310434_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Quai
II

i2-r3'1 7
l
Type of Visit: 0 Cam ce Inspection U Operation Review D Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency D Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: U(_ .•� /2tp - Owner Email;
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: { Y i 12a &tit rl tg _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Yop,
Design Current
Cattle Gttpttcity Pop,
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult . Ca aci P,o
❑ Cow
Non-Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other
Other
Discharges 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 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ YesN�No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesFN
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

F'acili Nbmber: jDate of Ins ecdon: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes efNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment h at, 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 Na ❑ 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 ZfNo 0 NA ❑ NE
maintenance or improvement?
Waste Annlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA
❑ NE
maintenance or improvement?
1 i . 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): 13e ro74cJ�, i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
❑ Yes
�' Na
❑ NA
❑ NA
❑ NE
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesgNo
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:)Yes
❑ NA
❑ NE
the a ro riate box
PP P
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfer ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number; jDate of inspection: 12 7 •-/
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 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 No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP? ❑ 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
CommentSgs.ofirac11firtobi
refer to:guestionTT#}:� Expliiiin'ariy Y1±5`answers andloir'any iiddltiorial'irecominendat€uns ar ariyotlxeir"ctmintents.,
i is �ar� a� r
Use_drawitter ex lain situatlons;(use,addit€bnalf a es as_ne*cmM . is 1
Co a,, '?- zz- i 7
5-1 1, 47 e Sri rV eIf '? - Z 2 -1 7
D - Lj Lt
ReviewerlInspector Name:
Reviewer/Inspector Signature: �J S •�� t
Phone: -?I ( - L( 2c,- G
Page 3 of 3
Date: _tz-_-6 11
21412015

(Type of Visit: &Com ance Inspection ❑ Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: utine Q Complaint Q Follow-up Q Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: ii 3 Arrival Time: Departure Timer County:_DtXEa0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: A) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1:7 !, f
Certification Number:
Longitude:
Design Current
Swine Capacity Pop,
Wean to Finish
Wean to Feeder
Wet Poultry
La er
I INon-Layer
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Eapaclty Pop.
airy Cow
airy Calf
Feeder to Finish
Design
Current
Dairy Heifer
Farrow to Wean
Dry Caw
Farrow to Feeder
D . P,oult .
Ca aci
P,o .
Non-Dai
Farrow to Finish
Gilts
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Putlets
Beef Brood Cow
❑#her
dther
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili 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. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structu Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: l.ri
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 rNo
� ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Ycs No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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
F:K0
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes 12<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [3 Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ t20 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �rNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - ec Date of Inspection: 1+
24,0Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check ❑ Yes [ZXo
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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ZNo ❑ 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 o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA E] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
N ❑ NA ❑ NE
V
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers.and/or any additional recommendations or any other comments. `
Use drawines of facility to better explain situations (use additional imaes as'necesssrv). f
Reviewer/Inspector Name: Phon(
L4E AJ
Reviewerllnspector Signature: Date:
r
Pugs 3 of 3 2/4/2 24

Type of Visit: W Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: lEoutine a Complaint p Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �u (7 C�A uym
Certified Operator: &U LA, W . `AGU 570A(
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrat�
ertitication Number:
Certification Number:
Longitude:
17, gtgj
Design Current Design Current Design Current
Swlne Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D . 1P,oultr. Ea aci P,v . Non-Dai
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Reef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
C] Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
[DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: 31 - D jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yeso ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L�
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 �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 structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? ANo
11. Is there evidence of incorrect ]and application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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): (s1
13. Soil Type(s):
.NL-
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?
Reguired_Records & Dacuments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[]WUP QCheeklists 0 Design Q Maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
XYes No
❑ Yes A
No
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis [] Soil Analysis ❑)PLe Trans rs
Q Rainfall ❑ Stocking [] Crop Yield 0120 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
0 Weather Code
(] Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: - Zn Date of Inspection:
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 t*No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? C] 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�kNo
❑ 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
X
❑ 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
A 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
o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ NA ❑ NE
Comments (refer.to question #): Explain any;YES.answers and/or.any additional. recommendations or, any;other comments:.::.:::
Usedrawings.of.faOlity.to better explain situations.( use.`additianal.pages as, necessary;::.:
14
c-N
a
a.S
Iq
�r1�111 '7> AC a
a ','�
Cam r T- LA__) Y
Reviewer/Inspector Name: i6 M(]6- 9P11r F 5
Reviewer/Inspector Signature:: -
Page 3 of 3
Phone:
Date: d'
21412011

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

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA E] NE
Structure l 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 ZfNo ❑ NA ❑ N>
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes FfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen
tal 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? [3 Yes KNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes FfNo ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlleation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
tr
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
PTNo
❑ 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
❑ Yes
KNo
❑ 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
7rNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate Coverage & Permit
Yes
NA
NE
of readily available?
❑
ZfNo
❑
❑
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 [f No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PT, No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: T i - ❑ate of Insnection: J A-"} 1 —I Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? r ❑ Yes 56 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes VfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 4 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 ZfNo ❑ 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 jfNo ❑ 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 �No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes A -No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Wo ❑ 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 vnees as necessary).
Reviewer/Inspector Name: Phone: �.�� j f '"'b%
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Division of Water Quality
Facility Number U Division of Soil and Water Conservation
p Other Agency
1"ype of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 4 Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: (2�� i AIN 1"`P W— VI& Owner Email:
Owner Name: /ITN g]U Q_t (y7{,� CAl�t/N Phone:
Mailing Address: SCn � IA(,I-I�L&141 Ms 9GLALAUILLG ./VC v' `00Eid
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: ?>I 1 LLr A JAGL, % i ON
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
Boars
Other
Other
Latitude:
Phone:
Integrator:
Dci l
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
"Layer
Non -La er
Pullets
Other
Poults
Design Current
Discher es and Stream Impact
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:
Region:
1-4-gM
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 oj3 214112011 Continued

Facility Number: - L4 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No [DNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �C
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? ]p
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) i4
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0,No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
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 M 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 Types): SG f F (L(1�
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?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box,
❑ WUP ❑ Checklists 0 Design [:]Maps [:]Lease Agreements
❑ Yes M No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes No
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )A No
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis [] Soil Analysis ❑ V�ste Transfers
[] Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections Q 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 minbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E] Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: 1 - LJ Date of Inspection:qla
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
P
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
�4 NA
❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yeso
to
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9/0 -�96' M4
Date: T d �&1
Page 3 of 3 21412011

Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit kRoutine Q Complaint 0 Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: y Q Arrival'Time: ® Departure Time: County: Region:
FarmName: (ZAA Owner Email:
Owner Name: L �AT�; PA/ J„2. i Dp
1 l N,V - Phone: is -
Mailing Address: _yg s(p N C yw y L[ J„ HIS S RiiLl c a Lai LLF A/C Q 8 S
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: ��-i __ �! N� Integrator•
9)o
Certified Operator: L.L • �STCY/ Operator Cer ertif3eation Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I = 11 Longitude: = 0 0 I = 11
Design Current
Design Current
Design Current
swine Capacity PopuEatiorn
t Poultry Capacity f'opulatian
Cattle Capacity Population
❑ Wean to Finish
Layer
DailyCow
❑ Wean to Feeder
-La er
Dairy Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dr Cow
❑ Farrow to Feeder
Ej ry
❑ Farrow to Finish
ElLayersLa ers
❑ Non-ts ers
Beef Stocker
Beef Feeder
❑ Gilts
❑ Boars
Pullets
El Turke s
Beef Brood Cowl
Other
❑ Otfter
Turkey Poults
Other
Number of Structures:
Discharees & 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 ofthe 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 4 No
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes >,No
❑ NA
❑ NE
other than from a discharge?
12178104
Continued

Facility Number:31
Date of Inspection I 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: dAQN f Qi
Spillway?:
Designed Freeboard (in). �c[
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 )� No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ NE
❑ Yes
No
❑ NA
❑ Yes
" 1 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 ol'the waste management system other than the waste structures require ❑ Yes ,Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
main tenan ce/imp rove m cnt?
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 > l0% 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) Sc^) g C—(Z ((-1�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes lZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
No ❑ NA ❑ NE
No NA NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
S�.i y: <k��'`ai'?:•: zd . is n: w. r:..-;
Comments refer to'. uestion,# :' Ex lain.an YES.a s e s andlgr an 'recvtnmendaiians'o'r°an 'other•:coniments. x ;,
(.e .. q 1 P. Y Y
Llse: drawiil 5 Of,f'aCillt : t0 better, ex lain.situatipns.:.(use?additional `a es,as_.necessar :.,, ; : ; ':°; .; : •" r : x °. '€>, J.
g, y P F; P g ":..;[ :eq
Z61io 1
11��511U 1 • `�
�'1�e1 �•
qV
Reviewer/Ins ector Name'
p
( g
Phone:
Reviewer/Inspector Signature:
Date: 11 Z(
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design 3 Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes >kNo ❑ NA ❑ NE
[] Waste Application [J Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ )�4ste Transfers ❑Xnual Certification
G Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EX No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes'0No
❑ 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
X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
k NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
El NA
El NE
and report the mortality rates that were higher than normal?
and
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ifi No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 f.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
_�No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Uditinnal Comments anchor Dra►vings:.
€..
;;F
.
Page 3 of 3 12128104

Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i5 Arrival Time: © De parture'I'ime: County: ttSIu40L_l Al Region:
Farm Name: CA,A I h1 Al F-t-t-t%^ _ Owner Email:
OwnerName:
I NJV Phone: 910-arx'72-2 & X 8 31
n np� p
Mailing Address: 1 S 51D IJe- HILAZ ►k ��� . 3 Q� L-) ILLC fie c9ss 1 ❑
Physical Address:
Facility Contact: Title:
Onsite Representative:
J N/V
Certified Operator: t-1— -� �Ao'S) o Al
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: J*_1CqQ 1
Back-up Certification Number:
Location of Farm: Latitude: 0 e = ' ❑ « Longitude: = o = 1 = «
Design Current
Design Current
Wet Poultry
JFQesign
Cattle
Current
es
Swine
Caw p
Popula ion
Capacity i'op� lotion
ity Popu[atiun
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
Layer
❑Dairy Calf
Feeder to Finish
MOO
kQC>
❑ Dairy heifer
❑ Farrow to Wean
Ury Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
El Beef Stocker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El
❑ Beef' Hrood Cow
❑ Turkeys
Other MIN
❑ Turkey Poults
❑ ❑ther
Number of Structures:
❑ Other
❑ischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes No
!!!�
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
12128104
Continued

Facility Number: 31 —y3N
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGCCL►/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes `oNo ❑ NA ❑ NE
❑ Yes ANo ❑ NA Cl 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 tdNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ElNE
maintenance or improvement? to
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
(Window
Crop type(s) �L1 Q,6
V
13.
Soil type(s) NOU-O -},
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
El NA El NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
`
�gNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
gNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
o
tN
❑ NA ❑ NE
18,
is there a lack of properly operating waste application equipment? ElYeso
❑ NA ❑ NE
eX 71 �`j nF C nr S 4- PcAr w I
Reviewer/ins ector Name r `'
p I � ���1 IICC- ;5:' : r . �' Phone:
Reviewer/inspector Signature: tCv Date: L 0
Page 2 of 3 l2/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
(lie appropirate box. 0 WUP 0 Checklist ❑ Desi rn
b 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application [l Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ /aste Transfers ❑/nnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit`?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. 1)id the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of'the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
Additional Comments and/or:Drawings:
❑ Yes
kNo
❑ NA
❑ NE
El Yes
�No
❑NA
❑NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Cl No
14 NA
❑ NE
❑ Yes
XrNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
�rNo
❑ NA
LINE
❑ Yes
eNo
❑ NA
❑ N E
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality =:e.
Facility Number D Division of Soil'and Water Conservation.
❑ Other Agency
Type of Visit §6 Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine D Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: TTO 6"c Arrival Time; Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: �-ttN ��>� integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 0 f` Longitude: 0 ° = 1 =
ig
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
❑
Wean to Finish
❑
Wean to Feeder
El
Feeder to Finish
] 4&0
1 1tv �jQ
[--]Farrow
to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Cilts
❑
Boars
Other
❑ Other
Dry Poultry
Non -La
PUllets
HLJurke Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field [IOther
a. Was the conveyance man-made'?
Design Current.
Cattle Capacity Population:;:;
Beef Feed
er
l3eef 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 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 Z]No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Vi No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 1 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [X No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure ] Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L1460014
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [X 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 T No [INA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 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 typ(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[)0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
M 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
[A 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):
W �u- 5r t•T u�oQiF oAf 13RCIC plE(� rN s p�.+,c To (�RE� FaGZPk+►�QtN�S'
L
er/Inspector Name p EC.CPhone: q(aer/Inspector Signature; r1. Date: 1 3a g

Facility Number: 3 1 Date of Inspection Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [29 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
91 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
[R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
t No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certifcation7
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
29 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IQ 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
11� 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
19,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number 4 3�j Q Division of Soil and Water Conservation
❑ Other Agency t/
Type of Vislt 6Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine a Complaint 0 Follow up Q Referral fl Emergency 0 Other ❑ Denled Access
Date of Visit: `,�j ' Ar ival Time: eparture Time: L; County:
Farm Name: � Owner Email:
Owner Name: Vg6_1 � +�Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
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
Region: b(le'Pe
Phone No:
Integrator: I z � 'q — &"2"j -
Operator Certification Number: o 3
Back-up Certification Number:
Latitude: = o = 1 Longitude: = e =' =
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
�I ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
Discharges & Stream Irn[!acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FLI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12/2"4 Continued

Facility Number: j — Date of Inspection'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stye ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
X,
ElNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen 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
dd]Drift 0 A I.cation
nOOutside of Area
12. Crop tYpe(s) `Ll 5f LIq
r'�lA
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes'
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes YNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ' [JNo ❑ NA ❑ NE
Comments {refer to question #):. Explain any YES answers and/or any:recommendations.or:Any other,comments:i::
Use drawings of facility to better explain situations. (use additional pages as: necessary):; .. .. .
41)
Reviewer/inspector Name Phone: ¢
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents r
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 j No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Dther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No"ANA
El NE
24.
h
Did te facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�[J o
/
I ❑ 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
A
❑ NE
Other Issues
IWN
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
Y
❑ NA
[I NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
X
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ YesA
No
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
I]
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
--5 .�
T
12128104

a , w
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routlne O Complaint O Follow up O Referral O Emergency ❑ Other, ❑ denied Access
Date of Visit: I *ITiSIDI1 Arrival Time: IIl "
Farm Name: It>4c
Owner Name: to
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �Pf2
Certified Operator:
Back-up Operator:
Location of Farm:
Time: Z ty: r� Region: iVWO
Owner Email: _._.
Phone:
hone No:
Integrator: D
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 ❑ = ` = " Longitude: = o = I 0 If
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capes ity l'apulatian
Design Current
Gattie Capacity Population
❑ Wean to Finish
ID Laver
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ M(iry Calf
Feeder to Finish
El Farrow to Wean
$
Dry poultry
Layers
Non-Layers
❑ Pullets
❑ Turke s
Turkey Pouets
❑Other
❑ Dairy Heifer
[3-Qry Cow
❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑Beef Broad Co
Numher of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ?No ❑ NA ❑ NE
El Yes El No
El NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes ❑No
❑ Yes No
❑ NA
ClNE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

r
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Sure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo
❑ Yes ❑ No
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
❑ Yes PNo ❑ 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?
El Yes
; N
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
[I Yes
f
l,Q 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
� J❑ Evidence of Wind Drift ❑ Applicatio Outside of Area
12. Crop type(s) �/' A, e In Ui]!l ! lti� I . �. 6. �0 [Jf�S� �) . J Gr C�� ("4
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
/No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility Fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ZjNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VJ No ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
/�6 No ❑ NA
❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations .or any other.c6mments.
Use drawings of facility.to better explain situations. (use Additional pages as necessary):
�.0
y Iz'e—ee K'
71
Reviewer/Inspector Name01 Phone: —.�
Reviewer/Inspector Signature: Date: 2 o
Page 2 of 3 12129104 Continued

Facility Number: — Date of Inspection I
/ ■
Reuuired 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
A No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists . [I Design ❑Maps El other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
El NE
El Waste Application [I Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfer❑
Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
$ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;1NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment [PLAT] certification?
❑ Yes
❑ No
ONA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
Y_YNo
El NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
[I 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?
❑ YesNo
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
I
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
No
El NA
El NE
General Permit? {iel discharge, freeboard problems, over application}
I
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XN o
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments andlnr Drawings:
MZ
Page 3 of 3 12128104

Type of Visit 0 Compiiance Inspection D Operation Review a Structure Evaluation Q Technical Assistance
Reason for Visit O Routine Q Complaint Q Foilow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time:'A2,djPeparture Time: "M unty:
—W ff
Farm Name: �•� Owner Email:
Owner Name:_ LVir&tA9 D _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�11�'
Certified Operator:
Back-up Operator:
Location of Farm:
1_...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:
Back-up Certification Number:
r
Region:
Latitude: = o = i ❑ « Longitude: = 0 0 ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
__ 1 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did (lie 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 ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)9No
❑ NA
❑ NE
❑ Yes
.8 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection1 b�
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
Identifier:
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in): `q
Structure 3 Structure 4
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 21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
V1 No
❑ NA
❑ NE
❑ Yes
;KNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify OWQ
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 ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes in No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 1 p% or 1 d lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wiindow! ❑ Evidence of Wind Drift ❑ Application Ou` a of Tea
12. Crop types) e���F/1 ILI�R [ A�/ 1 1 �iJ1�Q5f � 'P!;"F 0 f
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2fNo
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
Oyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
WN❑
❑ NA
❑ NE
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
;a No
❑ NA
❑ NE
Reviewer/Inspector Name
_._........_.
r�rrir
Reviewer/Inspector Signature:
Date: fi4l

Facility Number: Date of Inspection !�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP 0 Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 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'?
❑ Yes
gNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
ONo
❑ 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
Y No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Cnmments.:nndlvr Drawlng s'
��5i f
Z
fC.�vn�Ae- &,,2 di►�a1,0515VJ ,9�ii �Ia -3299
.5 vrJ��T`c�.►13
��►f�-.,moo r��� �j`�,�C',q�Jf ,�s�.Smi�Sw
12128104

Iiype of Visit fd Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ARoutine Q Complaint a Follow up ❑ Emergency !Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time:
CO Not O erational 0 Below Threshold
Permitted 4cerdlied 13 Conditional Certified Q Registered Date Last Operated or Above Th "hold: .............
FarmName: ............. f `�T� ...................................................... County: �... v. V� ..,..........................
OwnerName: ........... ..................................... ............... ................ ..................... ................ Phone No: _ ..... .............. .......... ....................................................
MailingAddress: ........... »....... »......................................................................................................................................................................................................
FacilityContact: ............... ..•... ................................ ........... ,... Title: .......................... .... .................. .......... QPhhonnee No: .......................... ........... ..... .......
Onsite Representative: ... % ► Y!r �....._.�4 c ............................... Integrator:... ?.1��Y dZ. V�......................................
Certified Operator:... ................................................
Location of Farm:
Operator Certification Number: ._.... _................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude •
.. .{ .... ,i y1. . . F f.D� tl y.. .ir. •..
accent D gn C rrent Design Current':
"Swine Ca aci Po elation;,. ;"Paultr y, .' i:::= .:: _ ..Ca '$ i `J 'Po uletioii` ; : tittle Ca aci '. ] Pa �tilatioa;'
❑ Wean to Feeder ❑ Layer `EN
ry
,:.
t!
n- er Feeder to Finish No La $ � ❑ Y 'on -Dairy
€i
Farrow to Wean :.. -, 1,
[3] _
❑ ❑ : !' al ! €iJsPl„}
Rl
Farrow to Feeder Other .Yl,i h ,� . ;,'I;
arro o
F w t Finish r . Total' 13esign Capacity, ]
❑ Gilts
" �'�li�, �=E I � '.' '• ';� .';,.� r 'ram y`,� ��� , r;
$oars ' tt 55L
. .;:. :� ... �i i•
wi
be Lagoons
M,
.�'F::;. .•C3;'; Nrxm"of r .,�.. ,�• ! !i i"� it ,i'.i�'?��'"sir,' n. �'• ^I �.
ii
N f•�.1. �: i; ..�l'i.�",:ilr; !d''!i�)`.
Discharees & Stream Impacts
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) ❑ Yes ❑ No
c. If discharge is Observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identi flcr:............ I. ..... .............. ............. ..... ............. ............................ ......... ... ................ ................ ........ ..._......................
Freeboard (inches): 12-S _
❑ Yes
Structure 5
12112103 Continued

Facility Number: — 3 Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M �yNo_
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;/No
elevation markings?
Waste AnnIication
10. Are there any buffers that need maintenance/improvement? ❑ Yes INo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes I No
❑ Excessive Ponding ❑ PAN Hydraulic Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type rA h £.. E Cr_ CD
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes :7'
b) Does the facility need a wettable acre determination? ❑ Yes ;<
c) This facility is pended for a wettable acre determination? ❑ Yes 7No,,
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes MINo
Air Quality representative immediately.
..- .. - -• r�:Mri.H•K'.F[+'Ir'...7„�.... -iF�¢t :S: •.',::..:: k-n:;::._.:.. »- 'vH.' .. 1�...1 .. ?d..: .i., i , :. �.. .. 1
;Comments (refer,to; question #}::;F,xplaW any,YES answers andlor.any,reeonmicadaitions orany othei caziiuruerits:° ,:1?' 'I ,
,, ...r-, ' .�. u. :
r
Use drawings of facility;;o'hetter.rxp. is situatio=is:.{use additlozaal.Isages ag nccesssi3')i' ❑Field Copy ❑Final Notes �[�1'ra N;'{
3^
:.. ��..e..i; .,�5�,:€�� � ,�p I � 7 rA'}. � I�'1� � � n'f"'16,ar� ..� • I ,
, ! ,r; .' . .:...it•:.. ....�. fir::.::. � . � u '?� i .. � .�:. :��'!... � . .-i ., .�...... ,. ...�.� �� [.. kt�"' .,u_ ..yM•:,7. M''71'rCi r�ii � i r
tjE ern_ 6k'('�CV ftAR�
0" 0ru C4i i UL_
N M-fOAT-Vy CN Ccl t'ts-r
F G5 cu ii� t_Q R-c-5E C b E D Zoo 3 5' i•A 00
ReviewerMspector Name J.
Reviewer/Impector Signature:
Date:
12112103 1 ' Confinued

Facility Number: 3
L7 43k Date of Inspection
'Renulred
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel WUP, checklists, design, maps, etc.)
❑ Yes
rNo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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
OINV
25.
Did the facilityfail to have a actively certified operator in charge?
Y P g
❑ Yes:yo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
KNV
(iel discharge, freeboard problems, over application)
❑ Yes
2
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N
28.
Does facility require a follow-up visit by same agency?
El
9NO�
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit /0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit j6Routine Q Complaint Q Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Vislt:
6 Permitted Certified 0 Conditionally rtified 0 Registered
Farm Name
Owner Name:
Mailing Address:
Time:
Date fast Operate or Above Threshold:
County: C
Phone No:
Facility Contact: Title: hone Na!
Onsite Representative: _ A26l'''< Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C 66 Longitude 0' 6 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW =
Number of Lagoons:.. :. Subsurface Drains Present La goon Arca ❑ 5 ra Field Area
T Holding Ponds 1Sol id.Traps ;;': ❑ No Liquid Waste Management System
Discharg1s &r Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify ❑WQ)
2. is there evidence of past discharge from any part of the operation7
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteC21[Ectlou & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier;
Freeboard (inches):
05103101
❑ Yes /ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El No
El �,Q No
❑ Yes �No
❑ Yes No
Structure C
Continued

Facility Number: Date of Inspection ail
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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?
12. Crop type
Excessive Ponding ❑ PAN ❑ Hydraulic
13. Do the receiving crops differ with those deAgnated in the Certified Animal Waste Management
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?
❑ Yes #NG
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes j� No
❑ Yes j dNo
❑Yes �Nu
(CAWMP)? ❑ Yes
No
❑ Yes
10
eNo
❑ Yes
❑ No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ 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?
•f 4kiorls.0i Ofboepom •►ire 4i4 4�i4g ik is'vlsF� • *; O ;11 tocoito OQ lift tt :. .
carres�imdeitee a�aut this visit.
❑ Yes ❑ No
❑ Yes ;dNo
❑ Yes XNo
❑ Yes ;dNo
❑ Yes R(No
❑ Yes ❑
❑ Yes No
❑ Yes XNo
❑ Yes �No
El Yes XNo
❑ Yes�No
❑ YesxNo
q) 9UA//.zF/Z /'s 'VbP �wc.
9 Al
Reviewer/Inspector Name'` ""` a`:`
Reviewer/Impector Signature: __ Date: e) Z' _ slpp

.11 `^
Facility Number: — Date (if Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNO
Additionni Comments an orDrawings:
A.
.�I y
SEe.r CN��PaG �ifFL'1'G�s
-t
n
{
E
,
A�Po/- / , 4,7-1il
5100
J

;. AT-=rc,r.., Quality
Division of Water,
Di'vision of Soil and Water Conservation
a Ok tl er Agency.:' _ ;
r �=
(Type of Visit )5 Compliance Inspection Cf Operation Review n Lagoon Evaluation j
Reason for Visit W Routine ❑ Complaint O Follow up Q Emergency Notification a Other ❑ Denied Access
Date of Visit: - [r]_CJ�'1'ittte: a3Q
Facility Number Printed o»t: 7/21/2400
O Not () erational O Belaw Threshold
Permitted 0 Certified E3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Lt p�e�y. County: ...............
FarmName: ........... .. 4�A .......::........f ....... .,.....................,..---�•-.........,.........................,..............
Owner Name:
Facility Contact:
Mailing Address:
Title:
Phone No:
Phone No:
Onsite Representative: ...... ir.............................................................................. Integrator:..l!Q.L`...... ........................ .......................
Certified Operator:
Location'of Farm:
❑ Swing ❑ Poultry ❑ Cattle ❑ Horse
Operator Certification Number:
Latitude 0 6 �4 Longitude �• �� «
Design Current
Capadty Po ulatia
9 "'FGilts
Feeder
inish Q
tR
ean
to
eeder
inish
In'
Design Current Design Current
Poultry Capacity Population Cattle Capadty. Population
Layer Fo-N
airy
❑ Non -Layer vn-Dairy
❑ Other
Total Design Capacity
Total SSL W
Dlschar zes & Stream lm acts
1. Is any discharge observed from any part of the operation? ❑ Yes KNO
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 Stater (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identi Fier: .......................................... .......................
.............................................................................
................ .
Freeboard (inches): ` ct
5100
❑ Yes
❑ No
❑ Yes
No
❑ Yes
]i No
❑ Yes kNo
Structure 5
Continued on hack

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes ONn
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
cloture plan'? El Yes VNo
(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 KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes X No
9, Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,�j No
12. Crop type ovt4e'
I3. Do the receiving crops differ with loose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14• a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available.?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.: N4.001at ioOK0. iieFc�eOION •►►irEre 00.ift s.v st. Yop wig# eeeij+e q tier . .
corresporideitce. abvtiLS .Visit. ::: ; ;
❑ Yes
❑ Yes
❑ Yes
❑ Yes
A! No
Wo
❑ No
❑ No
VNo
V No
❑ Yes KNo
❑ Yes 4 No
❑ Yes W No
❑ Yes No
❑ Yes No
❑ Yes P<No
❑ Yes 0jrNo
❑ Yes XNo
❑ Yes jo No
Comments (ricer to question #) Explain any YES answers and/or an: y'.: ecoinmeirida- ons or.any: otl�er eamisients i
„ ,..,;;.;..;,L.:. r..:.�;�.,....... .�.,...:, - ,.....: ,.... r,;T" ,� ..�.....�... ,y�x,;; .�;:,ri:• ..,i.:r.:,�us�'!ru':K:x'-ua�ni - ;� r ��}i��:: a:,� ,- . �.'�'u.;�i��fr ' �' ..ns,.,�. ,; ..`
[]se'drawiUngs of facility tobetter explain situntians: (use tuiditional pages
w . .. ,. ,.... _,._ .. .. T :..
ra
gib
Reviewer/inspector Name
Reviewer/inspector Signature:
Date:
LG1i

'
Facility Number: —
Date of Inspection u/-r-a--M printed
on: 7/21/2000
Odor [sacs
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 an 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 problemsmith the ventilation Innis) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, e(c.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a pemmnenl/temporary cover?
❑ Yes
No
I Additional Comments and/or Drawings: I
l5� GZ� V-C.9 co� + cY �AsAd', �C •.ac�-
v-.F�
CA\ i-5 Ra,
Q��ed.,-+-�5 �� 4c 1P(��r� ��, ire • n
�ke\to-rr WAS. Ve�yt,.. tb.,,,,,.-q 1,.�^S "�
s/00

;.;...:........::...:..:. ' ;::.'; vision aFSvil aced Water:Eoriservatiori,- Operations eview: r; � } :;'!
t
i
r j�
Y�
rvisian afS Water C lance Ins o 'an onser►r�i on - amp P� ar�I,.
I ..
Vision'of Water all - Cnin Iiadce.Ins ectiou = t i ;
vi
Qua t3' P P. ��i,. II
:........ : �y
,. Other Age1.
ncy- O erattnn Review: ttl
w , '.: $ . i ° .....::„
tine O Comolaint O Follow-uu of
Facility Number
of DSWC review D Other
Date of Inspection
Time of Inspection
Permitted © Certified 0 Condi 'onally Certified © Registered
r ]
FarmName: ........', r.................�1.............. -...................... ...........................
Owner Name:
Facility Contact:
Title:
Not Opera
County:
Phone No:
24 hr. (hh:mm)
Date I.ast Operated: ..............
Phone No:
MailingAddress:.................................................................................................................................... I......... ...... ..................... ..... ...I.................
Onslite Representative: 4Mt.L". . .......�.p........ Intii;ratnr:.......�:,�`��'G................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
.................................................................................................................................................................................................................................................................
... ..... T
Latitude ' ° 66 Longitude ' �' �«
Design . '- Current Design Current ? Design: Current
Swine Ca aci 1 Pa ulation Poultry Ca acit ..Po ulation Cattle' Ca aci r Pv ulatinn
❑ Wean to Feeder JE1 Layer I Dairy
Feeder to Finish 10 Non -Layer I Non -Dairy
Farrow to Wean
ElFarrow to Feeder ❑ Other
❑ Farrow to Finish Total+Design Capacity;
❑ Gilts
❑ Boars Total SSLWi ?:
Number of Lagoons L JE1 Subsurface Drains Present JJEJ Lagoon Area ❑ Spray Field Area
Holding Ponds l Solid Trapis ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If'dischargc is observed, did it reach Water cif the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systctn? (If yeti, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes `XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): 0....................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes gNo
seepage, etc.)
3/23/99 Continued on hack

- Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
KNo
(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
6(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
(Yes
❑ No
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
l I. Is there evidence f over applic t n? [I Excessive Ponding ❑ PAN
❑ Yes
�No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
(Y%No
14. a) Does the facility lack adequate acreage for land application?
El Yes
� No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
O No
16. Is there a lack of adequate waste application equipment?
❑ Yes
'RI No
Renuired Records & Documenbs
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
)O'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
b<No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
*o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes MNo
23. Did Reviewer/Inspector fail to discuss reviewlinspecdon with on -site representative? ❑ Yes V No
24. Does facility require a follow-up visit by same agency? ❑ Yes 1�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes &No
d'�1 yiQlit>�igos;o� d�ljcjencie5 •►ygrc noted �lktri> g t. s.��s�t! • Yoo Wiil•ti•ee�iye
rarreso6ridence.ab66t:th1s Visit . • . . . .............................. .
Comments(refer to question #):, )E;xplaitt any YES'answers and/or,any.'recommendations or: any other;coinments: •,.;` '" '' u
Use drawings of facility, to better explain situations. ( sse'addition-at -page s as necessary):.'°
�1 •: d11.1. .S. ..I.
AL
1 e�A v2�
Reviewer/Inspector Name it
Reviewer/Inspector Signature, i--A d Date: 7 g nn

A
Facility Number: Date ref' Inspection QQ
Odor Issues
26. Does the discharge pipe From the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes tKNo
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 VNo
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 OdNo
31. ❑o the animals feed storage bins fail to have appropriate cover? ❑ Yes x No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes, No
Additional omments and/or rawings: +' ;;,ii: ' •I'yr,. a. ;' �T 'f"i'Y a
I.I. ,�. `��,.',..: ' t;. :.t 1.�':1 y••I. 4���;,il.rh F!� �i—: �. �I � � r sl%� ��
J

13 Division of Soil and Water Conservation - Operation Review, u
ad W -.Cr �Diviion of Soil aer Conservation uj2rnnplia c nspe tioi�
Dlvl ion of Wat T s e Quality-Compliance,Inspection
Other Agency - Uperatioin-Review...: ±q„��;'rs'. .
rorRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number 1 [bite of Inspection b
lime of Inspection J 24 hr. (hh:mm)
Permitted 2fCertified © Conditionally Certified 13 Registered 113 Not Opera Date Last Operated:
..........................
Farm Name: C?.R&\... .S..o..-.t4^ f............... ...- County: ........ D5.]EtG.F.............. ........ ............ .......................
Owner Name: .................... ..................... ...
Facility Contact; .............................
Mailing Address:
' t
C?nsite Representative: ,,,B....e,,,....,.... ,,
Certified Operator: ................................................... ...............
Location of Farm:
Phone No:
Title: ............ ................. ...... .......................... Phone No: .....
w
IntegratorS.......... I ....... I..........................
Operator Certification Number: .... )„Q...............
Latitude • ` — Longitude • ` "
Design . Current Design Curren! Design Current
Swine. Capacity Population Poultry Capacity.Po ulation. Cattle Capacity.Population ."
❑ Wean to Feeder 10 Layer I I ❑ Dairy
eeder to Finish r7,La 10 Non -Layer I I Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑tither ;
❑ Farrow to Finish J1 Total' Design Capacity
❑ Gilts
❑ Boars r Total:SSLW
Number of Lrigoons 0 ❑ Subsurface Drains Present ❑ La9cran Area I0 Spray Field Area
Holding Ponds 1 Solid Traps �].. ❑ No Liquid Waste Management System
' 4
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (Ifycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struciure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier.
Frceboard(inches): �4............................................. ................... ............... ........ .... I ................ I............. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, ctc.)
3/23/99
❑ Yes m No
❑ Yes VNo
❑ Yes Vf No
❑ Yes gNo
❑ Yes effNo
❑ Yes �No
❑ Yes Z;� No
Structure 6
❑ Yes 0
Continued on 6,

Facility Number: 43 j —3e� hale nf' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify ❑WQ)
7. Do any of the structures need maintenancelimproventent?
8. Dues any part of the waste management system other than waste structures require ntaintcnance/irnprovement?
9. Do any stuctures lack adequate, gauger/ markers with required maximum and minimum liquid level
elevation markings?
Waste Anvlication
om�
❑ Yes to No
❑ Yes 0 No
❑ Yes XNo
❑ Yes 'A No
ld,
Are there any buffers that need maintenance/improvement?
❑ Yes 21 No
11.
Is there evidence of over application? ❑ l'Lxcessive Ponding ❑ PAN
g-,w. G is F --,,I
❑ Yes VNo
12,
Crop type exm a. E -c
13,
Do (fie receiving crops differ with those designated in the Certified Aniinal Waste Management Plan (CAWMP)?
❑ Yes 7 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes LINO
b) Does the facility need a wettable acre determination?
ElYes `❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes VNo
15.
Does the receiving crop need improvement?
❑ Yes ONo
lb.
Is there a lack of adequate waste application equipment?
❑ Yes )!J'No
Required Records & documents
17. Fail to have Certificate of Coverage & General Permit readily available'? ❑ Yes L'fgo
18. Does [lie facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W UP, check] ists, design, maps, etc.) ❑ Yes Z No
19. Does record keeping need improvement`? (ie/ irri ation, freetro-ard, waste an ysis & soil satnple reports) ❑ Yes &No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ] No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ 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 ZN❑
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Ff No
Nc .viola(igtjs -ojr ftrjcjent&9 -►;+tire )nofed• O(Wiiig •lhjs'vjsjit' • YGO will teOOiye t?R futtjho
corres' ari�enee: about. this 'visit. .
Comments (refer to question #): 'Explain. any YES answers and/or any recommendations or anyntlier.comMeints. -j
Use drawings of facility to better ex lain situations. use additional pages as necessary):
f�
g Y p (, A ry):
a „..
.1
5) i, -wAy (nc•xo L.-zc,>t_ r r[,- ►14y Cowt°_
Vez,j IJEAr PamO OEt~t- MA, f,1rAc Af j7 ZV—V-`r� t4r
wz 9 rz.>3,i;5 - 39M I.�.
Review r Name '" •.• - ,
e /Ins ector -_ ;; g...� ;.. q
Reviewer/Inspector Signature: �„ t , d,j _ Date: g / , t~ 194
3/23/99

r
` Facility Number: — 3 Date of, Inspection B (,
F
Odor lssries
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
ONO
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours'?
❑ Yes
C;KNo
28.
Is there any evidence of wind drift during land application? (i.e• residue on neighboring vegetation, asphalt,
❑ Yes
ZNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake: not Ideated near the liquid surface of the lagoon?
❑ Yes
INo
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i,e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
ZNo
31.
Do the animals feed storage bins Fail to have appropriate cover?
❑ Yes
• f No
32,
Do the flush tanks lack a submerged fill pipe or a permancnt/temporary cover?
❑ Yes
o
Additional Comments and/or rawings:...
3/23/99

:ivision of Soil and ��aiier Co •13 D, n n
Soil vis'o of Soil and Water Conservation [30therAgency r Qual
ity Ity
tISDivision of =Water Quality ality
— ---------
-
JeRoutine OCum plaint 0FolIow-ueofDW2ins paction 0 Follow-up orDSWC review 00ther
F Facility Number Date of Inspleefion
Time of InspLction 24 hr. (hh:
13 Registered [3 Certified E3 Applied for Permit [] Permitted JE3 Not Operational I Date Last Operated: ..................
FarmName: .................. . ........ &n . ....... rtw.m .................... ............ ......... ..................................... .......................
OwnerName: .......................... &.�6 ....................................................... Phone No: ... At . . . .........................................
FacilityContact: ........................................... . ................................. Title: ................................................................ Phone No: ...................................................
MailingAddress: ,,....24............ T-1 ........................................................... ......... ...... ................................
Onsite Representative: ................... ....... tlq�h ..................... ......................... Integrator: .. . ....... G;: ° I ......................................................
Certified Operator ............. &jArj ...... ......................................... Operator Certification Number ..... Mab ......................
Location of Farm:
Latitude Longitude
Design - Current,
Swine Capacity Population
0 Wean to Feeder
Feeder to Finish
t1k
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
0 Boars
Number of Lagoons 1 Holding.ponds 15DSubsurface Drains Present ]JE] Lagoon Area
Spray Field
A�
10 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
El Yes
MNo
2. Is any discharge observed from any part of the operation?
0 Yes
No
Discharge originated at: [I Lagoon 0 Spray Field [I Other
a. If discharge is observed, was the conveyance man-made?
0 Yes
No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
D Yes
RNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system! (If yes, notify DWQ)
El Yes
1] No
3. Is there evidence of past discharge from any part of the operation?
M Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
El Yes
No
5. Does any pail of the waste management system (other than lagoons/holding ponds) require
0 Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the lime of design?
0 Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
0 Yes
rVI No
7/25197

. Fucil* Number: jk — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes IM-No
Structures fLaMns,llgjding Ponils. Flush I145etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard(ft):............... q................. .................................... ............. ...................... ............ ........................ ......................... ........... .................... ................
10. Is seepage observed from any of the structures'? ❑ Yes PPNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 0 No
12.
Do any of the structures need maintenance/improvement?
❑ Yes'
14 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
1� No
W-Itste Applicatlon
14.
Is there physical evidence of over application?
❑ Yes
P3 No
(If in excess of WMP, or runoff entering waters of the State, notify) DWQ)
15.
Crop type..........................V. �Cx.".6................... Ls.c �...............! L.L YJL- car......................... ..
15.
Do the receiving crops differ with those designated in the Animal Waste] Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
O No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
+�
21.
Did Reviewerllaspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Qerlifed or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?,
0 No.violations-vr de'riciencies:were,noted-duririg this:visit: You'will receive ni o'ftirth�er� :.
:. cofOspandehee about this:visit', : , " . "' : . :
vmmenits (irr'fer to questi
on #); `k xplain any YES;
w'tlrarviings. Af raciuty to betteir explain, siivati jm%
+ c(.SCue .
.De►1 3 �SCve 1,r. �tl�s it-?_ 4 1�3
si addlLforal pages as necessary ,a , i=;;H,T O
toA-1 /11
❑ Yes No
❑ Yes No
❑ Yes [ No
7/25/97
ReviewerfInspector Name
Reviewer/Inspector Signature:
Date:

-----------
. ... ...❑!'Division of Soil and; Water Conservation' [3 Other Agen'cy';
T,�
on of Water Quality
re—Toltille 0complaint OFI)Ilo'A�-UP(if])Nv2ins pcation OFollow-upoft)SWCreview 00ther
Date of Inspection
Facility Number=P—E--Ei�
I -- Time of Inspection 24 hr. (hh:mm)
13 Registered IRCertified 13 Applied for Permit U Permitted 10 Not O cratinnal Date Last Operated: ..........................
Farm Name. 2y�� ................................. County:...
..... All" .......
Owner Name . ....... f>. . ...... g..
Facility Contact: ................... I .
........ ... ...................................... Phone No--( .. %1D .. ) ...... ............
.............................................. ....... Title................................................................. Phone No: .... ............................ ...............
Q<, Mailing Address: ...... .................................. .......................
Onsite Representative.-.,..Eo.'6.lal... .... ....... I ............... Integrator: ...... ....................................... - .......
Certified Operator .................................................. ..... I ........................ .............................. Operator Certification Number .......... r ...............................
Location of Farm:
A
........ r.%1A1A,& ..... W&J-f ....
........................
A .....M J.it .. LN....
Latitude Longitude
J� D . ..... ...
D Current. -sigri "Cur t esign De ren urjre
Capacity C*;,Acity; Population;;; winbCapacity.: Population Poultry. Po.puJi ti�in': "Cattle
ii" city.,
Wean to Feeder Layer ❑ Dairy
❑ I I
Feeder to Finish 10 Non -Layer TIE] Non -Dairy
........
0 Farrow to Wean ..
EFarow toFeder ❑10 other ..... ...... ......... .. ..
C3 Farrow to Finish
otA SSLW:
'
0 Gilts
C1 Boars T .1
T
Nurtiber of Lagoonsilidin ron
'KNubsurface Drains Presenjt][] Lagoon Area 10 Spray Field Area
dl;::
�
ID No Liquid Waste Management System
4..i
General
1. Are there any buffers that need maintenancelimprovernent? ❑ Yes No
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon [I Spray Field El Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
-d. Does discharge bypass a lagoon system? ([fyc,,, notify DWQ)
3, Is there evidence of past discharge from any part of the operation?
4, Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mainteriance/improvement?
6. Is facility not in cos-npiiance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0 Yes & No
C1 Yes 29 No
0 Yes IQ No
0 Yes K No
0 Yes � No
Ej Yes JR No
JR Yes 0 No
D Yes CENo
[I Yes §Z No
Continued on back

1
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ff No
Structures f Lagnons.11olding Ponds, Flush fi(s, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Jq No
Structure 1 Structure'2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,,,,_,,r...i...........
Freeboard(ft):........................................................................................
10. Is seepage observed from any of the structures? ❑ Yes RNo
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes &No
12. Do any of the structures need maintenancelitnprovement? 2 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 tO No
Waste Application
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type !.k - .......... ........................... ....�4..S :Y.. L..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes RNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes RNo
18.
Does the receiving crop need improvement?
❑ Yes
HNo
19.
Is there a lack of available waste application equipment?
❑ Yes
04No
20,
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
21.
Did Reviewerllnspec (or fail to discuss reviewlinspec tion with on -site representative?
❑ Yes
KNo
22.
Does record keeping need improvement?
(,Yes
❑ No
Egr
Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1UNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
B No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
®.No
® No'violatians"ar deficiencies. were noted during this'visit.- Y .VU4 11 receive -no fterther Y "
c6rresppM00 ah"out this: visit: :
,
Gantmenta:(t ferto questign.#): =E p]'in.any YES answers'andloc:an_�} recommend$tiaiiils'or•ani.: nt}i rycontmeo ;';''`::,„;v,'
�F•• �.. 5 �F$ F. •• —e•3. .6S `i5. •3. FF. «.. £ «F�eH
use drawings of„facuitot bet explain situ: oris.,(use additional, piige as necessary F
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L o-�.-t. p o w•� L �-.q o v a t I• A -Ls o, c-o ,.. I-v t t It n,if
4
22_ act. �_t -.IV v 11c qc VIP-" Y-,L *--O•-� C 1 t Vt d w� Lam �•Yp ..+.� t1� VA f-.- �a Ce-� 0 --fo
7/25/97
Reviewer/Inspector Name . :( ':: ? •�� '.'•.. x4��;.. 'l'Y .'�,.,� .'iii;.� .�. '�':�iis.
Reviewer/Inspector Signature: Date: 18
M

•
•
Site Requires Immediate Attention:
Facility No. 3 i
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: f , 1995
Time: _ o'� .,ro
Farm Name/Owner. c
Mailing Address:
County: I &,vl
Inte grater.
_Qv,vK
h 19L4 .9. Oou5+d
Phone:
:1.
On Site Representative: Q,) F4 (l aAy-X Phone: 2-1- f -
Physical Address/Locadon:
Type of Operation: S wine Poultry Cattle
Design Capacity: I�oo _ Number of Animals on Site: �. �a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -31 ._ '_,a" Longitude72 ' `/C ' A" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Incites
Was any seepage observed from the laaoon(s)? Yes or No Was any erosion observed? Yes or I
Is adequate land available or sprav? e or No Is the cover crop adequate? e_s or No
r
Crop(s) being utilized: C,G7�_ — S �r a„ ry „ �r
Does the facility meet SCS minimum setback criteria?. 200 Fe�t from Dwellingss or No
s 100 Feet from Wells?e�or No
t-,
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes off
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
G.-
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated an specific acreage with cover crop)? �s r No
Additional Comments:
21
r-
Inspector Name
ct:: Facility Assessment Unit
Signature
Use Attachments if Needed.