310436_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q Co r ante Inspection 0Operatlon Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �--� Departure Time: �.J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: r'^ y ..Jr' "` 5
if
Certified Operator -
Back -up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: + ��
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pap.
Cattle
DairyCow
Design Current
Capacity Pap.
Wean to Feeder
Non -La er
Dairy Calf
ceder to Finish
Farrow to Wean
Farrow to Feeder
70
2-o o
try
Design
Current
1P.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
OtherI
Pullets
Turke s
2Turkey Poults
I Other
Beef Brood Cow _t=9
Pi
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
ONE
❑ Yes ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

F"
Facility Number: j I - I r6 I (Date of Inspection: 5 / 42 I
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EyNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes a ❑ 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 environm�t[:]
at, notify OWR
7. Do any of the structures need maintenance or improvement? ❑ Yes NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
I I ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
gN
❑ 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
r N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other: i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly -Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes o ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection:
'gyp— ►
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Ye
No ❑ NA
❑ NE
41 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 ❑ N 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes <�, NA ❑ NE
r] Yes No ❑ NA ❑ NE
❑ Yes 0 No [] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
rNoo
NA ❑ NE
NA ❑ NE
NA ❑ NE
Y GCLe
r
Q S� r� C C� •+ � �i n -��
Reviewer/Inspector Name: �'� i I"a �—ti Phone:3 /,L V;7
Reviewer/inspector Signature: Date:
Page 3 of 3 21412015

Q Ivision of Water Resources
Facility Number L-.��----�1 - F D Division of Soil and Water Conservation v/
Q Other Agency
Reason for Visit: gRoutlne ❑ Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time:`l=—J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �e vt Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Pullets
Poults
Discharzes and Stream lmuncts
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 WIZ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Caw
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ][`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
En No
❑ NA
❑ NE
❑ Yes
E57-No
❑ NA
❑ NE
Page d of f 3
21412015 Continued

rj�
Facility Number: / - Y It, Date of Inspection: i
Waste Collection &'Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ONo ❑ NA ❑ NE
a, If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in):
5, Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El 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 D-R0 ❑ NA (] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7, Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
R. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C21Ko ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes MINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 25'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
F-1 PAN ❑ PAN > 10% or 10 1bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[] No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ff No
❑ NA
0 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
FZ(No
❑ NA
❑ NE
Required
Records & Documents
14.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dN0
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FrNo
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, checZthe propriate box ;�s
wWaste Application ❑Weekly Freeboard Analysis oil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections E�Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [] N 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
Page 2 of 3 211412015 Continued

Facility Number: - Date of Inspection:
Did the facility fail crate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
Is the facility out of cto ompliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate boxes) bealiblow.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? Yes [] No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ❑ No E�rNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes E�Ko ❑ NA ❑ N E
❑ Yes [2/No ❑ NA ❑ NE
❑ Yes M/No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[� Yes No
❑ Yes Of 6
❑ Yes fo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments:.(refer to,gt estinn'#) Explain any,YManswers.'and/or`any:.addit€anal. recommendations.or,.any;atiter,`camments:;; . .
Use�d'rawir'g$ i faeilltySto°Better cxpliiIn;situatiuris (usc iic[dltlorial`pa es as nereasury]...;
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Reviewer/Inspector Name: 1 (4 v .d Py •,,e
Reviewer/Inspector Signature:
Page 3 of 3
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Date:
21412015
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Reviewer/Inspector Signature:
Page 3 of 3
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Date:
21412015

NCDA&CS Anronomic Division Phone: [phone] Website: wwwaicanrmovlanronomil FY16-WO08566
4fs k- - Client: Jimmy Junes Advisor. .
Predictive
e _
Rainman Irrigation
23D8 Gamer Chapel Rd Waste R� �;7
Mount Olive, NC 2a365
�• Duplin County \�o
s.mpied: 06/17/2016 Rwei-ad: 0612112016 Compiowd: 06/29/2016 Farm: Links to helpful Information
5amvte information
Nutrient and Other (Measurements
Nitrogen ft (npm) P (opml K (ppm) Ca'(ppm) Rq (cmm) S opm) Fe [ppm) Mn (ppm) Zn (ppm) Cu (mm) B (ppna) Na (ppm) C (aprn)
SamiVe LID. #1
Total N 33.9 403 65.8 30.9 19.1 0.94 0.26 0.27 0.26 0.51 125
Waste Code: ALS
Descrlptkm.
Total lgeldahl N 200 '
Swine Lagoon t iq.
PI!DM tn36j SS {10 &cm) EC {mS/cmj CCU (9bj ALE(1000 gal.) C:N
Inorganic N
NH4-N 7.59
comments:
W03-N
Organic N Ni (onm) Cd (ppm) Pb (ppm) A► (ppm) Se lnpom) V looml As (ppm) Cr (ppm) Co (Rom) Cl loom} Mo fopm)
Urea
Estimate of Nutrients Available for Firat Crop 0b 1 1000 gal.) Other Elements (lb 11000 gal.)
Applksthm Method
N P205 K20 Ca My S Fe Mn ' Zn Cu a MCI Cl NA Ni Cd Pb Al Se Li
Irrigation
0,83 0.65 4.04 0.46 0.26 0.16 0,01 T T T T 1.05
Understanding the Waite Report' - additional information; www ncaer.govlagronomilpdffiles/uwaste,pdf & www.ncaar.00v/aafonomVD ilestwasteouide.pdf
Nutrient concentrations and other data on this report are provided'so that waste materials can be applied at agronomic rates, thereby supplementing or reducing fertilizer application and
preventing environmental oontaminabon. In reading the Laboratory Results section, remember that materials with a 15°% dry matter (generally liquids) are analyzed as received; all other
wastes are dried first. Values in the Estimate of Nutrients~ Available far First Crop section are based on the type of waste and method of.applicat)on you specify and reflect the fact that
only 40-60%7of the nitrogen and 70.100% of other nutrients become available within one year of application, The remainder may or may n ever become available.
' ppm = parts per million: S = siemens; m5 = millisiemens; T = trace (<0.005 lb/unft); EC = electrical oanductivity, CCE = Calcium carbonate equivalence; ALE = agricultural lime
equivalence; pH = acidty or basicity; DM•% = % dry matter (for semisolid and solid waste samples, this value facilitates conversion of dry -basis concentrations (ppm) back to wet -basis of
original sample]; C:N ratio = carbownitrogen ratio.
North Carolina Reprogramming of the laboratory4nformatlon-management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
! Thank you far using agronomic services to manage nutrients and safeguanl environmental quality.
L+t of irwt rurl Steve Troxler, Commissioner of

Waters Agricultural Laboratories, Inc.
S �. Crap
1E NC. 364 WestFark Drive Warsaw, NC 28398 257 Newton Hwy - P.O. Sox 382 PraduC#laR
t91 Oj 293-22fl4 F1Ui {91t3j 293-2183 Camilla, Georgia 31730 Services
[phone] FAX [phone]
CROP PRODUCTION SERVICES Soil Analysis Report Oro1Mer: JIMMY Account#- 1723
2954 MC 111-& 903 N Received: 6127M16
ALBERTSON, NC 28508 N� DA Index Field ID: Prmessed: 612WM16
�P-I K-1 Mg%1 11% Water ❑. ❑ ❑_ ❑ ❑ �J ❑ ❑ !��
Lab Number f Sample ID � ❑ _❑ C ❑ _ PH j Ac 5-I Zn-1 2rrAl �Mn-t Mn Ai G+rl �CECf 8596 HM°k Soil Class
1 8f3383UW`y1 - 118 10 21— 1i2 3.1 74.5 041 Min
.i
Recommendations - Ibs.1A P2D5 K2O ® ❑ Cu [� R Mn 'See Note
Crop BERMUDA Pasture M 0"3 220 0 220 tl 20 0 0 12
9= _ 3.8 63.0 a.Min8134)V;;.=? .t5 1#
Recommendations - IbsJA
Lime Tons1A
�` N�
22D5 K20 90
Q
Cer
Zn © Mn See We
Crop BERMUDA Pasture M
O.fi
220
0 200 0
0
D
0 12
813385UW 3 `
161
77 A,22.3
58.9: 1 6.5. OA-. 18 145
145.
37 f
32 44` 4.2 90.5 0.37 Min f
Recommendat}ans - lbs./A
Llme for+slA
N❑
P2O5 K20 Mgf
Q
Cu
2n ® Mn See Mote
Crap BERMUDA Pasture M
0.0
220
0 60 0
20
0
0 pH$ 12
F artil tter recommendations are based on the philosophy and recommendations of the NCDA Agronomic Division
DWQ Laboratory C ordfication Nurn be►635

RECEIVEOMCRENRIDwR
ILL 18 2016
Water Quality Re i
Wirmperatlo �gSection re
Irrigation Equipment Field Calibration F orrr�
Farm Name
Jimmy Jones
Date of Field Calibration
8/10/2015
Flow Meter Serial Number
M070780504
Equipment Number
Center Pivot
Measured Ring Size
0.00 ring Inches
Is ring size within 0,01" of origional
manufactured size?
Yes or No If "no", replace
ring.
Pressure Gauge Readings:
At Pump 70 Psi
At Traveler 60 Psi (if applicable)
At Sprinkler/Gun 50 Psi
Expected Flaw Rate (from manufacturers
375 GPM
chart)
Measure Flow Rate (from flow meter)
375 GPM
Flow rate variance greater than 10%?
Yes or g No
Expected Wetted Diameter (from the
600 Ft.
wetted acerage determination)
Measured Wetted Diameter
600 Ft.
Wetted diameter variance greater than 15%
Yes or V+ No If "yes", then
and/or measured flow variance greater than
Contact a technical specialist or irrigation
10%
dealer for assistance. Explain findings in
box below.
of Fi
Pivot set up with sprinklers to accomadate cenetr pivot are.
Calibrator's Signature
Irrigation Lquipnxnr Fidd CA11bMion Form 8-I5.03
Rdenrion Period 3 Years Oriyimw 2

Appendix 1. Lagoon Sludge Survey Form
A. Farm permit or DWQ Identification Number
B. Lagoon Identification
C. Person(s) taking Measurements
D. Date of Measurements
E. Methods/Devices Used far Measurement of:
Revised August 2008
31-436
Jimmy Jones - JJ 2
Norman Hatem
712512015
a. Distance from the lagoon liquid surface to the top of the sludge layer.
METERED 1-112 PVC & DISC
b. Distance from the lagoon liquid surface to the bottom (soil) of lagoon
METERED 1-112 PVC
c. Thickness of the sludge layer if making a direct measurement with "core sampler"
NIA
F. Lagoon Surface Area (using dimensions at inside top of bank) 1.30 (acres)
(Draw sketch of lagoon on a seperate sheet and list dimensions, and calculate surface area. The lagoon may
have been different than designed, so measurements should be made,)
G. Estimate number of sampling paints:
a. Less than 1.33 acre: Use 8 points
b. if more than 1.33 acre, 1.30 acres x G = 14 with a maximum of 24.
(Using sketch and dimensions, develop a uniform "grid" that has number of intersection points that match most
closley with the estimated number of sampling paints needed, Number the grid intersection points on the lagoon
grid to correspond with the data to be recorded for points of measurement.)
H. Conduct sludge survey and record data on "Sludge Survey Data Sheet" (Appendix 2). Also, at the location of
the pump intake, take measurement of distance from Ilquid surface to top of sludge layer and record it
on the Data Sheet (last row); this must be at least 2,5 ft. when irrigating.
I, At time of sludge survey, also measure the distance from the Maximum Liquid Level 3.9'
to the Present Liquid Level (mcasure at the lagoon gage pole):
J. Determine distance from the top of the hank to the Maximum Liquid Level
(use lagoon management plan or other lagoon records)
K. Determine distance from Maximum Liquid Level to Minimum Liquid Level:
(Determine from Plan or other lagoon records)
L. Calculate distance from present liquid surface level to Minimum Liquid level:
(Item K - Item I, assuming present liquid level is below Maximum Liquid Level):
M. Record from sludge survey data sheet the distance from the present liquid surface level
to the lagoon bottom (average for all measurement points):
N. Record from sludge survey data sheet the distance from the present liquid level surface level
to the top of the sludge layer (average for all the measurement points):
0. Record from sludge survey data sheet the average thickness of the sludge layer:
P. Calculate the thickness of the existing liquid Treatment Zone (Item N minus Item L):
Q. If 0 is greater than Item P, proceed to the Worksheet for Sludge Volume and Treatment Volume.
If 0 is equal to or less than item P, you do not have to determine volumes.
1.6'
1.9'
-2.0'
6.9'
5.1'
1.8'
7.1'
r�
Completed by:) Robert B. Mitchell [late: 712512015
Print Name � Signature

Appendix 2. Sludge Survey Data Sheet
Sludge Survey Data Sheet
Completed by: Robert 6, Mitchell
Print Name
Revised August 2008
Lagoon Identification:
Jimmy Jones - JJ 2
Date:
�SiBnature
(A)
Grid
Point
No.
(B)
Distance from liquid surface
to top of sludge
(C)
Distance from liquid surface
to lagoon bottom (soil)
(C)-(B)
Thickness of sludge
layer
Ft. & inches
Feet (tenths)
Ft. & inches
Feet (tenths)
Ft. & inches
Feet (tenths)
1
05'08"
05.7'
0708"
07.7'
02'00"
02.0'
2
04'04"
043
07'OO" _
07,0'
02'08"
02.7'
3
06,00"
06.0'
_
07'06"
07.5'
01'06"
01.5'
4
05'09"
05.7'
07-05"
07.4'
01'08"
01.7'
5
05106"
05.5'
06'0fi"
06.5'
01100"
01.0'
6
05'00"
0&0'
0703"
07.2'
O2'03"
02.2'
7
07'05"
07A
T 08'06"
08.5'
01'01"
01,1'
8
06'00"
06.0'
08-04"
08,3'
02'04"
02.3'
9
06,01"
06.1'
07'10"
07.8'
01109"
01.7'
10
0606"
05.5'
08,00"
08.0'
01'06"
01.5'
11
04'06"
04.5'
06'08"
06.7'
02'02"
02.2'
12
oToT
03,5'
05'06"
05.5'
02'00"
02.0'
13
04'01"
04,1'
05'03"
05.2'
01'02"
01.2'
14
O1'06-
01.5'
O3'OT
03.5'
02'00"
02.0'
Average
05'02"
05.1'
05'11"
06.9'
01'10"
At
4.4
4.4
4.4
4.4
pump
Intake
a All GrigPoints and corresponding sludge laver thickness must be shown on a
sketch
See Appendix 6 for the conversion from inches to tenths of feet.

Appendix 3. Sludge Volume WorkSheet
Revised August 2008
The average thickness of the sludge layer and the thickness of the existing liquid (sludge -free) treatment
zone are determined from information on the Lagoon Sludge Survey Farm (Items 0 and P, respectfully). In
this example, the average sludge layer thickness is 2.5 ft. in the cxisting Treatment zone is 3.5 feet. If the
lagoon has a designed sludge storage volume, see notes at the end of the worksheet. The dimensions of the
lagoon as measured and the side slopes are needed for the calculations of the sludge volume and of total
treatment zone. If the lagoon is a standard geometric shape, the volume and treatment volume of the sludge
in the lagoon can then be estimated by using standard equations. For approximate volumes of rectangular
lagoons with constant side slope, calculate length and width at midpoint of the layer and multiply by the
layer thickness to calculate the layer volume as shown in the example. if the lagoon is an irregular shape,
convert the total surface area to a square or rectangle shape. For exact volumes for lagoons with constant
side slope, the "Prismoidal Equations" may be used.
Example
Your Lagoon
1. Average Sludge Layer Thickness (T)
2.5 ft.
01.8'
2. Depth of lagoon from top of bank
11 ft.
11.0'
to bottom soil surface (D)
3. Slope - horizontal/vertical side slope (S)
3.00%
3.0%
4. Length at top inside bank (L)
457 it.
325.0'
5. Width at top inside bank (W)
229 ft.
175.0'
6, Length at midpoint of sludge layer
398.5 ft.
264.4'
- Lm = L - 2 S(D-(172))
7. Width at midpoint of sludge layer
170.5 ft.
114.4'
Wm = W-2 S(D-(ri2))
8. Volume of sludge (V)
169,860 ft. 3
54,445 ft. 3
V=Lm Wm 'f
9. Volume in gallons
1,273,950 gal.
408,339 gal.
Vg=V*7.5 gal.lf 3
10. Thickness of existing liquid tmt. Zone (Y)
3.5 ft.
7.1 ft.
11. Thickness allotal treatment Zone M 6.0 ft. 8.9 ft.
Z = T + Y
(Appendix 3 continued on next page)

Appendix 3. WorkSheet for sludge volume and treatment volume (continued) Revised August 2008
12. Length at midpoint of Total Treatment Zone
409 ft,
Lz = L - 2(S) (D - (Z12))
13. Width at midpoint of Total Treatment "Lone
181 ft.
Wz = W - 2(S) (D-(ZJ2))
14. Volume of Total Treatment Zone (Vz.)
444,174 170
Vz = Lz Wz L
15.Ratio (R) of Sludge Layer Volume to Total
0.38
Treatment Volume
R = Vs/Vz
264.4 ft.
114.4 ft.
345,048 ft,
.16 (16%)
If the ratio exceeds 0.50. then a Sludge Plan of Action may be required. Check with
DWQ for information on filling the Plan of Action.
Note: If the lagoon has a designed sludge storage volume (DSSV), subtract that volume from
both the volume of sludge (Vs) (item 8) and from the volume of total treatment zone (Vz) (Item
14), and take the ratio:
R = (Vs - DSSV) 1(Vr. - DSSV)
Example: If DSSV = 85,000 [�. , then R = (169,860 - 85,000)1(447, 174 - 85,000)
R = 84,8601362,174 = 0,23

-App4dix 6, Convemlim Table F ;;,arts ra Tent xs. a Feat,
jh4hcs
Tenths of
InQhts
s of
I—'—
I D,1
0,4
1,2
fl
8
3
ol 2•-
¢
3
0,
I3
04
b,
O.S.
s
i6

Appendix 1. Lagoon Sludge Survey Form
A. Farm permit or DWQ Identification Number
B. Lagoon Identification
C. Person(s) taking Measurements
D. Date of Measurements
E. Methods/Devices Used for Measurement of:
Revised August 2008
31-436
Jimmy Jones - JJ 1
Norman Hatem
7/26/2015
a. Distance from the lagoon liquid surface to the top of the sludge layer.
METERED 1-112 PVC & DISC
b. Distance from the lagoon liquid surface to the bottom (soil) of lagoon
Metered 1-112 PVC
c. Thickness of the sludge layer if making a direct measurement with "core sampler"
NIA
F. Lagoon Surface Area (using dimensions at inside top of bank) 1.25 (acres)
(Draw sketch of lagoon on a seperate sheet and list dimensions, and calculate surface area, The lagoon may
have been different than designed, so measurements should be made.)
G. Estimate number of sampling points:
a. Less than 1.33 acre: Use S points
b. I£ more than 1.33 acre, 1.26 acres x 6 = 13 , with a maximum of 24.
(Using sketch and dimensions, develop a uniform "grid" that has number of intersection points that match most
cIosley with the estimated number of sampling points needed. Number the grid intersection points on the lagoon
grid to correspond with the data to be recorded for points of measurement.)
H. Conduct sludge survey and record data on "Sludge Survey Data Sheet" (Appendix 2). Also, at the location of
the pump intake, take measurement of distance from liquid surface to top of sludge layer and record it
on the Data Sheet (last row); this must be at least 2.5 ft. when irrigating.
1. At time of sludge survey, also measure the distance from the Maximum Liquid Level 1.0'
to the Present Liquid Level (measure at the lagoon gage pole):
J. Determine distance from the top of the bank to the Maximum Liquid Level
(use lagoon management plan or other lagoon records)
K. Determine distance From Maximum Liquid Level to Minimum Liquid Level:
(Determine from Plan or other lagoon records)
L. Calculate distance from present liquid surface level to Minimum Liquid Level:
(Item K - Item 1, assuming present liquid level is below Maximum Liquid Level):
M. Record from sludge survey data sheet the distance from the present liquid surface level
to the lagoon bottom (average for all measurement points):
N. Record from sludge survey data sheet the distance from the present liquid level surface level
to the top of the sludge layer (average for all the measurement points):
O. Record from sludge survey data sheet the average thickness of the sludge layer:
P. Calculate the thickness of the existing Liquid Treatment Zone (item N minus Item L):
Q. If 4 is greater than Item P, proceed to the Worksheet for Sludge Volume and Treatment Volume.
1f D is equal to or less than Item P, you do not have to determine volumes.
1.8'
2.0'
1.0'
6.4'
4.0'
2.4•
3.0'
Completed by:) Robert B. Mitchell Date: 7/25/2016
Print Name Signature

Appendix 2. Sludge Survey Data Sheet *
Sludge Survey Data Sheet
Completed by: Robert B. Mitchell
Print Name
Revised August 2008
Lagoon Identification:
Jimmy Jones - JJ 1
- gate.
Signature
(A)
Grid
Point
No.
(B)
Distance from liquid surface
to top of sludge
(C)
Distance from liquid surface
to lagoon bottom (soil)
(C) - (B)
Thickness of sludge
layer
Ft, & inches
Feet (tenths)
Ft, & inches
Feet (tenths)
Ft. & inches
Feet (tenths)
1
04'11"
04.9'
07'04"
07.3'
WWI
02.4'
2
04'05"
04.4'
07'02"
07.2'
02'09"
02.7'
3
04'00"
04.0'
07'00"
0 77.0'
03'00"
03.0'
4
03'08"
03,7'
07'02"
072
03-06"
03.5'
5
03'06"
03.5'
06'08"
06.7'
03'02"
03.2'
6
03'00"
03,0'
06'01"
06. V
03'01"
03.1'
7
03'07"
03.6'
05,08"
05.7'
02'01"
02X
8
04-00"
04.0'
0607"
06.6'
02'07"
02.6'
9
04'06"
04.5'
06'07"
06.6'
02'01"
02.1'
10
04'02"
04.2'
06'07"
06.6'
02-05"
02.4'
11
04'06"
04.5'
06'03"
06.2'
01'09"
01,7'
12
04'05"
04.4'
05,08"
05T
01'03"
01.2'
13
03,08"
03.7'
0410"
04.8'
01-02"
01.2'
Avcra e
04'00"
04.0'
0605"
06,44
02'05"
02.4'
At 3.2 3.2 3,2 3.2
pump
Intake
* All Grid Paints and egrresponding sludge laver thickness must be shown on a_
sketch
See Appendix 6 for the conversion from inches to tenths of feet.

Appendix 3. Sludge Volume WorkSheet
Revised August 2008
The average thickness of the sludge layer and the thickness of the existing liquid (sludge -free) treatment
zone are determined from information on the lagoon Sludge Survey Farm (Items 0 and P, respectfully). In
this example, the average sludge layer thickness is 2.5 t. in the existing Treatment zone is 3.5 feet. If the
lagoon has a designed sludge storage volume, see notes at the end of the worksheet. The dimensions of the
lagoon as measured and the side slopes are needed for the calculations of the sludge volume and of total
treatment zone. f f the lagoon is a standard geometric shape, the volume and treatment volume of the sludge
in the lagoon can then be estimated by using standard equations. For approximate volumes of rectangular
lagoons with constant side slope, calculate length and width at midpoint of the layer and multiply by the
layer thickness to calculate the layer volume as shown in the example. if the lagoon is an irregular shape,
convert the total surface area to a square or rectangle shape. For exact volumes for lagoons with constant
side slope, the "Prismoidal Equations" may be used.
Example
Your Lagoon
1. Average Sludge Layer Thickness (T)
2.5 ft.
02.4'
2. Depth of lagoon from top of bank
1 i ft.
10.5'
to bottom soil surface (D)
3. Slope = horizontal/vertical side slope (S)
3.00%
3.0%
4. Length at top inside hank (L)
457 ft.
300.0'
5. Width at top inside bank (W)
229 ft.
182.5'
6. Length at midpoint of sludge layer
398.5 ft.
244.2'
Lm = L - 2 S(D-(T12))
7. Width at midpoint of sludge layer
170.5 ft.
126.7'
Wm = W-2 S(D-(TI2))
S. Volume of sludge (V)
169,860 ft. 3
74,256 ft. 3
V=Lm Wm T
9. Volume in gallons
1,273,950 gal.
556,923 gal.
Vg=V*7.5 gal.lf 7
10. Thickness of existing liquid tmt. 'Lone (Y)
3.5 ft.
3.0 ft.
11. 'Thickness of total treatment Zone (Z.) 6.0 ft. 5.4 ft.
L=T+Y
(Appendix 3 continued on next page)

Appendix 3. WorkSheet for sludge volume and treatment volume (continued) Revised August 2008
12. Length at midpoint of TotaI TreatmenI Zone 409 ft. 244.2 ft.
Lz = L - 2{S) (D - (Z12))
13. Width at midpoint of Total Treatment Zane 181. ft. 126.7 rt.
Wz = W - 2(S) (D-(7-J2))
14. Volume of Total Treatment `!_one (Vz) 444,174 ft3 185,540 ft.
Vz=Lz WxZ
15.11atin (R) of Sludge layer Volume to Total 0.38 .40 (40%)
Treatment Volume
R = Vs/Vz
if the ratio exceeds 0.50. then a Sludge Plan of Action may be required. Check with
❑WQ for information on filling the Plan of Action.
Note: If the lagoon has a designed sludge storage volume (DSSV), subtract that volume from
both the volume of siudge (Vs) (Item 8) and from the volume of total treatment zone (Vx) (Item
14), and take the ratio:
R = (Vs - DSSV) / (Vz - DSSV)
Example: If DSSV = 85,000 0, , then R = { 169,960 - 85,000)1 (447, 174 - 85,000)
R = 84,8601362,174 = 0.23

Appc
ciix 6, Conversion Tabir F ;,,ohcs to Tanis, of Pis*t,
dnahos
I
Tcriths Of
ir,AO
fact
Fe-
i
0, }
2
v.
s
3
d 2
�
,3
S
Qv4
!} }4
}
16

(kMvision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency VVV
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ❑ Routine 0 Complaint o [row -up D Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: [� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: D'x S Integrator:
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
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
Non-L
Pullets
Turkey Poults
Other
Design Current
Discharges and Stream Imnacts
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?
Longitude:
Design Current
Cattle Capacity Pop.
Daia Cow
DairyCalf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes EYNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
F] Yes
Q No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility umber: 3- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CJ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a 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 UWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
�E
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
dNE
maintenance or improvement?
Waste Application
NF
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
[I
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ From those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [D NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [] No ❑ NA E�rNE
16. Did the Facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA Eff NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA rNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [�N
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA El"NE
the appropriate box.
❑ WU P ❑ Checklists ❑ Design [] Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA rNE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412015 Continued

Facill Number: -16 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] NA NE
❑ NA NE
❑ NA [�NE
Lw.J NA [ NE
❑ Yes ❑ No ❑ NA [JNE
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA El"NE
C] Yes E!f_No
❑ Yes [No
❑ Yes Ef No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date:zz
r
Page 3 of 3 21412015

type of visit: a Compliance Inspection 0 ;Follow-up
er tion Review Q Structure Evaluation Q Technical Assistance
teason for Visit: Q Routine Q Complaint 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: E1= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: � Title: Phone:
.
Onsite Representative: t m r k y 9 �i r Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
❑esign Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
I Layer
[Non -Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
eeder to Finish
Design
Current
Daia Heifer
D Cow
Farrow to Wean
Farrow to Feeder
lt .
Layers
ers
Ff
Ca act
Po
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Beef Brood Cow
❑then
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

A
Faellity Number: 3 -_7 Date of I nsp ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1__ —2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EKo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed through a [:]Yes EJ'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0--Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E],4o ❑ 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 2-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E!No ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 14 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 ED�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FD'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA [:fNE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E3 o ❑ NA ❑ NE
❑ Yes [5'No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA Mf NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA Fj_NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " 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 E]"'NE
❑ Weather Code
❑ Sludge S�VE
❑ NA
❑ NA �' E
Page 2 of 21412011 Continued

Fac1H Number: qj - Y7b Date of inspection: z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ❑ No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA Q-NE
❑ NA NE
❑ NA BNE
tR A ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No [3NA
1-1
E] 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 E! 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
01C
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 2 No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA
❑ NE
Comments (refer to question #): Explain Any. YES answers and/or:;any;additianal recii�nmsndations``ui anyF;ottier� cotexmerits: ' '�:::"„ :
Use drawings.af facili :to better.i is (ain'sltiitftians'(usi additional a es:i� necessa)~:`d'4.11. Ltd
V4,5(1 r;';;+
�..�Q / p n ! r�"� e t,_4 4-k 5 6 ! 1 OL "^ L �� Y."GIIC r— CS % wa f� .s / OFC J+ r
.J 7Cr J
r r Q Lj)n n
4.r
&3 w e4r- J. vt jP f cif rl ti'Tn n ccw1 r-/ &r-'SJ°q)
k-re eS- (on4-f C Ctti'f —+ree
S?w Fat
Ci A44y+[ 5cLn•ey ati
+^Seecf�'L'rItf'1
F-oL pe 919 3 s7b ZQC `f
t,rt_ +c y4-
j,Y r r,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ti's 5 k An�f S'_S �-Vvvpllv (J '5
Phone: [ T 731
Date:
I or
21412014

Cype of Visit: Co nce Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
teason for Visit: Routine O Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: O Ir Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: II Title: Phone:
Onsite Representative: /�r►+ ^ti r eo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
ou
Wet'Pltry
_,upity
Pop.
Es#tie Eapacity 1 op.
Wean to Finish
Layer
Dairy Cow
n to Feeder
Non -La er
Dairy Calf
ceder to Finish
SS 9
D
Daia Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P,oultr.
Ca ac€
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
01 Other
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?
[:]Yes P ' o ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
0 NE
❑ Yes
❑ YesFT-No
❑'i`o�
[DNA
❑ NA
❑ NE
❑ NE
Page I of 3 214120II Continued

Facility -Number: - Date of inspection.
f it -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. 1 f yes, is waste IcveI into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Io ❑ 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 D Yes EfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or env nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8, Do any of the structures lack adequate markers as required by the permit`? ❑ Yes E-N o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes D<o ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes {fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0--No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to lncarporate Manure/Sludge into Bare Soii
❑ 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
[Er&
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[ yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FN❑
❑ NA
❑ NE
acres determination'?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ZrN o
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
rZ No
❑ NA
❑ NE
Required
Records & Documents
14,
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
<No❑
NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21, s record keeping need improvement? If yes, check the appropriate box below. EI-Yes ❑ No ❑ NA ❑ NE
Lyr ste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
D Rainfall ❑Stocking ❑ Crop Yield 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections �QSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jjlNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
thh propriate box(cs) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
��A❑
NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C]"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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EjeNo
❑ 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
[:fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ ❑ NA ❑ NE
33. Did the Revi ewer/] nsp ector fail to discuss review/inspection with an on -site representative? ❑ Yes L�J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Io ❑ NA ❑ NE
x .
Comments (refer to ques an ;< xp a n any, .E answer�(an , oreany.:a d t onal.rezorrimen at Ens"or"any otli:er cnmments.:g;
Use di•awing� of facility;tn better explain.s(tivations'.(use:itddltianaipeges as;iecessaryj b°=; yg,i+'d.. "�'��
,�I`fCC �jt [I L (`���i�� � ��iif %L� C❑/I�ry' ►vir�L 9 1� rial�' a 7� -K1y
lCWCle- � �J ��� �P S r_�
N 0 �/.� S-� a 5-1-5 4, � �� CT P r� l� li /' -J n , �it S r �l 1 ' e � So S i✓► F!
do nn o �rr� PPJr �� � �.� � 1►'P�td,
1 b ' 1 ' +n5'eC �-.V LS _ GD R e t­ :T'
25► �4S 14A_je- 5r'Bey
Reviewer/inspector Name: _ Q --r t( : _ Phone: k? 77
Reviewer/Inspector Signature: Date: / %
Page 3 of 3 21412014

1
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: J2Moutine O Complaint D Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: � Arrival Time: Departure Time: County: 7
Farm Name: h►► Owner Email:
Owner Name:
Mailing Address:
:Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Integrator:
Phone:
Region:
Certified Operator: _ �.11M.P1 Certification Number: )VU
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
on -Layer
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish `
Design Current
D . l'ouIt . Ca aei Pop.
Layers
—DryCow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars 3
Pullets
Beef Brood Cow
Other
Other
Turkeys
TUTkcX Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharger
1
❑ Yes J;3'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes []No
❑ Yes E!]"No
[:]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility. Number: - &Y 3TJ Date of Inspection:11/77
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b LI
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONO
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�Vo
❑ NA
❑ NE
waste management or closure plan?
?�`
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PlNo
❑ NA
❑.NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EE'No
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Ej_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
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J�!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
,EI—No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OENo
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JoNo
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design []Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
,E!'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONO
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesT!j'0No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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 ONO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ]'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [;fNo ❑ 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 0"No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface the drains exist at the facility? if yes, check the appropriate box below,
❑ Yes
?fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
[�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.other comments.
Use drawintm of facility to better explain situations fuse additional pages as necessary).
Reviewer/Inspector Name: Phone:
_ 4_.
Reviewer/Inspector Signature: wzulr. P210--_� Date: &—O—)Lf
Page 3 of 3 IU 21412411

Division of Water Quality
Facility Number �7 - Q Division of Soil and Water Conservation
Q Other Agency
Reason for Visit: U Routine Q Complaint Q Follow-up 0 Referral Q Emergency Q Other Q Denied Access I
Date of Visit: Arrival Timer Departure Time: County: Region:
Farm Name: ys 1� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: F Integrator:
Certified ROperator- ��-y • ��yN Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capaelty Pop. Wet Poultry Capacity Pop.
I E La er
Non -La er
Non-L
Pullets
Turkey Pouets
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy fieifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes 0 No
[:]Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 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
G61slo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ 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
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
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
No
❑ NA
❑ NE
S. 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZfNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zf No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2�N
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - pate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2!fNo ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[d No
❑ NA
❑ NE
Yes
2fNo
❑ NA
❑ NE
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes
4 No
❑ NA
❑ NE
[D Yes
V] No
[DNA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or any other comments.:;
Use drawings of facility to better explain situations (use additional pages as necessary).
7771
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:0 l5__ �` eic��
Date: Wjn'
.,-----
2/4/2011

Division of Water Quality
.facility Number ©- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: �&Routlne ❑ Complaint p Follow-up 0 Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: , dC T-14 tR Owner Email:
Owner Name: rn 3U - S Phone: 9 — (OS R — 7
Mailing Address: l_#-J� ` G VAC! ► t [ I,tnl T �1 ` I tAP-1L►
Physical Address:
Facility Contact:
Onsite Representative: i fi1171 o v 5
Certified Operator: rvl Q S
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
YL Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Phone:
Integrator:
001 no`
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -La ers
Pul lets
Turke s
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?
Longitude:
) 9 9(a a
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes iY I No ❑ NA C] NE
❑ Yes [] No ❑ NA ❑ NE
C] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes,
❑ ❑NA ❑NE
Page 1 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
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
I
Spillway?:
II
Designed Freeboard (in):
Observed Freeboard (in): —T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., iarge trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
12. Crop Type(s): %F[Z( H
❑ Application Outside of Approved Area
S
13. Soil Type(s): AVAyQ.yjU%LLe �7a(Le sTaH
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
(DNA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
[� Waste Application 0 Weekly Freeboard Q Waste Analysis [] Soil Analysis
❑ Waste Transfers
Q Weather Code
Q Rainfall ❑ Stocking Ej Crop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LqNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Q
Facilit Number: - q3 C7p Date of Inspection: Ellyll
r'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
29, 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
01"
❑ 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
0
❑ 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 CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑Yes
No
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,.g.
Ilse drawings of facility to better explain situations (use additional pages as necessary)..
CAC-169LOT/C A/ CW C.C-"M-CL ?1UdT pGE ad
w . A . -4 -)
a ac�J I r* g� ���� �
8J lolacv
V1
-- o1L.S IN �CJ1C] w4�-�oS] �' a�L.11 � H�Vt✓�L�F� T14rGl�
SOIL `:Oe_ 'C)o� 1 5'
�j �lGams i 5�uv� S�C�-��� Q�j ► ►�� TzNti7 CA
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: glU9r���
Date: yA/ll a
21412011

Type of Visit `Compliance inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 4Routine n Complaint ❑ Follow up D Referral Q Emergency D Other ❑ Denied Access
Date of Visit: 1V r7 11' Arrival Time: Departure Time: County: U N Region:
IPAQr� ] -L-/
Farm Name: C� i , Owner Email: Owner Name: I 4A N G S Phone: 91 R — toss- 5 g
Mailing Address: 4 _�Q L"1 WtXE 1L CM P RE L Y� l.� 1t�uH 7 (,.f��E. Y/ V C 008
Physical Address:
Facility Contact:
Onsite Representati
Certified Operator:
Back-up Operator:
Title: Phone No-
Ve: , i Mokot owas Integrator:
J l M Lk� �= - - ._ Qperatol Certification Number: , cf9�v 9
Back-up Certification Number:
Location of Farm: Latitude: = e = ` 0 " Longitude: 0 ° Q i Q
11
M=�Deslg�MOffrrent
l7csfgIII Current
❑esign
Current
Swine Cxpa�ity Population
Wet Poultry
Capacity Population
Cattle Capacity
❑ Dairy Cow
Population
❑ Wean to Finish
1 ❑ La er
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
00c> I
❑ DaiEX Heifer
Farrow to Wean
17ry Fottltry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
El Farrow to Finish
❑ Beef Stocker
Gilts
Non -Layers ers
❑ Beef Feeder
❑ Reef Brood Cow
❑ Pullets
Boars po❑
Turke s
Other
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
❑ischarees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ANo ❑ NA ❑ NE
[]Yes
❑No
❑NA
❑NE
[]Yes
❑ No
❑ NA
❑ NT_
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V"No
❑ NA
❑ NE
❑ Yes
)4So
❑ NA
❑ NE
Puke 1 of 3 12128104 Continued

Facility Number: —C 13(o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes El No ❑ NA ❑ NE
Structure �—1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed freeboard (in): 19,
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ElNE
(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
R. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes No ❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1K
9. Does any hart of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
14. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes j4No ❑ NA [:]NE
m ai ntenance/i nip rove m ent?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes X No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �� � �►! JG C-OW "AT S !> --
13. Soil type(s) R"-7 -�_k U 1 uE
14. Do the receiving crops differ from those designated in the CAWMP?
❑yes 9No
❑ 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 0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
El NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes ❑
❑ NA
❑ NE
Cuinments {refer to.questi�n:#)s Explain any YES ans►ycrs-in d/urdany . rccommendAtions or any,„nthWcomm_ ents,
Use drawin s`of faciiit to-better.explain situations: use'addrtional a es`as nccessa "
Reviewer/inspector Name e b Phone: 0
i= �.
Reviewer/Inspector Signature: `"� - Date:
Pugs 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
)A 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 El Checklists 0 Design [l Maps ❑ Other
J ,
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis C] Soil Analysis ❑.aste Transfers ❑ t]ll'nual Certification
[] Rainfall El Stocking � Crop Yield El 120 Minute Inspections 0 Monthly and 1"
Rain Inspections /El
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 rainbreakers on irrigation equipment?
❑ Yes
ANo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
iqNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Drawings: Comments.an /or
di.: , .. ..r
.„
4J A
5 ENr o FF - ru I�->cE s� _. LC E err a w A. Fc µArc ►-�P►x�i
a�-
U,nanr nn
S t�O�E ��R
�C F ]Gf� M "r l.�N T ! �- eC� J* Foe- S ti f L4 Foggy � o�
7- A- CROP `J tr C.i�> r►h IF-0V_ - pL_& +s e rzcz �S oN ►4 pp-o U is D FG(Lr
Page 3 n f 3 12128104

Type of Visit GLCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for VlsitRoutine Q Complaint ❑Fallow up ❑Referral ❑Emergency ❑Other ❑Denied Access
Date of Visit: )d Arrival Time: �(�� t Departure Time: County: Region:
Farm Name: ��'5 1AOt; ppx� - 1-1l_ Owner Final� I 5 -
4 . - - -- 0 \ - ..-. ttil� cl
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Sa"Llos
Certified Operator: Jt0 101 LA j e 5
Back-up Operator:
Phone:
I UE 0 %I1(Z S865- �D )Cy
Phone No:
Integrator-
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ` = " Longitude: = ° = 4 0
11
Design Current Design Current Design
Swine Capacity Population VVet Poultry Capa�lty Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
I
1 ❑ Dairy Cow
I ❑ Dairy Calf
Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stacker
El Beef Feeder
ElBeef Brood Cnwl
Number of Structures: E]
❑ Wean to Feeder
JEJ Non -Layer I
Feeder to Finish
Dry Poultry
❑ Farrow to Wean
El Farrow to Feeder
Layers
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
❑
El Non -La on -Layers
El Pullets
❑ Turke s
El 7'urke Poults
❑ Other
Discharaes & Stream I_ mpacts
1. Is any discharge observed from any part of the operation?
El Yes
XNo
❑ NA
[I NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
El NA
❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
El Yes
El No
El 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
El No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
El NA
El NE
other than from a discharge?
12/28/04
Continued

Facility Number: — y'f (p Date of inspection 1 t7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: } �r
Designed freeboard (in): + , 5�-E I •�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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 OWQ
7. Do any of the structures need maintenance or improvement'? ❑ YesVNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part ❑f the waste management system other than the waste structures require ❑ Yes No ElNA ElNE
maintenance or improvement? 4
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesXNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ONo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 14 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) G___-�_ (24:%LN ww E4T SR
13.
Soil type(s) f'lLl'ffL U lL4_r__ Tali
14.
❑o the receiving crops differ from those designated in the CAWMP? ❑ Yes
tNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
�` No ❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application? ❑ Yes
No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
J-No ❑ NA
❑ NE
Comments"(refer'to.question #]: 'Exp€ain anyYI;S:answGrs_andlnr atiy:jrecommendatIons or an other eonimeaft p ;
. . .g .'.p:aRgUse drawingrs of;facility tohition. ssa�s..�nc16: ei.:�syys.9arcrQyiti]
Phone:
Reviewer/inspector Name - - - - - J F Se'a .`'�yy r` 4 • 'r?.d. �¢ ta��
Reviewer/Inspector Signature: Date:
JZ18104 Continued

Facility Number: ' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists Design ❑Maps ❑ ether
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
0 Waste Application El Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ t nual Certification
0 Rainfall ❑ Stacking 0 Crop Yield El 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additlanal Comments and/or prawings:
1�fly�a� 1.5
❑ Yes bNo
❑ Yes �allo
❑ Yes No
ElYeslNo
No
El Yes
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ONE
El NA ONE
kA ❑ NE
❑ Yes ✓ ` No
�/,.
El NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes. No
❑ NA ❑ NE
❑ Yes jKNo ❑ NA ❑ NE
❑ Yes ,tNo ❑ NA ❑ NE
[--]Yes 154io ❑ NA ❑ NE
I2/28104

Type of Visit WCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit; Arrival
Time: ® Departure Time: County: u Region:
Farm Name: 3 � � S 1Fa(L� — LLf Owner Email:
Owner Name: l C7iN S [} � —Phone:
Mailing Address: ,y?�D� 1�--[7 _!_! ►�l�V 1�C-1y E� O���
Physical Address:
Facility Contact:
Title:
Onsite Representative: _.. ��N F_�__ _ _ Integrator:
Certified Operator:
Sack -up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = ❑ = 6 = Longitude: = ❑ Q 6 0
14
design Current
Design Eurrent
Uesign Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑ La er❑Dai
Cow
o Feeder
❑ Non -La er
❑ Dai Calf
to Finish
❑ Dai Heifer
to Wean
VE]Fa
ry
❑ D Cow
to Feeder
Non -Dairy
to Finish
❑ Beef Stocker
Non -La ers❑
BeeFFeeder
❑ Pullets
El Beef Brood Caw
❑ Turke s
Other
❑ Turkey Poults
❑Other
!Number of Structures:
LEE10ther
Diseharees & Stream impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
X'No
❑ NA
❑ NE
Discharge originates! at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge From any part of the operation?
❑ Yes
❑
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —tJ36 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V,No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
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
(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 an of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7�y o any of the structures need maintenance or improvement? ❑ Yes -E�LNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 9N❑ ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes A No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes [ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wii 4,Drift ❑ Applica ion Outside of Area
w-A 47-31 [� r A I Iaa��a y-1 Hya y-I-q-IS
12. Crop type(s) rip ►J! l.� 7�,5 co" t S 17 1310
13. Soil type(s) AL , 2Au_ iL.-L c roui s Sa/ `
v
14. Do the receiving craps differ from those designated in the CAWMP?
❑yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
it No
❑ NA
❑ NE
imSV'�-:.9�..l �::4"�: .�:;•.'.:7'�". u 4:1..••�D�..R6cR..
u`Camment;(refer-ta.gnestian`#}:Frplaln,anyfYE5;answersandlneerLuny.([ppp�arL(ecotnmew,an,.d.catinns'�,aryry��r any•othercommefits.
G
JT'8�
Use {�CAWIn�5
t tst YoFfacility'tobetfer explain;situation�s:.{use ailditlrinalipages as necessary):'
j 0q 43 f c- C-ARZ) /VCsT oL4i c E i- CacT�) aims G!G A-crI u 1S=
C P LA aza-rj O/V 'bL L ! N
Reviewer/Inspector Name - v t1 A - t41'04' � } Phone: []-'1r7(o 3
Reviewer/inspector Signature: Date: g
Page 2 of 3 IZ'2&04 Continued

Facility Number: 7 Date of Inspection
Re
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
V 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. 0 WUP ❑ Checklists Design ❑ Maps
g p [:1 ether
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
` No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑Xaste Transfers ❑lnnual Certification
❑ Rainfall ❑ Stocking O Crap Yield 0 120 Minute Inspections 0 Monthly and V
Rain Inspections ❑
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;qNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'R 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
tE�No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NI3
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
Zj No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
Cl Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Aifilitianal'Eunimeafs'anillor"Uruwin`s�
co F( `T�] KG 5t�► � �► cT��� S
r
ptrr anao • yne_g�D nCrnt33 l . net
Qlo�
aft (nPIL 1 o
f f(nAW PA C0/�Q,
xjr
f Q, Cs:gv
v6rQ,"/ /VC
ILMt
'OS90S
Page 3 of 3 12128104

Diyisinri';af Watcr;Quali
Facility Number Q Divisiain of Suil xrid .VL'iter. Consservation:
3 f y3�
OtherEt1C 'A 3 x•..
Type of Visit (Z) Compllance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Q Routine 0 Complaint D Follow up d Referral Q Emergency n Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �upci Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 I = 11 Longitude: = o ❑ 6 i
Design. Current:: . ,: = Design'.. 'Current ; ;'r';Tpesign Current=
Swttee: Capacity. Population ` Wet Poultry Ca aci I'o uliiition ..Cattle:'tCapacifyl?tipula�tiun��
tY p . P h .. P z�s
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
% b
61(000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
Non -Layer
Dry Poultry ..
Non-L
Pullets
Pouits
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?
❑ Daia Cow
O-Dairy Calf
❑ Dairy Heifer
El Dry Cow
Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Num ber: of, 5truCtt
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 2RNo ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NF
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes
❑No
❑NA
ONE
[--]Yes
�4 No
❑ NA
FINE
❑ Yes
12� Na
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 j — 936 Date of inspection a q
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: CO�O=
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ti
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 11 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 5n No ❑ NA ❑ NE
❑Yes NINo DNA ONE
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? N Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V1 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?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. � Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ® Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or Operate per the irrigation design or wettable acre determination ?
❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
GN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
14 No
❑ NA
❑ NE
Comments refer to question # : Explain an YES answers.and/or an recommendations or:aniother°co n nents
( q l P Y Y�,.: Y.:
ary):; Use drawings of facility to better explain situations. (use additiunal pages asneess;-1;:��.::_.`�:;:':�:;,::�.��.. ;.:.4.,•:,,.;
V GGE"iA 110AI '70 S10? &(10,51cW 6Af C046GO/V1
PAM? D la i5 D,000 . AL56 g[-VAU]A W1NWcj�i 596ALb
}{Qua 6ELN Uisl 'SoAACt 6JZA1l1? QLFASC �- C►41LC- r+uL
,D}. nC�E6'To 14)71AC4b911E ANL��ZRiIY F+9LL a\jr-,f- I"
Reviewer/Inspector Name f _ ti ; NVOSv- �pyN p(�y�LL Phone:
Reviewer/Inspector Signature: `�r i . Date: jz;; r, d 8
P", a 7 Af Z I I11MMA.f r.,...:.....a

Facility Number: 3 - 930 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ g Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. tQ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 5Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments andlor Drawings:
❑ Yes
Od No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
(4 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
tZ No
❑ NA
❑ NE
❑ Yes
(3 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
�No
El NA
❑NE
Page 3 of 3 12128104

I Type of Visit 0 Compliance Inspection Q Operation Review Q structure Evaluation 0 Technical Assistance
`` Reason for Visit .0 Routine Q Complaint Q Follow up ❑ Referral Q Emergency D Other ❑ Denied Access
Date of Visit; Arrival Ti e:'--P, Departure Time: I 'aCounty: +C Jy G Z� Region:
Farm Name: Owner Email:
Owner Name:,�_1 rrl -.�Dn� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _
Certified Operator: I
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ a = I = Longitude: = ° [� g ❑ fl
Design Current Design Current l3esign
Swine Capacity Population Wet PnuItry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
I0 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
0-Dairy Calf
❑ Daig Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of structures:
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
f?ry Poultry
El Layers
❑ Farrow to Finish
❑Non -La Non -Layers
❑ Gilts
ElBoars
❑ Pullets
Uther
❑ other
El Turkeys
❑Turke Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (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? (Ifyes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
0
ElNA
ElNE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: 4/p /J10
Designed Freeboard (in):
Observed Freeboard (in): 2 a r�
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
❑NA [I NE
Structure 6
El Yes No El NA El 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No El NA El NE
maintenance/improvement`? /I
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind [Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crap and/or land application site need improvement?
El Ye
No El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No ❑ NA
❑ NE
17. [Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
0
❑ 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):::. : ,s`.. :...:. ':...:: •.'; :. ;' `.
Reviewer/Inspector Name Phone: w
Reviewer/Inspector Signature: Date: C�
Page 2 oj3 121281014 Continued

Facility Number: Date of Inspection *Zt�—
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ql No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No El NA ❑ NE
the appropriate box. ElWUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �LJ No
❑ NA
El NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El 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 P"No
❑ NA
❑ NE
//ND
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes &No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes I[J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ff No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �(No
ElNA
ElNE
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
I
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 O No
❑ NA
❑ NE
Additional Comments and/or Drawings: }
Zoo 't,-
go
Page 3 of 3 1212&04

r
L
f Vislt 9f Compliance Inspection D Operation Review Q Structure Evaluatlon 0 Technical Assistance
n for Visit Q� Routine Q Complaint Q Fallow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 3/ d Arrival Time: ; Departure Time: 1Q County: W1fZx7 � Region: ►��
Farm Name: . _. _ L� (� Owner Email:
Owner Name: - rj oo f-�orJ�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r ,�_ _ t � .'O JCS
_I ---
Certified Operator:. � 0-13, A146
Back-up Operator:
Phone No:
Integrator: 1u — &RoWA)
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 13 0 ` = " Longitude: = o = 6 = ,6
Design Gurrent
Swine Capacity Population
Design11ffiurrent
Wet Poultry Capacityulation
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
-Layer
❑ Dairy Calf
Feeder to Finish O
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
aDry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -La ersPllt
El8eef Feeder
EBoars
uesGilts
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
r No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any past of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number —
Date of Inspection laL
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: # I 112—
Spillway?: NO AAA
Designed Freeboard (in): 147,5 S
Observed Freeboard (in): j 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes 0No ❑ NA [IN F
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. Ayes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Froxen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of
Wind Drift El Application
�Outside of Area
12. Crop type(s) AlAne,'__1411-1A,
13. Soil type(s)
14. Do the receiving crops differ from.those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes o No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O'No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers. and/or any recommendations or any: other.comments:.:
Use drawings of facility to better explain situations. (use additional pages as. necessary)::.,
Reviewer/Inspector Name f
ry,
Phone:19/17
Reviewer/Inspector Signature:
Page 2 oj3
Date:
r.
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. ❑ WUp ❑ Checklists g ❑ Maps ❑ Other ❑ Design r+le
21. Does record keeping need improvement? If yes, check the appropriate box below. VrYes P#No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections P Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ZNo
❑ 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
i No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other issues
6i
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMF?
9yes
#KNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IIVNo
❑ NA
❑ NE
jAdditlonal Comments and/or Drawings:.
4(' S Y�aRr e_
- DwW4Z 613,60 /a D Sr i W644. GrJ/1/2 17 v
21)anJ-
Af-CORD j5VI EN r PIJ AeOpRov ea /&21ns
g8 0 Ii � D� .S�uoc,4-
4P"' � P4,` & 0 ��
,'VWr
1 46 �
`` �R9i�F�IL I'�C�Py2CA�Pa�rJ �dig Gc�.d
Page 3 of 3 1212&04

Type of Visit 9Compliance
Inspection
Q Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit fd
Routine D Complaint
a Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: '� O Arrival Time: Departure Time: i County: 1 Region: r•`
Farm Name: �s /�G FrQ4li7 7 Owner Email:
Owner Name: _ =TzaifY1l;I =�34F'5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
❑nsite Representative: J ='-Mn*4 �!dit5
I
Certified Operator:
Back-up Operator:
Location of Farm:
�f Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o =. Longitude: = ° 0 I =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish ZO 1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
❑fscharges & 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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: FTI
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
Cl Yes ❑ No ❑ NA ❑ NE
El Yes ❑No ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 13L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes ;MN. 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 b
Identifier: �,�,, ll
Spillway?: I v10 Nv
Designed Freeboard (in): /q 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) tZ
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 7No ❑ 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 6'No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside rofAcceptable Crop Wind w, C;❑ Evi nnee of Wind Drift El Application
n Outside of Area
12. Crop type(s)�&C? 4Yf/7 f1�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes_ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
si:::.,�, :i �.{�°
;Cbmmcnts (reter'to'quc$ inns4} ;t4lairifany„YES answers ancllorAany recommendations ar any other comments.
ilse•drawings of fa 'I ty'tu..better.explainiAtuatio`'n.;(us6,hddit[dital quges as necessary
�s '�..;.. .az. ,.
arai"a �. r's'-.l.:: �. ',x.�. r•v' � �i:i!Y;. i:q•<�.r. �i�_..: Wn.:r��w'y
C an,►J' 1 f�orJS �U y °Ariz>y rr� Cj�Loe),,J Ado.
Dom . , ",N' emu,- Df G �� 2,
Reviewer/Inspector Name
Phone:
Reviewer/inspector Signature: Date: O�
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 appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ ether
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 ❑ Crap Yield ❑ 120 Minute inspections [:]Monthly and 1"
Rain Inspections
❑
Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ 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
oN❑
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA/f� NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 4o ElNA ❑ NE
and report the mortality rates that were higher than normal?
X.
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El
❑ NA
ElNE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VNo
❑ 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
[IN E
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
'AIdditional Co:nments nndlor Drnwin s•
{ ; `''; ;
6 :-:';
a i,
I - �I�� I7��� �rj /[� �- v(f�--GL � ' •rri1--���-z��.
12128104

Time:
6ermitteS,J�*Certiflied [j Conditionally Cer 'hued [3 Registered Date Last Operated or Above Threshold: •........................
11 r �j
FarmName: ...... .4 ...........! 0. ...re-q-M l........ ............................. County:.....D t...........,...............,..,...................,
Owner Name:
Phone No:
MailingAddress: ........ ..... ....................... ......... ............ . . . .............. . ................................ ................ ... ...... ...... .............. ............................... -...»
FacilityContact:..................................................... ............ Title: ... ...... ................... ............... ................... Phone No:...................................................
Onsite Representative:..... ` �3.1y1fi!�c,7L...................................... Integrator: ._..........................................
Certified Operator:
Location of Farm:
......................... »...I.......I.................... Operator Certification Number:
❑ Swine ❑ Poultry ❑ cattle ❑Florae L htude " yy�4 �" Longitude �,1�• �/Y� C�64
Ci�rr�e tt•lf Fl + .i} I''r"; i.. .} .. Le� ih:if. C�irr�nt� .. 'R'� _..1,.." ,rfT^.'k.� •#1GAi�gn urrent ..
.5 i; 1 .iP'. -rk ��l;i. Y li gib ._ ".
Swine ; 'F {t.. ,' `Poutt' A ��! ' y Cattle is
Ca 'aci ,="Po relation ::. i 3' . A:__.Ca ci �. Pow
e�ilatioit r Ca aci Pe tilatiion
❑ Wean to Feeder',; ❑Layer ;;F ❑ Dairy
Feeder to Finish 10 Non -Layer ❑Non -Dairy
Farrow to Wean .� ;;....r.; .
7
Farrow to Feeder {Y', ❑ Other _
...
Farrow to Finish
g,;,�;.;
�.
?�
n
` C� e�
Giltspr
�. :f'... � I'.k� �'F
Tota %� � y
❑ �5..
Roars
'L I
., y k, ��' * ' '':.1� iry i� x.t.i�'...'3•.jri''1.:•,.. 13 "�41 .I ry�.'�'�.` j.H Kji'
T.A ; f' , Ci: ff ,. i �... i'la:: ', j•
x ;tNlIrrlb I:agoons p
.Ys� u� ':]ry:,"''�?i.;= `, i' iii;}� I�'1" ;:., i'•� �:, �i'
i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ Nq
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�Zo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 010
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure C
Identifier: .................................... ........................... .... ........ ........................ ................. .............. »......................................................................
Freeboard (inches): 3
12112103 Continued

Facility Number: Date of Inspection
1� Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ZNo
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes dN�
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type j3 U_M✓Diq ( U) J!►''#ALL tin&T J ASC-�F_0 CWS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ErNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes Z
c} This facility is pended for a wettable acre determination?
❑Yes
15. Does the receiving crop need improvement?
❑ Yes �N79
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Imues
/No
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes
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 o
Air Quality representative immediately.
.. ....,:°:k?f£ss.."':.a S"•:i.ri•..�Fx:i.. .4.: -'MLr: -�:.'.751:� •.,-........,,..-. �..:ia'Hfc.:
'li:. �.'-.�.. •1:$I'I`R':f .....,. . ... �.-...,.•1 .•.'...:�"::'...,:�'-.....«.z.. <.at':::'::"t:::"
Comments;{re>:er. to. question O Explain any YES answers and/or any recommendations or, any o6er.comments::
'°i44 'ir: 't;'�ff`. �.�,r...:. t3t.::P?,wc�,.cwrw..M,a...:ra.... ..w....::...i«..:..w
' x° J.
;��:......
.:I?:: ..S .w:�1r�# W' �;�b:S3iiyt�_:4i#3:': ....:r"#:`�:siYP:�'.?:J'�;.s><#s,z::&:�':..;s%;{�:
Use drawings'ot,iacllityloibetier, rxpla�n sitihtlons.;(use additioinai. pagesas.necexsary):fY' Field Co
EI H�! ' t • Jip t 4 #.{apy,: ❑ py ❑Final Notes,
rr ::+': [i �i��pprh ii I f .k ii..F Fi •j� ,�f�: !I'�+ .,r : f1';. , I �,:�s��y::ryi;
:d i:q�,. .:u:,,.r...: •i?�iir�.. di .�Ca::il�iTrr+; •'�iN'vl!..,,{.�iTk. .:., k�.�:,:31'�,...,;i,e.�i.{��l.. r. �:: •}:'srts•:: <.... ... �V.. r �""'�"':".'"..L
�7) CvtJ',LNUE uJ6"L Otj GRAZ COOCK-,
U P PATE C aff `ti'T-E L,0 Fb am
I/
masK crror A+ TC.rr-
c4eiES of
R6c6p,.05I
5LOO&� �M\/Cy
Reviewer/Impector Name w
Reviewer/Inspector Signature:
K09 C-ALEga-A�:�>t" 6( kEPT
Date:
wsr-�
Tt;i
12112103 1 ` Continued

FacilityNumber: - 3 Date of Inspection
Reauired Records & DocumenLs
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [fNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel W'UP, 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 ff iv
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes EfRo/
26. Fail to notify regional DWQ of emergency situations as required by General Permit? — f
(iel discharge, freeboard problems, over application) ❑ Yes o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes 7
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPI)ES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35) Yes ❑
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Y s ❑ No
35. Does record keeping fo DES required forms need imWInspection.
ment? If yes, check the appropriate box below. Yes ❑ No
❑ StockingForm Crop Yield Form ❑ Rainfall After V Rain
P
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

.:....... ......... . .
Divisio a#cr.
...::.;:...
=x
aall ry �
i i
I.
.Wa Co se t3a
�isio d ter.
........
....... .., .
.. .. ..........
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�.3,... , , ..
� OtherAn
uk<
FI I0.
,AtteneY 3 . . ................
Type of Visit (j5 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
EFacility Number Irate of Visit: 0 Time:
Not 'a low Th es old
Permitted © Certified O Conditionally Certified [3Pegistered Date Last Operated or Above Threshold:
` rdFarm Name: � 4~ Connty:. �`l M1r
Owner Name: -:r-�- O r Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: M:'c)oo Integrator (!KkKo L mu►4p► r �1
J
Certified Operator:
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 Li Longitude ' 0
Design Current' F Desigh:. Current Design' Current
Caacy :o ice Ca acy Population 'Poult . acity Population
Wean to Feeder 1❑ Layer 1 ❑ Dairy
Feeder to Finish ❑ Non -La er l.. ❑Non-Dai i
Farrow to Wean _...... .
Farrow to Feeder ❑ Other
[] Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of.LagDons ❑ La Subsurface Drains Present oon Area S rav Field Area
:I H•.. i.�l -
Holding'Panels I.Sa[id:Trapsl j' , ❑ No I.i uid Waste Management System .
Di5chaEges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes x No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & Treatmen
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ 5pillwav ❑ Yes )z No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; I Pump
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, Cl Yes ;jNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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 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 Ievel
elevation markings? ❑ Yes No
Waste -Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
I I- Is there evidence of over application" ❑ Excessive Ponding ❑ PA ❑ Hydraulic verload Yes No
12. Crop type fJ �Rmu n Ps f f .�— �-; ©df k6� �' 17� . t.Ule f q'00,gnl5
13.
Do the receiving crops differ witki those designated in the Certified Animal Was a Management Plan (CAWMP).1
❑ Yes
No
14.
a) Does -the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
;zNo
c) This facility is pended for a wettable acre determination?
❑ Yes
XNo
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNO
Ree uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;!fNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
RfNo
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Oe/ discharge, freeboard problems, over application)
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
/0
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZRINo
15 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conim' 'eiuts (recer:.to 'questlon o", Exptsiwany :YES answers.a4or any i�ecnmmindatians or;any of er comments.,,
1.
Use tl 'iwit gs of.facllliv to better explain situatitins,'(ttS additional pages as necessary): T Field Corsv ❑ Final Notes i
6AfC— _A /►��YZCF� �-3-40E h1le F 4 ,paw Ael
Afjl?1KA2}r
f5 oW 1,,z�5X'O,_,O
Hw
Reviewer/Inspector Name ILAOrIA
Reviewer/Inspector Signature: Date: 2 f7
05103101 Continued

Facility Dumber:
Date of Inspection
dar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
j'Additionai Comments and/or Dra wins:
❑ Yes El No
❑ Yes 1—No
ElYes No
❑ Yes /No
❑ Yes No
❑ YesNo
❑ Yes ❑ No
r� } Ne,C p 1,40 aa1a LJe sr-e'd fox Avrw
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05103101
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Division of Water (duality
Q Division of Soil and Water Conservation
10 Other Agency
Type of Visit Compliance Inspection Q Operation Review ❑ Lagoon Evaluation
Reason for Visit X Routine 0 Complaint ❑ Follow up 0 Emergency Notification ❑ Other ❑ Denied Access
Facility Number Dale ur visit. ® Time: ® Printed on. 7/21/2000
Q Not Operational 0 Below Threshold
Permitted 13 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ..,..........T a................................................................................... County:.........................................---.................
Owner Name:
Facility Contact:
Title:
Phone No:
PhoneNo:.. .................................................
MailingAddress: ......................................................................................... . .......................... ....................................................................................... ..........................
Onsite Representative: 0.t j%- Q V............................................................................... Integrator: ... C 41� r................................................ .
Certified Operator:.....................................................„......................................................... Operator Certification Number;
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 « Longitude dd
Design Current Design Current DiWp.. ,,,6jaiistt
iy"'wit� " ' Poultry CapacityCatte Po ulatnn Ca d Population
t.
Wean to Feeder 10 Layer I Q Dairy
Feeder to Finish rj ' O ❑ Non -Layer ❑ Non -Dairy
E Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capaeity
Gilts
� . soars Total!SSLW
€..': Numbew of Lagoons' ❑ Subsurface Drains Present ❑ lagoon Area Spray Field Area
.Holding Ponds/ Solid Traps' ❑ No Liquid Waste Management System
Discharge- & 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. li' discharge is observed. what is the estimated flaw 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 Strllucturo 2 Structure 3 Structure 4 Structure 5
Identifier: ........... 11. A.""�".............. ....... ............................ ................................... I .............................
Freeboard (inches):
5100
❑ Yes J No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
)�No
❑ Yes
to No
❑ Yes X No
Structure G
Continued on back

Facility Number: 03k — 4 345� Date of Inspection Printed on: 7/2112004
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes gNo
(I£ any of questions 4•6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? %Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes X1 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenancelimprovement'' ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,� No
12. Crop type Ctu►-h t..r� 5� .s . i�o 5-<4 c ►�4Qd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ioNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Off No
b) Does the facility need a wettable acre determination?
❑ Yes
P No
c) This facility is pended for a wettable acre determination'?
❑ Yes
No
15.
Does the receiving crop need improvement?
MYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
X No
18.
Does the facility faiI to have al components of the Certified Animal Waste Management Plan readily available?
XYes
(iel WUP, checklists, design, maps, etc.)
❑ No
19.
Does record keeping need improvement? (iel irrigation, frechoard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J•No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
b�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
�rNo
(ie1 problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
Z91io
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
bRNo
�'V !yi#1at 5 •o� d�fci00H -►zero ��O�� 00.iog 01s,visit; - Yv(r w011 tooiyo 00 ftitth
Cor oride' 'e' ab' ' this :visit. •
Cotntnents (refer to question`#): Explain any YES answers and/or any recommendations or any.other comments: :! , + ;
Use dra►wirigs of facility to bel�t er explain situations, (use additional pages as necessary}:
!�Q1•,pu� 't+•ca� cam. !"+�i �[ivo} aT a d1 P 't`
ao0 30 t�
' I �l R�Q1 eta- 1 ,c 1--P_W Ic"o C C �, �Vz j
M.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: S 9-'Q( 5/O0

Facility Number: 3 Datc of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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 O 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 J No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 5QNo
Additional omments and/orDrawings: [
�� �1� �a-►-,� �t�t� e�� �s2 sGr,.e. � wo�� ��1-+,-� . ��e;-3ee�:[
. L 1
ass ► `��5 5�. t�,�- r^o r� t.-r Lre�.lc �,� �t-.e►-� 1�
G V e I VQ--cC �i s A- LIt L-. a G J 6AW,O\�
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► VIO

© Division.of Soil and Water, Conservation - Operatiot► Review
vision of Soil and Water Conservation,- Complia nspeetion E Di ace •I • I:�:' ��6�;;_
+ • ' y . " Division of Water: Quality': Cornplianee Inspection.
ther Agency - ration Review' ;. Operation ,
WRoutinc Q Codplaint Q Foilo►v-up of DWt nspcc6on Q Fnilc►w-up of DSWC review Q Other
Facility Number Date of Inspection --J Time of Inspection 24 hr. (hh:mm)
WIPermitted 0 Certified © Conditionally Certified [3 Registered JQ Not O erational Date Last Operated:
.....a.. .. ............... i�-,............................... . Farm Name: G county: ......................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress:..................................................................................................................................................................... ........................... ..........................
Onsite Representative: ,•,` 1.�` ................................................................ Integrator: ...C.;.k,'!'��.11.......................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude • 4 6k Longitude • �� �66
Design 'Current Design Current';Design, Current
,Swine Capacity Population Poultry Capacity Population Cattle Capacity � Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Q ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity-.,
❑ Gilts
❑ Boars Total SSLW .,
ci
Number of Lagoons' .. ❑ Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Dischar; es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
.t. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, slid it reach Water of the State'? (If ycs, notify DWQ)
c. If discharge is observed, what is the eslimoted flow in gallinin?
d. Does discharge bypass it lagoon system'' (Il•yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation? 1
3. Were there any adverse impacts or potential adverse impacts to the i aters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequat. ? ❑ Spillway
Structure I Structure 2 Struclur 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):-__--.....r�.
❑ Yes gN❑
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
PjrNo
❑ Yes
ONO
❑ Yes Xf No
Structure G
5. Are there any immediate threats to the integrity of any of the
3/23/99
observed? Oel trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
Continued on back

i
Facility Number: raJ — Date of Inspection Printed on: 712112000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �<No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes '9No
9, Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 13(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application?? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type 5 y C" 1 L�Liv
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes NfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes WNo
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment'? ❑ Yes ;<No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
19.
Does the facility fail to have :it components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement? (ie/ irrigation, frecboard, waste analysis & soil sample reports)
N(Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
JgNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
C�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'!
Oc/ discharge, freeboard problems, over application)
❑ Yes
�rNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
❑ Yes
PfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
%No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP'!
❑ Yes
0 No
yi¢1p i[j"s ar.. . cjendes -►►sere noted. doting #b1s'vIsit; - Y:o(i will-tooiye f14 fuf ft�
correspondence: ahoiuk this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
V_-�V_v �.I�
+
vlp�5-. fie$ 0d
Reviewer/Inspector Name
-'ITS
Reviewer/Inspector Signature: las ( )t Date:
"� �� 5100

Facility Number: — =3K Date of Inspection G;+
Odor Issues
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 I�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 t;(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes WNo
AdditlanaMomments an or ra n ,w.• � •t +• •,�:,,,.: r.; w:p�;.�r:t�. - �a.:. V„
R
�►� cal' � 64d � Ca r t� � I�2 c� 0� G � "
�G

] Division of Soil and Water Conservation Operation 4onRaview
13.Division of So and Water Conservation - Curripliance Inspection
AP
ivisian of Water Quality.- Cottriplian Inspection n
13 Other Agency 'Operation Review.,
kURoutine O Complaint O Follow-up of DWQ inspection D Follow-up of DSWC review Q Other �
Facility Number Date of Inspection re p
Tire of Inspection u • 24 hr. (hh:mm)
fidPermittedAITCertiflcd 13 Conditionally Certified [3Registered 113 Not Operational Date Last Operated .
Farm N:ime:................ ......5i�....s.................. .................................. County ,PcJ*LT
OwnerName: ...................... ................... .... ........................ .......................................... Phone No:......................................................................................
FacilityContact: .......................... .................................................... Title:................................................................ Phone No:...................................................
MailingAddress: ..........................................................................................................................................................................................................
Onsite Representative:......1.�`.M ! `......'j'o'jE................................ I.................. Integrator:......Gt'4 7�- ,,........ I .............
.................
Certified Operator : ................................................... ............................................................. Operator Certification Null] ber:., 1.14..Z ..............
Location of Farm:
Latitude 0 ' .4 Longitude
Design Current Design Current Design Currcnt
Swine:'. Canacity Population Poultry Canacity Pnnulation Cattie Canacitv Ponulation
❑ Wean to Feeder
ceder to Finish
3S- Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑spray Field Area
.,, . Holdin Ponds 1 Solid Tra s = ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify ❑WQ)
c. II'discharge is observed, what is the estimated flow in gal/min'!
d, Does discharge bypass a lagoon system? (Il'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
Identifier:
Freeboard(inches): ......... ........................................... ..... ..... ............ ................... ....... I .............. ............. .....
❑ Yes 0<0
❑ Yes 2fNo
❑ Yes 0 No
❑ Yes No
❑ Yes N?
❑ Yes o
❑ Yes ZNo
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 7rNo
Continued on hack

Facility Nurube r. — Date of 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 DWQ)
7. Do any of the structures need main tenancelimprovement?
8. Does any part of the waste management system other than waste structures require mainten ancelimprovement?
9. Do any stuctuies lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over applicatipp�
G, t3�❑ Excessive Ponding ❑ PAN
12. Crop type CA t %Ckk A . jeL&6x z4 C"r..1/w j S
@ z�
❑ Yes ztl;o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This Facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack Of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
19. 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? (iel irrigation, freeboard, waste arfllysis & soil Sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; $5� ibla000s'ao dtricje tH "re 00fied• il0ing #h SMsit; • yor will r ee�iye 06 rutft
• carres� ntideitce. ab�r.tt. this'isit . .... ..... • .............. .
❑ Yes ZNo
❑ Yes ONO
❑ Yes dNo
Cl Yes wNso
El Yes
❑ Yes R5�No
❑ Yes XNo
❑ Yes )ffNo
❑ Yes 0 No
❑ Yes 2"No
❑ Yes ONO
0"?es ❑ No
❑ Yes IETf�o
❑ Yes eNo
❑ Yes 0No
❑ Yes Rf"No
❑ Yes ZdNo
❑ Yes 2<0
❑ Yes j�2rNo
❑ Yes {�No
Comments (ref&46 question It)?Zxplain any YES answers and/r any,recomrnendations of any other comments. "
Usc'drawings o f facilrty;.ta better ezplairi situations.. (ilise,addi6x hal pages as neeessary): � 1 ' .
17) CW—T ca f -� aF CSC WCA A l_ IF-44Lk ZT i`aE..t� TM iZittC.e l+�S ,
% .a0 %A CC$_ 6, LLo,-Mp ►st 'ra ZT 5 t ••1({s� 'Fn e-
c-i'^ .S'Ctra tJ, Lk%ft ►A Ta roJL`" PX_ L ge9^AQ0A, vl C;aLSP A00J rwl 7b 124 c[37 ,
W: foa ) qb 395" • 39as f.I
Reviewer/Inspector Name
ReviewerlInspector Signature:
Date:
3/23199

• Facility Number: — 3 hate of Inspection Zv
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
O"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
Z(No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;3"Nc3
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
Io
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
El Yes
ZNo
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
gNo
3/23/99

. ................
❑ Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality ;
0 Routine 0 Comnlaint 0 Follow-un of DWO inspection 0 Follow-uo of DSWC review 0 Other
Date of Inspection I��Ia�IR
Facility Number
Time of Inspection 2; 24 hr. (hh:mm)
© Registered OPCerlified 0 Applied For Permit Permitted JE3 Not O erational I Date Fast Operated:
tt Count `
Farm Name:.................. �?l. ......�.... rv............~............................................ y:.......�1�.�z.11k......................,...,...........................,..
OwnerName:.............................dixmj......... ,......,,....,.................................. Phone Nn:.....�. ,f��...�a .. 7Ge....................................
FacilityContact: .............................................................................. 9Title: ......... .......... .............................................. Phone No:...................................................
MailingAddress:....2 ....... ........L.......T ............................... ......1 .k. r....... '.v„t..�....�'.r.............. ................. ,�i��.�.....
Onsite Representative ............. i!fX�> ..........PV4.............,....................................... Integrator. ...... L fj 1r YGC.1.��........................................................
Certified Operator:.......................'hV.W'.nV1... R......... Alt.V.W4................. I ................ I.... Operator Certification Number......1336A .....................
Location of Farm;
Latitude �• ®� _ 4? Longitude ©• �° ���
°,._: Design elrren ;...` ;;:;:.: Design Current
g wine'" ,, € Ciiipiacity :: 0p.U.. on Poultry Capacity Population.;. Cattle Capacity Population
❑ Wean to Feeder ❑ Layer El airy
to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gitts �, •, F: 1
❑ Boars:. " , F... i;; :. Total SSLW .3 -75, Z oa
,; Nudd er of Lagoons I Holding 1P6nds 2 ❑ Subsurface Drains Present [J Lagoon Area 10 Spray Field Area
i:':. ,' €€:..: . _. ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes [9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated Flow in gallinin? . N
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require] Yes Of No
m a i nten an ce(i mprove me nt?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 7No
7, Did the Facility fail to have a certified operator in responsible charge? ❑ Yes rtNo
7/25/97

Facility Number; 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon0jolding puds,_Flush Pits ems)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1' .L..........
Freeboard(ft):..............-.\.............. ............................ ........ ................................... ..............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Fj No
❑ Yes
51 No
Structure 5 Structure d
❑ Yes
No
❑ Yes
No
JM Yes
❑ No
❑ Yes 'P No
W-AsILApplication
14. Is there physical evidence of over application? ❑ Yes El No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..........6T AtlU�a................�45.Ct! L........... . � 4 ni........ .cLe�.... .....SGr'J.6gt!!R-....................................................................................
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 JR No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certiftdgr Permitted Fac_Qj(jes Qnly
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. viotatiansor' dertdenci& w' e're.ntited.during this:visit. You:w'ili recei:ve_no-flintier
c0rrespb6deitce 6460t -this' visit:•
,1Yes ❑ No
❑ Yes W1 No
❑ Yes CA No
❑ Yes [Po
M Yes [I No
❑ Yes 7" No
❑ Yes 1P No
❑ Yes R No
`�. Q£rwlRww­X fti"ArY-c+rS 5i tryi(nD.�Dh G'wLS SkAIA (00— iRS�7lil,td i+4 S�;►� fi� ���5.
1z' Gml ar. 6r\ IrXML�r d'kL k 144 1t o� tolcon &Wa lot- rt feed J .
t V. Co^{ t n%)e >t va ve. �eC C V V_ MA �t SC V e-
Lz• CaYYtGT P S kcuj1 V job&1*a or, 4L Mtord& pr tPc=4+- r_V'O j 5� ft• 5
axe, 1i-4� 1r-- '�" Wt , Y�
7/25/97
Reviewer/Inspector Name
G
Reviewer/Inspector Signature: .._ _ �.. - Date: _ 1 1011y

r ,s;, E :°� >�, ; ; �• � T, 77 4�
❑ Division of Soil and Water Conservation ❑ Other Agency
"i`"' `�® Division of Water Quality
vpp..egw,ry„y. F""".e resFH ... :. dSP'.",��r.-T.....::,iSi?5""!..""..""""'�'^t3t'-".wr�w..�a msi,f�.. =,r•..'-'Snt`^nF!°. .::: .:. ..:
10 Routine Q Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review n Other
Date of inspeetion
Facility Number
Time of Inspection Etitl 24 hr. (hh:mm)
E3 Registered V'Certified © Applied for Permit © Permitted 113 Not O eratinnal Date Last Operated :..........................
Farm Name: ..,, .�.+� ... s........
s�..........!f .....r.+L� y......................................................... Cnunty: t r �],
Owner Name: .............L.sM..m ............. c ��.xa S................., l'honc No:....L1.1.i... ...`..S Z ..[1 ..
FacilityContact: .............................................................................. Title:................................................................ Phone No:............,.,....................................
�rL:.....................s Mailing Address:..., ...r.,C� a�...... ......... .... :..................r........,1. Onsite Representative:.... ...x.. 3............. ti ...Ll.1 .12. ......................................... ................................................
CertifiedOperator;............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
❑r...... M.LAA.... ,t.a.�4.....� ..C. 1.. ..Q.j...�.....gr..
....................1........................................................................................................................................................
Latitude a 1 66 Longitude 0 ' "
Al Design:,,; : Current:; Design Current. Design Current"r;> .
Swine Capucrty; Poptt[atinn .;; Poultry; Ca acit Pa ulation ,. Cattle Ca .acit P6 elation t
Capkit p Y .. p.
❑ Wean to Feeder
❑ Feeder to Finish
❑ Far -row to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of I a gnns I Holdin ;Ponds ❑ Subsurface Drains Present 0 Lagoon Area ❑Spray Field Area ;{
E • No Liquid Waste Management System
=i 4 R Y
General
1. Are there any buffers that need maintenancelimprovemetit? ❑ Yes IRNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water" (If yeas, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
I 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
maintenanceli rnprovement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Rj No
❑ Yes 19 No
❑ Yes R No
tJ 14 .^^
❑ Yes ® No
❑ Yes
®'No
❑ Yes
RNo
❑ Yes
IR No
❑ Yes
9No
❑ Yes
la No
Continued on hack

r
Facility Number: 31 -- N 3
A
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (j,agoons jtold1rig Ponds, Flusla_1'1B. etc ,j
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
tj No
Stricture 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
Freeboard(ft) ............................................................1.............................. **....... .l......... ........ ................. ............................. ........
..................l....l.l..........
10. is seepage observed from any of the structures'?
❑ Yes
bjr,No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12. Do any of the structures need maintenance/improvement?
9Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
® Yes
❑ No
3 'aste Application
14. Is there physical evidence of over application?
❑ Yes
&i No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................................... -a rs .........................................................................................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Myes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ENO
18. Does the receiving crop need improvement? ❑ Yes Q No
19. Is there a lack of available waste application equipment? ❑ Yes BNo
20. Does facility require a follow-up visit by same agency'? ❑ Yes RNo
21, Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo
22. Does record keeping need improvement? ® Yes ❑ No
For Certified or Psrrnifted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes EZNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes &No
0' No.violitions'ur de'fidencie's.rvere nnted-_during this:visit. 'You:wiQ 'receive`itn flirtl_ier
eorrespnndebee aKoW thkvisit' :: .: :.:...' .....
s.....esss: �'.:::: :ill:::'::";ss! ': •:: �.. .. ..:� ::' ...s:• ._':. .., -ss� �:.i,. .: ..�::�:• _
n .. sw # t}tnnxe is re er o' oast on x to a att er :an ar, an rec t n at on r.ari a eY:co s... . t rl .'..
n s ! vmn e s � mrne�
::i WilS ..... ... ,. :.F:. ....-. .
� �, sk •..::-. $ ��er. i:..:,F.: i •�:.. .f�,
":.'�...-1:. .'. :"!Se iS•:FFF �?.:�:;::: 'i 'FFi.iiy: -'i� �: iys S:•�Ss ;: j;; j. .
F.
>C3se[trAWlnt;9'Pf.laCllitj to better:expiutnsltuattuns;usq addl#tonal pages as necessa,i. •,r,:l;: ; . ,: F; _. 'F`F, , ", �.
'€ki'i'334355 .?t�s !!4t't _it °'ii :it : $� 3;'3Z ,•3 . EiI i [! ,e �� S;i•..
.,r e•e .. �. ,5 .s , ,. . ! ..
t ► . t 'Z - 5 o m.e- S v,.•.-.. I 1 lrra i i 0 ,n W vµ�•v-� o L � e.+ry�-+.•�i. o v. [ �-q Cr1 +•v y,J p. i 1 • F i L l � ., 1-'k�; C cv fs ;
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lJC t-E. t:� t] �+ C i c y rJ i L l 1a.t, z e...E { 'tor we f t-a { Ln ,u i--e v [ o-" 7125197 ,
f Reviewer/Inspector Name ;
AF
A.
�• �. Date. r„ 47
Reviewer/Inspector Signature:

Site Requires Immediate Attention:
Facility No. � 1 -y3�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: i I - Z l , 1995
x Time:
Farm Name/Owner: rs1 4 fmepu
Mailing Address:. 2 3 5/ v- vw
County: -0
Integrator:-- Phone:
On Site Re -presentative: .• �r►�i �. cY►�- Phone:
Physical Address/Locadon:
Type of Operation: S wine _� Poultry Cattle
Design Capacity: 3400 Number of Animals on Site: 6(SOO) 3 GdU
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0' S Longitude: ' ' " Elevation: 3�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) Or No Actual Freeboard: J�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? C 90r No Is the cover crop adequate? U-s or No
. Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? �r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore
Is animal waste land applied or spray irrigated within 25 Fee: of a U S GS 1lap Blue Line? Yes or o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Vo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? J ddVor No
Additional Comments:
�._ 41ncto"rXame_6�_ 7 'nature
cc: Facility Assessment Unit Use Auachmenis if Needed.