❑n Area 10 Spray Reid 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 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was (lie conveyance man-made? ❑ Yes CKNo
b. If discharge is observed, slid it reach Water of the Statc? (Il' yes, notify DWQ) ❑ Yes ZtNo
c. If discharge is observed, what is the estimated flow in gal/min? _ . AM
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes KNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Watste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Dd No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 1
Identifier:
Freeboard(inches): ......... '�� 7 rr......I...................... .........................................................................................................................
5. Are (here any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes 0,No
seepage, etc,)
3/23/99 Continued on hack

Facility Number: f Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crop6iffer wit those dAignated 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 & GeneraI Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Cc/ WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (iel 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?
0.*Wa094s •or ilciencies Were dµ-rift #h}s;vjs% Yvix ;will toei*e IJo further.
' icarres• aricience: about: this visit: : .
❑ Yes KNo
❑ Yes $No
❑ Yes *0
❑ Yes O'No
❑ Yes $�rNo
❑ Yes �No
❑ Yes ONO
❑ Yes [RNo
❑ Yes XNo
❑ Yes 0 No
❑ Yes %NO
❑ Yes ANn
❑ Yes KNo
❑ Yes 14 No
❑ Yes AZNo
❑ Yes K_No
❑ Yes �No
❑ Yes o
❑ Yes No
❑ Yes VNo
Comments (refer to yuestior<'#)- Explain any.,"YES attsrvers ui &or,any recommendations or,any nt lier,.eamments-
Use drawin of facility tv better ex lain situations; use additional a` es as neces'sa' '
t i'i., �3G
71(r S75Aool h,0S /vrd UWtO ar*rrlde I.2-z-41 14 e BP Ais aAo:=hee.0i
15�)`Ywwdl hadL -e44,e-_
�If�P�W �' a,� � l i� GU■'��/ J�'�s b'►�r ,S'� dv`° rfs-cL9'� �
V
Reviewer/Inspector Name : , _ Mt-" _.•i��!' irr ;` ;'
Reviewer/Inspector Signatutpr--`o, �,, �_ y/fjj�, % , a 1 Date;

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �"No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ��No
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes �ko
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 V�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'K40
32. Do the flush tanks lack a submerged fill pipe or a permanentltetnporary cover? ❑ Yes No
Additional Comments and/orDrawings: r• t:
[All
3/23/99

Facility Number. Date of Inspection
Time of Inspection 24 hr. (hh:mm)
■ Permitted ■ Certified p Conditionally Certified p Registered 0 Not Operat€ona Date Last Operated:
Farm Marne: jClaro-Stiriuud.Faxm...................................................................................... County: Duplin WiRO
Owner Nanic: Glard....................................... StrjuiLd ........................................................ Phone No-. 9.10-29.6.-.0ft6h ...................................
Facilir►• contad:................................................................................Fitic:............................................................... Phone No:
Mailing Addrvss:9.6.LE.Kards.Rr.id&c.Ruad.............................................................. Kxmansx.Wc... INC................................................... 28M ..............
Qnsite, Itepr•escnlative:.......................................................................................................... InIegrator:Carxall's..F.a,tells.1.nM............. ................................
Certified Operator:GlairD....................•.....•........... Strand ............................................... Operator•CcrtificaIion Number:1.73t14.............................
Location of Farm:
a�n.xbit;..axtt.sAd�.a�x.13!].[�.apxax_a ris trsf,ul.itttxs.��ta.wxtbl.sxl..1.2.......................................................................................................... —
Latitude Longitude ®14
Swine Capacity Population Poultry Capacity Population
p can to Feeder
® Feeder to Finns i
❑ arrow to W7an
tj arrow to Fee er
t3 Farrow to Finish
p Gilts
❑ Boars
❑ ayer
p on- ayer
Design Current
Cattle Capacity Population:
r13 airy
on- airy
❑ Other
Total Design Capacity 1,860
Tote SSLW 251,10
Number of Lagoons ®Subsurface Drains Present 11[l Lngoon Area IN Spray He rea
Holding Ponds 1 Solid Traps JE3 No MquiH Waste Management System
1)kC11arges & SIreaIn Iit] paCIs
1. Is any discharge observed from any part of the operation? []Yes p No
Discharge originated at: ❑ Lagoon ❑ Spray Field p Other
a. if discharge is observed, was the conveyance man-made? D Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ©Yes p Na
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system" (If yes, notify DWQ) p Yes []No
2. is there evidence of past discharge from any part of the operation? p Yes []No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? © Yes [:]NO
Waste Collection & Treatment
4• [s storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [:]No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure G
ldcntif ier;
Freeboard (inches): ...............1.8...............
S. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, []Yes [:]No
seepage, etc.}
3/23/99 Continued on buck

Facility Number: 3]-417 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need raintenance/improvement?
p Yes
p No
8,
Does any part of the waste management system other than waste structures require maintenance/improvement?
[:)Yes
[]No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
[]No
Waste Aplilicalion
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[]No
11.
is there evidence of over application? Cl Excessive Ponding p PAN
p Yes
[]No
12.
Crop type
13,
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p 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
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
p No
Required _Rveo rds_& Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
2l •
Did the facility fail to have a actively certified operator in charge?
❑ Yes
© No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
p No
C] ; Nn:�itilativrts;ar. ;d�ficien� res-�vere,n�ted:duririg:this :visit.: ipuvwi, p ee.�e na further...:.
.... ... . .......... ... ... ...... .................
::orresirndenee: �b:oirt thi�:►'isit; :::::::::........ .
urricane Floyd Assessment with DLQ
problems observed. Good grass cover on dike walls.
W
Rcvicwcrllns cctor Name .
iI Reviewer/inspectorSignature: Date:
I

r:
�0 Division of Soil and Water Conservation 0 Other Agency
^' y® Division of Water Quality
Facility Number [I-L3LLJC - Date of Inspection z R8
Time of Inspection I ; 00 '24 hr. (hh:mm)
Registered UCertified 0 Applied for Permit 13Permitted 0 Not O era[ional Date Last Operated:
FarmName: ......_GLard....... ..��mJ........ Fox[ ........................................................ County: .......blelih...................................... ......................,
Owner Name: ........... Clfrro ........S{.tG Phone No:..C`.119�..i9G,-OP..&C�............................................
FacilityComa ct:.............................................................................. Title:................................r................................ Phone No:...................................................
Mailing Address: ...ILA ...^�1.....QQaxJ).5.... ak.A...:......Qa...............:................. ...��.aasMil�bi..N.L............................................ .�&}.`.frL........
Onsile Representative: ......1.1.?v4.._���.���'r.OM�.__.....//........................................................... Integrator: ........CFeva.t1A.......... ..............................................
Certilled Operator;...._L�a� ,.7.f.1.:37.1:VM` ... Operator Certification Numberzj....7 S..t..............
Location of Farm:
Latitude 1 '55 l*1 O(' h i 25 I" Longitude 1-7-7 10 L5:S-J' 140 1"
to Feeder
We
LJ farrow to an
' -
0 Other
B Ilw r
❑ Furrow m Feeder
,! Total Design Capacity( labo
❑ Fatrow to Finish
❑ Gilts
:<.DBoars
TotaLSSLW
' Number of Lagoons/Holding Ponds".IQD Subsurface Drains Present ❑Lagoon Area P
Spray Field Area
`❑ No Liquid Waste Management System
w.
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
2. Is
any discharge observed from any part of the operation?
❑ Yes [� No
Discharge originated at: 0 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ® No
b. If discharge is observed, did it reach Surface Wauer? (If yes, notify DWQ)
❑ Yes R No
c. If discharge is observed, what is the estimated flow in gaUmin?
nr le
d. Does discharge bypass a lagoon System? (11Yes, notify DWQ)
❑ Yes IJ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes RI No
4. Were there any adverse impacts to the waters of the Slate other than from a discharge?
❑ Yes W 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 Ep No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes M No
7/25/97 Continued on back

Facility Number: St— }
8. Are there lagoons or storage ponds on site which need to be properly closed`? - ❑ Yes [N No
Structures _(Latctnttti,}ipidi3i ['cttttl4, Flu fits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 02 No
Structure I Stricture 2 Structure 3 Structure 4 S(ruCtUro 5 Structure 6
Identl fiC r:
Freeboard tft):.........3.-�
10. Is seepage observed from any of the structures'? ❑ Ye` ® No
] 1. Is erosion, or any other threats to (lie inlegrity of any of the structures observed? ❑Yes No
12.
Do any of the structures need ntaintrnancelimlirovetrtent`?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notiry DWQ) '
r
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
.Waste
Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WHIP, or runoff entering waters of the Stat{e, notify DWQ)
15.
Crop typee.Y.mv.r�.�................. Vm7!.....�?I]V�.►1a.1.....................G��....G yntairt�l............... ...............
................. Y............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWN[]')?
❑ Yes
® Net
17,
Does the facility have a lack of adequate acreage for land application'?
❑ Yes
No
18.
Does the receiving crop need improvement?
$j Yes
❑ No
19,
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did ReviewerAaspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
22,
Does record keeping need improvement?
Yes
❑ No
For
ertitied or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the PertniI?
❑ Yes
,No
0 No. violation's or deficiencies were noted during this. visit..Yau.rr`ill receive no further
correwbndence about this_vi5it:, � ';
F
mments.(refertoquestion#): Explain any YES answersand/orsinge drawings.of facility to 6elier`ei kplain situation's. (use additional pawl es as necessarv):
AL
Ix. �,o rc. s ti � foe. rt strdst�. r~sros:ar arcc� at•o„4,� t L � i •5kocll� �� All Lid 014. V_(Ily &J
Jte4tj. slvj e. ( VIO 56Q IOe_ ce±,6cf Dk r.'V# t4lxts �Y ass►� �:.
:Z . CDYr t `� t k &j ( caJ., J [bdt �n, L w• L.koi A j Ule.. v A �-K V-L cork .
7/25/97
1
Reviewer/Inspector Name �e ,
Reviewer/Inspector Signature: Date:

-r
f Soil and Water Conservation 0 Other Agency
3"{;f
N[3D7iav1sion
Water Quality
...:::...Fl:G......•...a..w�..�rw•.«m++w>«+n»+m„e,w.,meeunuew..-�eeee�.ewevmeewu+rrwl�»»w.+++
_ ii F � S I ij•+y'�,,'s €. s?�Ss� ���
[G Routine ❑ Compluint Q Follow ,up of DWQ inspection Q Follow-up of DSWC review ❑ Other
Date of Inspection
Facility Number Time of Inspection HE 24 hr. (hh:mm)
0 Registered ® Certified © Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated:
Farm Name: ...... ! ..1I.. .... .,r...................................... county:.... .L.p.!.^............................... ,.ww.t
Owner Name:.. ................ C..L.a.xz............ ..... ..ta.1..................I..............s. Phone No: 1.1.L.0i)...... ............................
FacilityContact:.....................s,...........,........................................... Title:................................................................ Phone
tNo: ...................................................
Mailing Address:... . ...... . k�.tt...c:4 i...�ar .t �.....�. d................. . r��rt�?�.,r�►.C�1►5.�..� sL �'�!. �................ ?"S.3.4_1......
Onsite Representative:.....�.t..o ra........,S.�a�o., a�. I.ntegrator:...Co...r.T.v ..L.Li...................................................
Certified Operator:.......,. ay.'L7........... VC??1 1................................................... Operator Certification Number:...121!2t..............
Location of Farm;
....O.:.. ......xvh.".1.Y.riA
se..'a.Lo .►� ..... r . i .. .. i�...l. `...._..............................
Latitude �� ®� �" Longitude
.
s i4 i::. r!r �.:..gc ::: s:;;: =.:F::'; ni.3:4
es n : : urren ,, :.: n.,:.:.°'3 t�,t� tll tl ::: ,: ; n: 'i
3.'F.g. .:,f':a ,I,:- ::ia. ..s.&'�iY' ri Y..'... j.::
X.
a ; a �.
,, •„q. F•, Capacity ipapulation i'oultry '_,, Cappcity.,PopulxtionF sCattle .i
Wean to Feeder
Feeder to Finish
6
EJ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Layer
Dairy
{{ E
❑ Non -Layer
Non-Dai
;f
:'i:;, S" IF :.:33a'.e:... .�i53, tF- :•..,;::e1:i i
.: �FFF.3,: E�y ..° 6�F�:ifF i :i ?��iF�. s: ets e��4.+.eg,
n
'€ �: •' iii�! �i� s ' fSi�is'� .
❑ Other
1,
ll ,
pill
'! ::E:".:.5'u
:Fi TgtalDesign
Capac.ty;
::.
s' .S€� :�
'F :i. j::: F, �;
v. �Fi��s: !£!£`::t ieF: s
t
:Ii f: a;.• 3 5.:: ..�.{.. ...• l� �: i s�
�� .s..tt:
d:
;...
}�■■
I%'�i��LW
,d�{F
i f:... - ..... ..........
.�!3i�d:':.'.:'��:-'.4.'. .....�.
_tt
.` `�� ' •. [33�`e ..'t�F::i", .::ii° - .. o!
V0
.................................... .... ..............
'F. ....:
din 6r.of:Lagiians 1.][ialdirig ]Ponds :
�1F2��.'�:: '.d 5
S
vas ;� q� ,.:i::��:7�.:::.:.w:O'F.`.'Y.. ,.'.''....i�•,:.. :F h:�..s il,:.' .s. :'.. i "��3:eFl4x' �i
."
...... ............................... .....
i� Subsurface Drains Present
❑Lagoon Area
Spray Field Are2j IL
❑ No Liquid Waste Management System
iai - :;;3sRs v :tsii'i;: f' si �d"::.'� • ,3�:.
General
1. Are there any buffers that need maintenance/improvement? - ® Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flow in gaUmin?
,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 ELNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
mai ntenanecli mp ro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes allo
7, Did the facility fail to have a certified operator in responsible charge? ❑ Yes rsLNo
7/25197 Continued on hack

Futility Number: N— 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
El No
'truet Irtj (l,ggg2n5J111ingPonds, 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 6
Identifier:
Freeboard(ft):..........................................................................................................................................................................................,,,,.............,...........
14. Is seepage observed from any of the structures?
❑ Yes
§ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
f!9.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
R[No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .. ............... ":............ ~................... ..................................
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?
r CeElifiedc' 't'
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violitions 6def'iciekle's4e're•n6ted.during this. -visit., :You will receive•>Eto ftirihe `
correspb6dence ahoiut this'visiL-''
❑ Yes RLNo
❑ Yes l$ No
❑ Yes ff No
❑ Yes KNo
❑ Yes O.No
❑ Yes IgNo
O Yes ❑ No
❑ Yes 55 No
❑ Yes V No
❑ Yes PSNo
. kA a 14 Sr u %t {+ X-C.R-� O� 4 O 4 r t to V (}-i.r O 1 V 8 C r L S t L.- E I "t AC.4 r 1 fGnrvk.�f Der
01 L X"' L{, � i & 0_,V .-tom I s " f P 1n Off; 4 [ 1L) r �e t Q{ P L p_t.� . i
. r Y p 1 S-a Q V t+ La W r ti -..5 vr1 k-D V i-¢d 4 V -Q 'V U �i41 ITk 1 1-'t'LA.�+r tl V it i 0 V -
t k-10, +> LA —IL a p cl Q. G.,.�tl r -4...1 4 i 1 l tl
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �A J1, `ems J1 �, , Date:

Site Requires Immediate Attention:
Facility No. _1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: Ur '�'+S S v ., �5' I L
Mailing Address: `� I- C C.] G Y c S ri [eIA1,K3 V' 12§ 3
County: U ' F
Integrator: N)VQ Y Phone:
On Site Representative: �� "�"�+ Phone k C►10) a-9 6-0 ❑ C
Physical Address/Location: C S 1 3 O D ❑ � Q . _ `
_L,­, / -7
Type of Operation: Swine Poultry Cattle
Design Capacity: 2- 1Number of Animals on Site: 2� q
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 6 I' a '�) " Longitude: ? : ' ° _,5 2- ' 37" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
18 (approximately 1 Foot + 7 inche Ye r No Actual Freeboard: *Ft. Inches
Was any seepage observed from the la oon(s}? Yes o N� Was any erasion observed? Yes o 1Vo
Is adequate land available for spray? Yes r No Is the cover crop adequate? es r No
Crop(s) being utilized: e V- +r`--" J 011—
Does the facility meet S CS minimum setback criteria? 200 Feet from Dwellings? es r No '
100 Feet from Wells? (OrNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or i
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or Nv
Is animal waste discharged into waters of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes ore) 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 o No r
Additional Comments: W Pr o - " o r-
•
C/'j e 5 +
Inspector Name
�S
Signature
f
cc: Facility Assessment Unit
Use Attachments if Needed.