310482_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: C) Coiance inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 2 P Departure Time: 3 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ! /� Title:
Onsite Representative: C v1 / , S �� 13u �( �4e' a
7
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: (�{_
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capaci
op.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wea -to Feeder
Non -Layer
Dairy Calf
eder to Finish
Dairy Heifer
Farrow to Wean
Dge�gn
Current
Dry Cow
Farrow to Feeder
D . I'oult
Ca acl
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from. any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E31qo__0 NA ❑ NE
❑Yes ❑No []NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes �No NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Z
Facility N.imber: - Date of Ins ection: Z f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity
of""any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ N E
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enveron mien taljknat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 6No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 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 [/3 NNoo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is
❑ Yes ❑'lo
Yes ENo
❑ NA
NA
❑ NE
NE
there a lack of properly operating waste application equipment?
❑
❑
❑
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
,—�,�
❑ Yes ltJ 1VO
0 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 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes to
❑ NA
❑ NE
Page 2 of 3
21417015 Continued

Facilit Number: - Date of Inspection:
24rDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ N 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 o 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 concem? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dN�oE] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes rNo"'D
E] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes NA ❑ NE
Corri`itientc"(refer.�to�aue_stibn#1:,Ez'nlain,an`v.�YrES's'answerkl'and/or:�a`n`vladiiitinngLrecommendationsnr.auv:�atiier,';cnrii`mentc:?,,,;e: , :�.�.E
A�gj :1y"'Jubaft L'v '0 4""e
Reviewer/Inspector Name
Reviewer/inspector Signature:
Page 3 of 3
Phone: '� `� 7FC ;;�POy
Date:
21412015

Type of Visit: %;,=nce Inspection CV Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 39 Departure Time: �County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f /Title:
Onsite Representative: f� 5 f 4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 6
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
mfiacity Pop.
Wet Poultry
Gapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
can to Feeder
Layer
Dairy Calf
Feeder to Finish
?
{
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D.rr P�oultr,.
C_a s�city
PAo
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
.ar�mrrraiwaa
usrr•nrs[�r:P
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J� "o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No Q NA ❑ NE
❑ Yes �No❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: IDate of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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
/�lA
❑ 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
T ❑ 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
❑ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[.P+f�❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[]_NT ❑ 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):
l3. 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
[�o ❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5-K ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'No'❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
N�No
[3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ' ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections -❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ Now❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E ' o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ 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
C3--N-o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑-No '
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]-N—o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L;-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to`yuestion,#) Explain any YES"answers';and/or�any`additional reconnniendatians or.any other,comments.
;
6e dra' hus df facility to betfer ezplain`situailons (use' additional pages.ai:necessary}
Reviewer/Inspector Name: l,/ i V _I X, A "( I/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Otto
Date: Z' /Z Ab
21412015

(Type of Visit: a Co pliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ( Title:
Onsite Representative: ��4 5404,1_
Integrator.,
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
W an to Feeder
I
INon-Layer I
Dairy Calf
eeder to Finish \1<
Dairy Heiler
Farrow to Wean
Design C+urrent
Dry Cow
Farrow to Feeder
ltr, C•_a acit P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_they
NJ Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge'originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify 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 En No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes FX`o` ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facilit Number: 3k - Date of Inspection: i73-71
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: Q L LL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ' 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�`No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes M—No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes D,11to
❑ 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 Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
D. Yes [2'go
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ]hs. ❑ 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 EYNo ❑ 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 fo ❑ 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 ErN-o ❑ 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 LJ "o ❑ 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 [3-N'6- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D N ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

1Facili Number: j - Yz- Date of Inspection: tja
24. J)id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C:I—No ❑ NA ❑ NE
1.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ 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? es jE?� io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 L'_J No ❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
❑ Yes ❑/ rNo ❑ NA ❑ NE
❑ Yes L2-No ❑ NA ❑ NE
❑ Yes ❑•Nb [DNA ❑ NE
❑ Yes �'o ❑ NA ❑ NE
❑ Yes L]-Mb— ❑ NA ❑ NE
Comments
Us�e■.�drawin(Qefoef�fatociglntyesttoiobiet#t.)EzplainanyhYEnweandloianyadditioencaelssraercyo}mmendations orany other com}ments
s%xplaimsituaons(asddnhpagestasinw
Y
,j�. &c �- OTC Ca(�_ r �f c,� 0k � � Y4- r--I �,
51 C, 2-0
Z'af`&L
f
(ssn{14t~e�
Reviewer/InspectorName: �u.`-`(S a c.4- t 7� �' Phone: � lG3 0
Reviewer/Inspector Signature: -e Date: k t 3 9 r I T—
Page 3 of 3 21412015

Divi"sign of Water Resources
facility Number 3 ] - Mi,§"'MiWofg6-oiiran—diwa-te-ric-un—ser,—vation
O. Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 I Arrival Time: is Departure Time: I r _ County: C.f/\/ Region:
Farm Name: &4L.LA Owner Email:
Owner Name: Cala-IS i N FLiwE(L CAuL-vALAQ H Phone:
Mailing Address: ]r�Lv 'Stbwc-cA C AUEwAtAC tl Ly WALLAcr - A)C p' &Li b 1p
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Certified Operator: (A-) IzU AM gt_C-n/ S)40L4R
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
r
Design Current
Swine C►apacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle C*apacity Pop.
La er DairyCow
Wean to Feeder
Non -La er
PDairyCalf
Feeder to Finish j
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current D Cow
17�, Ioultr. Ca aci Pao Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
L—Mrkey
I
Turke s
Pouets
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes * No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes '[ No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facili Plumber: - y Date of Inspection: j1 t'o y
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
urn
Identifier: ', ^ o��J11 3 ('�"
Spillway?:
Designed Freeboard (in): )9.5
9. 5
Observed Freeboard (in): W-
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.) 34
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 1ANo ❑ 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
0 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): so-3, .Ze_
13. SoilType(s): �oA VloA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Zt No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Do No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Q WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements
❑ Yes '&No
❑ Yes "4No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.' ❑ Yes �4 No
Q Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
0 Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Farili Number: J - Date of inspection: j/ &>
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 TA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or -any additional recommendations or any other comments.
Use drawinEs of facility to better explain situations (use additional paces as necessarv).
C A LI Q(L►47 )0A/ aC� I Ll 3
w. A . 9 L t-L
C)IPJIL4 SO .-is(
Lom /. vg )-S9
j2.]0f13 y.L4 ) 3a
'SO ILSN MPOE (Ia /I a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �ANo ❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Phone: x) *'iqy+38c,
Date: t 1AIf Ll
21412014

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —I? Arrival Time: Departure Time: �JUI County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2-1-f6rM
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
IDairy Calf
Feeder to Finish PIS
Dai heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
[:]No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: ' r
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: L
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in): "J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
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 ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

m&
Facility Number: -L4 Date of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Ycs KNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes /E No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
;2r-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZrNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature: Date
Page 3 of 3
: 2S W �a
21412011

Type of Visit: Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Mb7ZM Arrival Time: Departure Time: / to County: l W/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (rC_�- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
Swine C►apacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Design C►urrent
Cattle G•apacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►0rrent
Dr. Poultr Ca aci Po
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
SL Other
Turke s
Turke Pouets
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili umber: jDate of Inspection: 30
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: �?
Designed Freeboard (in): i�.�� } `7 • _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes �J No ❑ NA ❑ NE
'maintenance or improvement? A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance 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 a 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): LLL Sc
13. Soil Type(s): Sd 8 LW_ p A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes4N'o'
N
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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.
E] WUP ❑Checklists [] Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes aste Application Q Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste TransaT"ers
❑r Rainfall 0 Stocking r❑ Crop Yield 0120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �Vo
Page 2 of 3
❑ NA ❑ NE
Q Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facilitµ Number: - y jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yeso
kNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No kNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
rVo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesgZ
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
XNo ❑ 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 ages.;as necessary)
bfIjIQ tl�(
Lila M 0. L9 -
C�
9) . C FT C.
�f MS To i'YIR�E 54LC p�cT1u C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �4-93g1�
Date: �S�3o11
21412011

Type of Visit: 3Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 10/jAEl Arrival Time: Departure Time: County:
Farm Name: b(.A!L: ;•_ d, V Oo� �AGZnhS Owner Email:
Owner Name: C N (Z1 S 1 `N E . C Ayr_- ti! A USG fl Phone:
Mailing Address: )-Ju 1 /vim (2AUENA)U_6+) LV l/V t _LPCE ,/ V C. 0a L/ (D
Physical Address:
Facility Contact: Title: Phone:
Region:
Onsite Representative: ILL Intyratc r:
o
Certified Operator: �HO(_ fQCertification Number: _oQ L/to /Q
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Capacity Pop.
f 5 jqqS
Wet Poultry
La er
-Layer
Dr. P.oultr,
Layers
Design
Capacity
Design
Ca aei
Current
Pop.
Current
P,a
CatDesign Current
tle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Points
Other
Discharees and Stream Impacts
�(
1. Is any discharge observed from any part of the operation?
❑ Yes
I X I No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -W W rX Date of Inspection: Q I a !I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure Structure 2� Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
.5
LI GO q 1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (] No [] NA ❑ NE
maintenance or improvement? ]�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes "``1TTlll"""������ �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): �S C--�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
[3NE
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
El No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes$�No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvementAf yes, check the appropriate box below.
No
❑ YesInsfers
❑ NA
❑ NE
Q Waste Application El Weekly Freeboard 0 Waste Analysis Q Soil Analysis
[] W/ste
0 Weather Code
Q Rainfall O Stocking ❑ Crop Yield Q 120 Minute Inspections 0 Monthly and V Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fac ility Number: ] l - L4 Date of Inspection: /
24._Did'tlie facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Olvo - ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 9 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No [3NA ❑ NE
0
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 [3NA ❑ NE
0
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers arid/or any additional recommendations or any other comiriments }: k ,
Use drawings of facility to better explain situations (use additional pages as necessary).:a
(_.(��,i l¢1 A5V l )CA. E
9--l'.,L LL
Ll iwl
tit
Reviewer/Inspector Name: S
Phone: ��0���-T�
Reviewer/Inspector Signature: -
Date: 1D l
Page 3 of 3
21412011

Type of Visit Kcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit J&Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r® Departure Time: County: N Region:
Farm Name: mS Owner Email: n
Owner Name: t C-nnE ��} lal��vAuC�H Phone: ! 1(3-
Mailing Address: 1 ,_S tiZVVr�-1 Cq UE VOLA614 �W �Lt ACE 11 IVC- DYq��
Physical Address:
Facility Contact:
Title:
Onsite Representative: LL- M
Certified Operator: (&) i LC, ANC 6L et nLAV
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number
Back-up Certification Number:
�M/
Latitude: = o =1 ❑ « Longitude: = o = , 0 "
�_U_urrent
Design Ourrcn Des#gn
C•urrent
Swine apacity opaUM,
Wet Poultry C*opacity Population Cattle C*opacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
�j
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ Dry cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Beef Feeder
Gilts ElNon-La crs
❑ Pullets
PE313oars
El Brood Cow
_I Turkeys
_I
Other ❑ Turkey Poults
❑ Other I ILI Other
Number of Structures:
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
12128104 Continued

Facility ;umber: -3
Date of Inspection I =
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
❑ NI:
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in): Ig!,
Observed Freeboard (in): SCE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
ElNA
[INE
(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
X 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
X
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)qNo
ElNA
ElNE
ElExcessive Ponding [3Hydraulic Overload ElFrozen Ground [IHeavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El
ElEvidence of Wind Drift ❑ Application Outside of
Area
12. Crop types) Q �{�
13. Soil type(s) Fo A
W. 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
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
&No
❑ NA
❑ NE
Comments,(refer,to question #) Explain any YES answers and/or any,rec,ommendatrons or "any other,comments
Use drawings of facility to better explain situations. (use additional pages.as necessary):°
l/V - L I LL
Reviewer/inspector Name ID' Phone: 10 96
Reviewer/Inspector Signature: C609jal Date: b
Page 2 of 3 - 12128104 Continued

Facility -Number: 3 1 —4j8Qj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box, El WUP ❑Checklists 0 Design (] Maps El Other j�.,,�
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes No ❑ NA [3 NE
0 Waste Application ❑ Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑ Waste Transfers' ❑ AAal Certification
EIRainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections 0 Monthly and 1" Rain Inspections [3 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
P(No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
y
ElNA
ElNE
ElYes
El NA
El NE
❑ Yes
❑ No
(NA
❑ NE
❑ Yes X No
❑ Yes /kINo
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes XNo
❑ NA ❑ NE
El NA ❑NE
El NA El NE
El NA [:1 NE
❑ NA ❑ NE
El NA El NE
Adtlitional.Commenfs and/or Drawings.1t,,y:.
cACg ZA7lav b�_A rZ_ Dot I
Page 3 of 3 12128104

Type of Visit JP Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J&Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 1;74Q_mS Owner Email:
Owner Name: -1+CZ-_1 STt.� �4LY] E-_U�I�I►I,l_f�t� _ 1 , Phone: (T20"s�I CC. �S�so%104
Mailing Address: i3� [�NEu CAuEn►Ac�C� N l i�-%ALLACE , / Y'09L) DCD
Physical Address:
Facility Contact: (� Title:
Onsite Representative: ::AkLL °r&MU,
Certified Operator: W t LC t to fn 1 S'H 0 L A CL
Back-up Operator:
Location of Farm:
Phone No:
Integrator: n
Operator Certification Number: QL4 (OR&
Back-up Certification Number:
Latitude: ❑ n ❑ d Longitude: = ° 0 1 ❑ !{
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish ID Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
El Farrow to Wean
Dry Poultry
❑ Layers
❑Non -La Non -Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑Beef Feeder
El Pullets
El Boars
❑ Turkeys
Other ❑ Turkey Poults
lother ❑ Other
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes I ❑ NA ❑ NE
12128104 Continued

Facility PFumber: — WQ1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )�No El NA El 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: L LL-
Spillway?:
Designed Freeboard (in): 1
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.)
r ,
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No ❑ NA ❑ NE
maintenance/improvement?
✓
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes]
No ❑ 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 D Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
W-A, 6 - LL
Uu. A . N4% 6aem 5&Arr FoF- `41/0:11
Reviewer/Inspector Name Phone: "/U -11&-i 5W _f-
Reviewer/Inspector Signature: UWitQA Date: Q
Page 2 of 3 12128104 Continued

Fu&lity'lumber: 1 —ZRO Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
FINE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes YNo
❑ NA
❑NE
0 Elthe appropirate box. WUP Checklists Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfersinual Certification
[] Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections [l
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El 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 ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
,(
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
I `
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes to
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
�.. — 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: LJ N Region:
Farm Name: Owner Email:
Owner Name: C����� t4UEMRVIC Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CHI-IST�I C.40kW4L&Ct (+
Certified Operator: w �l ate-LEN 3;10L_WL
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: vbb
Back-up Certification Number:
Latitude: [= o = = Longitude: = o = ' ❑
r Design Current,`$ Design.'.Current
Swine Capacity:. PopulatioqWet.Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ]❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
I
❑ Farrow to Finish
❑ Gilts
❑ B oars
Other
E;;, ❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
,; Designs: Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-Daity
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes � No
❑ NA
❑ NE
❑ Yes [INo
❑ NA
❑ NE
12128104
Continued

Facfiity Number: — Date of Inspection--�-�-�
Waste Collection & Treatment
❑ 4
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: 50'kf4t—L L {=
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V0 60
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 1ZNo ❑ 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
14 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.
❑ Yes
�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No ❑ NA ❑ NE
No ElNA [INE
No ❑ NA ❑ NE
4No ❑ NA ❑ NE
EdNo ❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers andlor any recommendations .or, any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name f -�M414QAT 04 1 6 S._�_ � � 1 Phone: q 14 0- �
Reviewer/Inspector Signature: Date: i d
Page 2 of 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ElNE
❑ Waste Application ElWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
-1q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Pl�qo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
"�No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Faeiiity Number. Q Division of Sail and'Water Conservation
C. Other Agency
Type of Visit
Corppliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ib Arrival Time: 00 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: [7 `) Title:
Onsite Representative: GV'4_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet. Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
ElGiits
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
El Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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?
El Yes [YNo El NA [I NE
❑ Yes
El No [I NA
El NE
[I Yes
❑ No El NA
[I NE
❑ o ❑ NA
❑ NE
❑ Yes
El Yes
N El NA
❑ NE
El Yes
o El NA
El NE
12128104 Continued

acility Number: — Date of Inspection �3 0
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 Structur 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L (.rd6Ai 1 a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Cl Yes CKNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes — No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CNo ❑ 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
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E211 o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes [o
El NA
[I NE
17. Does the facility lack adequate acreage for land application?
El Yes Zo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
-rg kccoros , oPF_e-A rom- SI xb TAB rU L%�AJ CvL LA, G ,
i
Reviewer/Inspector Name Phone: ,3to A(5A
Reviewer/Inspector Signature: yj Date: )0 b
12128104 Continued

,Facility Number: — Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WCp ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspection�No
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ElNE
ElYesyNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
aN
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
LJ'Yes
❑ No
N
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
�/NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
lJ� 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
N ❑ 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 ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit fflcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f2rRoutine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f /en Departure Time: ounty:
Farm Name: LILL ,O t S Owner Email:
Owner Name: ' h (�/4 � � Phone: _
Mailing Address:
Physical Address:
Facility Contact: I
0 Title.
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region• ��
Location of Farm: Latitude: ❑ 0 0 f = Longitude: = ° ❑ 6 = "
=__re11 Design Current
Capacity opuation Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
I I0 Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
s
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Coyd
❑ Turke s
Other ❑ Turkey Poults
❑ Other 1 10Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Ye No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

rt
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 Struct re 2 Structure 3 Structure 4
Identifier: f 3
Spillway?: ND NO
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes yJ No
El Yes /❑ No
Structure 5
❑ NA ❑ NE
[I NA ❑NE
Structure 6
❑ Yes )�No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes�fNo ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 1Q 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 [I NE
maintenance or improvement? /
Waste Aoalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ 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) �em
13. Soil type(s) n p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'No ❑ NA
yj
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�p P fff oak �� ��>/1 p�z.✓c� ovr/ �Grl,�,z�,J
.
FV
Reviewer/Inspector Name —� Phone:/10 Zol?
Reviewer/Inspector Signature: Date: 7—
Page 2 of 3 12128104 ' Continued

Facility Number:, —elRIJ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does therfacility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA El NE
the appropriate box. ElWUP El Checklists El Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
(VNo
❑ 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
o
❑ 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�ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�z) 60-C,
nn�y}�` Z/✓t�n- �/ —t�,�'! IfiC �%I-V'�N�G� / �a�COI�(,'Sr
T
Page 3 of 3 12/2&04

=Z,_ . t�
L
f Visit A Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Z Q Arrival Time: Departure Time: laffAzi—county: Region; + �C
Farm Name: kll5 Owner Email:
Owner Name: G�(�-� Phone:
Mailing Address:
Physical Address:
Facility Contact: ,� Title:
Onsite Representative: &/ff— I !%1_%�lC
Certified Operator: 1.t�I
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = 11 Longitude: = ° = 6 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;KNo
❑ NA
❑ NE
❑ Yes
,An No
❑ NA
❑ NE
12128104 Continued

Facility ]Number: ' f _iW21Date
of Inspection /2 Z
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 Struct re 2,, 'r Structure 3 Structure 4
� Identifier: "+6 3 65;A
Structure 5
Structure 6
Spillway?: 10 /vo
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes oNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �'ZNo
❑ 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 VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �No
❑ NA El 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 VNo
❑ NA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes VNo
[I NA [I NE
❑ Excessive Ponding El Hydraulic Overload [I Frozen Ground [I 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) TOec 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
yes ;ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[]Yes ZNo
❑ NA
❑ NE
RZ r7� ' 04? WUn Oo_-c 7-e, ,WV A!5 - Q1?fINTS o
Zj l��
Reviewer/Inspector Name ,'s Phone:
Reviewer/Inspector Signature: Date:
l2/28/04 Continued

Facility Number:, — Date of Inspection �O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes,ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,ZNo ❑ NA [IN E
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other wC
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes 09No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield /i 120 Minute Inspections ❑ Monthly and 1" !fain 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 pen -nit or CAWMP?
29, Did the facility fail to properly dispose ofdead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32, Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
'o
❑ NA
❑ NE
❑ Yes
;1'No
❑ NA
❑ NE
❑ Yes
'P�No
❑ NA
❑ NE
❑ Yes ;No ❑ NA ❑ NE
❑ Yes ❑ No ZNA ❑ NE
❑ Yes�]Nlo ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes g/ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
e 7!-=-0AJ,
`�ct'+e,� ! v ll iEEI� ��►� e'if/i4GL _� �f}�"-'�✓��Z��� � 7 ��
r7)�
12128104

Type of Visit 0 Co liance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification' O Other [] Denied Access
Facility Number Date of Visit: t't a Time: / S 6
0 Nat O erational 0 Below Threshold
Permitted Certified 0 Conditionally Certified Q Registered Date Last Operated or Above Threshold:.
FarmName: .......... aul.t.... `f .✓00 `1......p2M.... ................ ..... County:... _. Q?�PS»»..»....». ............».».....»».
OwnerName: . _» » »» »......»._» ...... » ......__ . W__. __ ..»......W .. ...... 'Phone No:
MailingAddress:....._..................................»....»..........._._._...._...................................»................................ .......................... ................... ........ ».»..._........
Facility Contact: _ . ».W__.W W ... _» .. . » »» Title:._ . __... .._ .. » » . __. Phone No:
Onsite Representative: ?.Shr.Aa?fi �?!�aJSxi__....5?i� lw.Lllf�� Integrator:.»»P,&CLSIP16 .,
Certified Operator:
Location of Farm:
____... _ .......... _ .....».» Operator Certification Number:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a A " Longitude • 4 96
Swine
Wean to Feeder
❑ Layer
Feeder to Finish
Jq S,S
s
❑ Non -Layer
Farrow to Wean
Other``
Farrow to Feeder'
Farrow to Finish
a , 1 TOE DeSj
Gilts
Boats
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes Q No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �❑ No
❑ Yes p'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [],No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: »» s +!^�?l�4� .._ ... _» tP R s _» __ .. _ _....._. _.......... _ _..... »......_... »» » .»... .. ........... _-----
Freeboard (inches): 3� 3
12112103 Continued

Facility dumber: — Date of Inspection $ 0
J
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
C. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
.12. Crop type gkf_ DA L H)__ S Gd
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
7,) UP Afl b.1E(--0.5 c4 YNS=DE WD 0U-r5_T'-DE
C.o,j r=tJU& WAG ConjiL'�
OeL") UJUP f34.f.R_C— US�►JCa N t.>>r'�
Cei fd, 3 49 _ 39a0
ReviewerAnspector Name
ReviewerAnspector Signature:
❑ Yes 9No
❑ Yes 2/No
E(es ❑ No
❑ Yes No
❑ Yes Q<
❑ Yes ;�o_
iYes
❑ Yes
Ed ivo
❑ Yes
❑ Yes
�:/o
❑ Yes
❑ Yes
[iq0
❑ Yes
o
❑ Yes No
❑ Yes L No
❑ Yes [Woo
❑ Yes Id4o
❑ Field Copy ❑ Final Notes
OLLEwA t,c-S C.n-
C. t_.E-A R- C D LA i.S!) ,
Date: "�A /9I a
jAUZ1UJ flonanuea

Facility Number: 31 -.._77-9 Date of Inspections i �1
;i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZNO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 240
❑ 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 ❑W1,
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Q'1Cfo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EjNo
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
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �Zo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ff/No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit WRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z Date of visit: 4 1 DL- Time: :3
Q Not Operational Q Below Threshold
0 Permitted © Certified © Conditionally Certified [3 Registered
Farm Name: .......... ............................
Owner Name
Mailing Address:
Date Last Operated or Above Threshold:..... _... ..
County: ,'.4!....L^................--•---.............._........
Phone No: ---------_ _ _------------------------------
FacilityContact:...........................................................Title:............................................... Phone No:..........................
Onsite Representative: ��� i4�G{G��naV 1" __-_- - Integrator: _?TBSf a. e
CertifiedOperator: .................................... :. ............ .............................................................. Operator Certification Number:.........................................
Location of Farm:
J!f,Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 46 Longitude • 6 64
' 'Design 'Current
Design ,Current ,; Design Current
Swine Ca 'acit
Po ulation Poultry
Ca acio :Po' elation Cattle Capacity -Po elation
❑ Wean to Feeder
❑ Layer
❑ Dairy
�ffFeeder to Finish
O ❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
❑ Gilts
Tafal De§zgn' Capac><ty
❑ Boars
Total SSLW --
i+ -Number ULagons" . Z ❑ g ❑ P Y
yur; �Y Subsurface Drains Present ❑ Lagoon Area S ra Field Area
3 k
t r M1 ♦ I
f yHoldmg on I Soltd'Traps; �,; , �' ❑ No Liquid Waste Management System
Discharges & Stream Impact ,
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes )2�No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes &No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.............. `_r.M_u......... .......................... ........................... ........................... ...................•-_.....
Freeboard (inches): 30 .3 Z
A.- in tni
_� .. __ - .....:n>?: _:nxlic �- T:,.Jtr.:•:+.r_r,:rwfr�v.4W�+Y.r?.i:lr�a�,tzr:' y; 9!vrr,••rFr.�-.,-:r.�._�,��:. ;•r:�, ��•�xW.' I, r_ eris,-

UNUNvl wrlrrnueu
Facility Number: 3l -- y8 Date of Inspection L�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes EfNo
❑ Yes ZNo
❑ Yes PINo
❑ Yes,ZNo
❑ Yes ONO
10. Are there any buffers that need maintenance/improvement?
❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ❑ No
12. Crop type Sermvd'i ua e;ng 1' �3rwg3
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ZNo
14. a) Does the facility Iack adequate acreage for land application?
❑ Yes J?fNo
b) Does the facility need a wettable acre determination?
❑ Yes &No
c) This facility is pended for a wettable acre determination?
❑ Yes ,�No
15. Does the receiving crop need improvement?
❑ Yes 006%4^01-
16. Is there a lack of adequate waste application equipment?
❑ Yes �No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
JONo
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 'ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ,2rdo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes JeNo
24. Does facility require a follow-up visit by same agency?
❑ Yes )ErNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
All —Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comm nts'-'(rem to u stion #; xplaln any YES an e s and or any reco rn�ie rdations orany otherEcomments,,.
r g I d .arn,sitnatloris (itse.additional'pa es as necessary i Field Copy ❑ Final Notes
., ❑
'
11,ZZ')a44 25. THe pa;rGle Sfr;nkle--s are Dies;Vned lock-A+.3 4he
`
ae f li e,4410r, r,14e ;S more 4ham 4he 0,5' �'hlhr A1towe4l in
fh� taq.sae flan. IVicept 4o Gonjoq 4etho;Ctj yee;a/;t4 and mAke
g6[JvJ-f Cyl'If �4 GOr"��ty w;4k flgh. Nkje Or 4he
ehq^je qr%,4 eyeeg4e 41/z601di+'�gllt ;rl 44e 40$1r- eve 41-4 ek
e
reed v c: R i o ►, i n *p221e .S i Le 4 c Wt _ V %yf P v eSS v r w1 zL jai 1 Ab►l -�
1
fi
i". `J �r. r+ w-2.-r . — J � i ti_. %'� f ^ �T' � ti? p� " .I +"M�a�^,'? r a
Reviewer/Inspector Name �,��°, ��b " A, :�t: Sid,', "'l'%uG�,�r, "" �
-:"'�f y�!&:, _
Reviewer/Inspector Signature: Date: WI 0 D 7,

Facility Number: — bate of Inspection
Odor LUM
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ONO
❑ Yes No
❑ Yes 01,40
❑ Yes 4dNo
❑ Yes ❑ No
Additional omments and/or Drawings:
11)22,2s- 44e zivvLe w,s4ed egd-'vs Whille 11eAU1,;g9 4Ae Irlevt/
e,44e - o an otf-eg fable level -fin -Qty blow the 0,5 r44,t .
III, 'Be svrjf -ib pv4 4he VC4f ah 4ke O(A�e w/ Ae Freeboard fr avds.
25. �'r-" ! 1 �e* h l t/AS w f . T--� aP7 114 be"e. -e
)PA-+/-fix coLlid wa.s svbs�9vcn� / herned .
1>tee.d 7A0 ehlvre 41 q:4 Graf/ is 4-,ves4e4,y -44d
We4 A)1d eerLtovoky - eem 1)e l d .
15.T1-�e beemod a -'; a Ids ire •ea.}1I ;,o ove.X s;+lee "� la.s�
s a 9ce/t s4a�;e.{' tiev'&-t.VA^ and /0/7n1 'Ore
r+►raGQP � slpr,t� PL�Gei��ly GiP4feaf gtI'er� befwet+� �%iraldl l�gn41
D-fher -1 h� � rlo¢ed aba�c, The .44, h4y , rod � 4n ct recur d ;r--
',re well -rl ere q evs 40 die rAvA,14
.�he �grr+-7 vmAe�r Ae tVtrew L��owne..-S
hgve -lake ov¢✓ s;hce T have
O5103101

Ision of Water Quality
Q Division of Soil and Water Conservation ,.
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1$.Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: F0N=otO
1"ime: Printed on: 7/21/2000
Facility Number ---A " erational Q Below Threshold
Permitted © Certified [] Conditionally Certified 0 Registered Date Last Opera or Above Threshold: ........
Farm Name : ....... ......t.r4............. ...... .......... .................... County:..........
OwnerName: ................................................................................................... Phone No:...;<�� .................-.......... Z �...a Fs��if
C
Facility Contact: ................ ....... ....... ..... ...........Title:..... . ......................... Phone No: /...�L1v ��.li5,
Mailing Address: (i l r3 }
Onsite Representative: C. ... (QVe' IM(.�irmw:x... Integrator:...... r'!
J..�r.................................. ...... .
Jr%id�Ctr`
Certified Operator: �a' L�+� Operator Certification Number: � �/
L!i.(............................................................................................ P o....,.......11.�P.........
Location of Farm:
i
d swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° •4 Longitude 0 ' i'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I JE1 Dairy
ceder to Finish y ❑ Non -Layer In Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ subsurface Drains Present ❑ Lagm)n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. ll' discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. ll'discharge is observed, did it reach Water of the State'? (1l'yes, nolil'y DWQ) [I Yes ❑ Na
c. If discharge is observed. what is the estimated Ilow in gal/min?
d. Does discharge bypass a lagoon system? (ll'yes, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate`? ❑ Spillway ❑ Yes <Nc
Structure I SIMCturc 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: tt.....................................................................
Freeboard (inches):
5100 Continued on back

Facility'%;umber: Elate of Inspection I Aff 11. Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? ic/ trees, severe erosion, El Yes g-,No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 64�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'? ❑ Yes ;91,No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J;�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes kNo
Waste ADDlication
W. Are there any buffers that need maintenance/improvement'? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Z No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Flo
b) Does the facility need a wettable acre determination? ❑ Yes ENo
c) This facility is pended for a wettable acre determination? ❑ Yes_—Z No
15. Does the receiving crop need improvement? ❑ Yes AEPYo
16.
Is there a lack of adequate waste application equipment'?
❑ Yes
.�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
E.No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
?�No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
11 'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
\
43ZLO
22.
Fail to notify regional DWQ ol'cmergency situations as required by General Permit'?
❑ Yes
(ie/ discharge, freeboard problems, over application)
,'640
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�&o
TS,o yWatidris;or Mcie;rtcies -mere poted. during 4his;visit: - ;Y;ou ;will -receive tio; fufft ;
comes' oricience: ab' 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):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
f

J Facility,6Number: r� — �� r/ Date of luspection 1?:,�/
Printed on: 7/21/2000
Oder Isst.es
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or helow Vyes ❑ 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 ale'
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ; .o
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 / �o
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 5IN°
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes tR40
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? �❑ No
AdditionalComments and/or ravings:
Ak
UV
sroo

Z Drvision�'df Water Quality-.,
Division"of SoRand:Water Conservation t
Q'.OIegenCy.
Type of Visit QrCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ORoutine O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
Facility Number
Elate of Visit-
] "Z.
0 Permitted © Certified 13 Conditionally Certified ❑ Registered
Farm Name: ........ �! 1� V ... Fie '-7 t
El Time: =3[> Printed on: 7/21/2000
Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
1, ►-,
.... County..... ..... V.............................................................
Owner Name:........�h S Cv¢n. (h,V�..............:.............................. Phone No:.......................................................................................
.....
FacilityContact: ..............................................................................Title:.............................................................. Phone. No: ......................................
MailingAddress: ........................................................ .................................................................................................................................................. ..........................
OnsiteRepresentative: 9.0.!,1 4 dui.,• �V,� 61VlV L1 .... Integrator eS�]
..I.......... �........ .......... !.........................................................
Certified Operator:
Location 'of Farm:
............................................................. Operator Certification Number:..................
L(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • 4 41
Design Current
Canarity Ponulatian
.:; Wean to Feeder
Feeder to Finish
1
Farrow to Wean
F
IMg Farrow to Feeder
Farrow to Finish
Fra Gilts
.rye.".`.
Design Current Design Current
Poultry Capacity.Population Cattle Ca adi . ' Po eila66n
❑ Layer I Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
hluinbeir,oiLagoans'
i�— ❑ Subsurface Drains Present
r --
Htildingv.Pondsiih � d Traps - ❑ No Liquid Waste Manages
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 conveyancc man-made'?
Area J❑ Spray Field Area 1
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; at ............... ..... ISL.....................................................................................................................
Freeboard (inches):
5100
❑ Yes 0"No
❑ Yes J No
❑ Yes�No
A
❑ Yes 2rNo
❑ Yes )?�No
❑ Yes '12NO
❑ Yes�No
Structure 6
Continued on back

Facility Number: Uate of Inspection 41 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )?fNo
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes Z No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
IQ Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? j�t ❑ Excessive Ponding❑ PAN ❑ Hydraulic Overload
12. Crop type 73 e r^ evi Vd e, hcl it -rv-7-N4 11 G n5), A,
❑ Yes ErNo
❑ Yes �No
❑ Yes Oi No
❑ Yes E!rNo
El Yes .ErNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes—'FrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes"ONo
b) Does the facility need a wettable acre determination?
❑ Yes XNo
c) This facility is pended for a wettable acre determination?
❑ Yes ZTNo
15. Does the receiving crop need improvement?
❑ Yes,,fTNo
16. Is there a lack of adequate waste application equipment?
❑ Yes _044o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ZNo
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ffNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,`No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
freeboard
❑ Yes No
(ie/ discharge, problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 2rNo
24. Does facility require a follow-up visit by same agency?
❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JO No
dg?Ficienhis-visitbwii•Tce0iiewere dning i0o futtiter
6 res• orideRce' about: this visit.
Cotnnaents'(refer to questioiy #]:.Explain any -YES answ rs and/or any irecotnirnendations or any other comments �, 1 ,�,
;Use dFawings,of facility to; better explasn situations (useaddxtronal pages as necessary) ! • ra „', , a,i-, :, .f 1.j` .�',a a b'' , �, .'�, r a',
)57. Wa xle (,/,O,s aP� ri ed 4a - 1Ae S•,r, ! 1 e, rrz %�. OI'+-seeOl, ye -NA 1/ Cf,-e,i I-, `
K1v mot,(d 6e U�a4 a,,id t4 lad 17' L Jr- S4 is 41P f, �Gf /,a 1�tov C,a,✓s C'ej),
fr-�-il�t
Le c ev�eYseeo[ .
�e st9 ne -fo Lt-Se q WG• �7C G ►^G s ."s 44M 6VAI 1, bo Aar r a6
s�rotil�; On4Lle rAW� I
;--IP ►r'oV'Zd S;`cQ V11,y le- CI Vil ►,7 • 4&9 64Od 1N/ rk—
Reviewer/Inspector Name +"1eL✓�•' . f ?Ile I ,- ,''1 ' i ''' „`,
Reviewer/Inspector Signature: , �.� _ _ _ Date:
5/00

Facility Number: Date of Inspection / Q n Printed on: 7/21/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes&No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �YNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes _.�?No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 21No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZ"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
5100
5100

�t © Division of Soil and,Water, Conseirvation , peration Review ` r, '
Division of SW andWatei�Consei�+ahonComplianceEUispection�, = �,�';
Division of Water Quality .,Complrance Inspection �(
Oder Agency - Uper,,tion Review i! E y „ . t „fir . �..a �, 4� Ifl i. �.' f i ! ;. 1'SE
® Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection tl
Time of Inspection 24 hr. (hh:mm)
0 Permitted 0 Certified © Conditionally Certified © Registered Not Operational Date Last Operated:
FarmName: .... ........................... .....re`.rr+1S............................................... County:.......1�.�........................ I ...... .......................
OwnerName: C + +r .... ®r ......................................................... Phone No:....................................................................................... .. ..........
FacilityContact: .............................................................................. Title:................................................................ Phone No:.............. .......................
,Mailing Address:........,............1...................................................................................................................................................................... ..........................
Onsite Representative: ......... lC,d'^d.�.�.. ��.................................................... Integrator:..... e................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number..................... ..............
Location of Farm:
jt�
................. ..... .. ................................................................... .................
Latitude • �' �" Longitude
;? Design Current Desigm Current Design Current: _;
Swine PoultCn CCapacity Population
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish 1 10013 ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other „ °
❑ Farrow to Finish _ Total Design Capacity
❑ Gilts
❑ Boars E '' TgtaI;SST;W
` Nuber;af Lagoons Subsurface Drains Present ❑ Lagoon Area Spray Field Area
0
Holdiii ,onds/ Solid Traps .P'll.' ❑ No Liquid Waste Management System
. $„ 0�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Docs discharge bypass a lagoon system? (Ifyes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Old 1VeL4
Freeboard (inches): ' b................................ .....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes %No
seepage, etc.)
Continued on hack
❑ Yes 9 No
❑ Yes
10 No
❑ Yes
® No
Let
❑ Yes
tA No
❑ Yes
12 No
❑ Yes
9 No
3/23/99
9 Yes ❑ No
Structure 6

Facility Number: Date of inspection
6. A7re tfiere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
19 Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement?
❑ Yes
ba No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IR No
Waste Aj2plication
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
0 No
11. Is thcre evidence of over application?f ❑ Excessive Ponding PAN
❑ Yes
Ig No
/❑
12. Crop type vJ c ✓' ► -glt-G qq, y j yrl tot I+)[71rC4 ►h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
19 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
;K No
b) Does the facility need a wettable acre determination?
❑ Yes
:9 No
c) This facility is pended for a wettable acre determination?
❑ Yes
56No
15. Does the receiving crop need improvement?
zJ Yes
❑ No
lb. Is there a lack of adequate waste application equipment?
❑ Yes
:0 No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
19 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
14 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
S No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes A No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ri 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 19 No
�'�io vi. tioris:or• deficiencies •were PAt;e#• Oiwirig 4his;visit.............. .
i. . ts` refer•to� uesh y ._. , ..gyp ...^ ', .;� €......,f t Hi.r • n 'ni
Coinmen (,q om#) �'Explam'any YES answers and/or any`recommendations or any other comments 0,
Use€drawings of facility to better explain situations (use additional pages as necessary) i r F , 4 { �t°
s!... .� 33 ii f€9 ?' 3i .. ... €!.'r .i � 1 �.n v l d :.€" f. 1>- ,rzr .1< P� ;.N! .I hr,' a )� .�t :
_, t i
.,, . E ,
�� Tl,c did l��oah needs -�a 6e rnoWeeros;ot.\ rlecds 4o be
refc,,;re v45E-lF4o'an 5-400141A 6,- c4abl"A"A
15. T'hc 4wo l o%.r er r_oa 9 I berw► udel �'r'� � Slf, er41d /-lave L,1e rk-
doYrc �a rs�a l: rl, Gait O'n I eVL
_r C Ids .<40LA- AIx re s1 /,5�cd ih 'r��;-� 2000, qept ,:M
y t- acGe,��l' .l
so;1 4C.54 4,0 11 a It l I 9 j rhr orAe
�
r%� �} y -c7
p 6�Q, W , J' r I Y„ti.... J� .,9,r D[./.r�r WJ
Reviewer/Ins ector Name ti F w r �'
Reviewer/Inspector Signature: Date: 1 r! l t Ay,l/,
3/23/99

Facility Number: 3 — lri Date of Inspection
. .
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
'ZYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s); inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ' ;gYes ❑ No
and
/or rawin:,s i i
tt10Ra 8R]fRCR gs
1`7. �a�►'hCfr✓ St'wLkl d �4gin t+��.ebva�A fecol'G�.s ,
b fe
3/23/99

-[3 Division of Soil and Water Cons s'e"r '466n Operation Review
1 -� te,
k ""' �I i, ['3 Division Of SOiI andsWater,CoI1Se1'YAt]on, ' COmphance IilSpeetl0[I"
t JDivision,of Water Quality CoMpliance'Inspectio
5"s w'
.
it t 1 OtherAgency: Operation Revue , ;
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 19 Other
Facility Number ,'Z Date of [nspectiou {p•-
Time of Inspection ® 24 hr. (hh:mm)
Permitted ❑ Certified Q Conditionally Certified [] Registered Not Operational I Date Last Operated:
FarmName: ...........1. ay......� r.MI............................................................................ County:......)).4.11r.1........................................................
OwnerName:................................................................ Phone No:......................................,................................................
Facility Contact: ....................................................
MailingAddress:.................................................................
Onsite Representative......
Certified Operator:.
Location of Farm:
Title: .................................................... Phone No:...................................................
.............................................................................................................................. ................. I........
......................................... Integrator: ......Tl.n..6f ..................................................
........................................ Operator Certification Number:..........................................
................aF.................28,,c...1.•.........''' .tef...nS�r...4 ..��!� f??', S QL!^....Fv.l i........ ...f.{.�4.,..............I...............
.......................................................... ................... .......................
Latitude �' �° �" Longitude • �° �"
g Design Current
Swine , ,1� on,, P9ultry C g
Capacity Populati
Design Current, Desy n Current
I1r _,,, ; a acrt Population_ Catty Capacity Po ulation., ,-
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer „ ❑ Non -Dairy
❑ Other
1 Total DeMgWCapadty
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water or the State? (If ycs, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard(inches): ........... 3..............................1.+................ .................................... ................................... ...................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back
lclrfrAL=t

Facility Number: f Date of Inspection
.'-b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan`?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
[]Yes []'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the.Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21: Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over'application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NO yialatigris'or dtecie iin' * vt= .. hated• daring tbis:visit' • Y:oik wiiI-tooiye •no further
- corres- onc�ence: a�aut: this visit : •
L q you * I Aqr er-Odcef
1_ayan5 are q4 13" 9,"4
Reviewer/Inspector Names
Reviewer/Inspector Signature:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (_1 No
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
in some 4114eal" in e-raSrVn q✓eq •
'1941r;a I e,714d. A f ro& )„qss Offs-C
1 z `t • Pae_bazvd
V
Date:
6V c�T �* 3/23/99

..._ - e:,�w�., .r ^;. �t,•.- ., - -.i .,. ^..�.�r..,... _-'r.,,^�..�L.i.,.��.���...�._. _r-s.:...•� � ,.. ,.•...>���,...jy.i,v� �. � i � •,1 ^ , A„ rh, �'X ]. ^v a
._� _.__. ....•. n

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
Deidre Foy
Foy Farms
1136 Ben Williams Road
Richlands NC 28574
Dear Deidre Foy:
LY.AUG 1 1999
April 8, 1999
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS310482
ation Request
Foy Farms
s e Operation
Duplin County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject application. Additional
information is required before we can continue our review. Please address the following by May 8, 1999:
We recently received a letter from G. Glenn Clifton regarding the past discharge from your animal waste
management facility. Mr. Clifton stated that the irrigation system on site was recently checked for any
leaks that may have caused the wastewater discharge, and no problems with the system were discovered.
He also stated that since the irrigation system appears to be working properly, that the discharge may have
been caused by over application of wastewater. To determine if an over application occurred prior to the
discharge on December 9, I998, please submit all irrigation records for the month previous to December 9,
1998. If the irrigation records show that application occurred in accordance with the Waste Utilization
Plan (WUP) please have a technical specialist review and revise the WUP to address the situation and to
prevent any future discharges.
Please note that all WUP revisions must be signed and dated by both the owner and the technical specialist. Please
reference the subject permit application number when providing the requested information. All information should be
signed, sealed, and submitted in duplicate to my attention at the address below. The information requested by this letter,
must be submitted on or before May 8, 1999 or the Division will return your application as incomplete in accordance with
15A N.C.A.C. 2H .0200 and your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is a violation of
North Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the Environmental
Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 502.
,SiDcere�ly, % f
Sue Homewood
Environmental Engineer
Non -Discharge Permitting Unit
cc: Wilmington Regional Office, Water Quality
Permit File
G. Glenn Clifton, Prestage Farms, Inc.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

r ❑Division of Soil and Water Conservation ❑Other Agency
IVA04
Division of Water Quality
W Routine O Complaint O Follow-up of DWO inspection O Follow-up or DSWC review O Other
Facility Number
Date of Inspection U d3 {QS' '
a -
Time of Inspection FTTGO 24 hr. (hh:mm)
Registered Certified 0 Applied for Permit 13 Permitted [3 Not O eratic)naI Date Last Operated:
�h
Farm Name: �`4 �....5.�`-- County:............................................................................
............. `�.... ........... .....
Owner Name: Phone �Io: — s —
4
...................'-.......................................................................................1...........................
FacilityContact:.............................................................................. Title:.................................... ........... Phone No
..............
Mailing Address:... ..1.....5 g.-m,.... !'��2 ` ........ I
.......�'`'�.\�^.'.��....1 ...................................
b ........... ..........................
OnsiteRepresentative:. "!`2v.... !...1J .................. Integrator:.... � .. �^' Y .....................
Certified Operators......
...................................................... I...... Operator Certification Number;
Loc ion o F
..".^.........Y.......................:.`.`:1.!:�s...� 'L
.`................... ...:....... .... `LS............1'.r!'\. ...".:ifs,l�.l.!:1n............................................................
a..... -,-—...1U..... 3,,.Q...�s....�.�.!�.............. . .....
Latitude Longitude
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
. .
" Uestgn. Current
N
Cattle , CapAcity Population
❑ Dairy
❑ Non-Dairy
N ❑ Other
ix
Total Design Capacity"
Total SSLW
Number of Lagaoas I Holding Ponds �_ �, L Subsurface Drains Present LJ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management SystemARM
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes t!�No
2. Is any discharge observed from any part of the operation? ❑ Yes ;4No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 4No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 4No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 4No
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 NfNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 14 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes O'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0No
7/25/97

Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? El Yes No
Structures (Lagoons,11olding Ponds, Flush flits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..............
Freeboard(ft): .......... ............. .......... . . .............. ................................... .................................... ....................................
....................................
10.
Is seepage observed from any of the structures?
0 Yes
gNo
IL
Is erosion, or any other threats to I the integrity of any of the structures observed?
El Yes
QN0
12.
Do any of the structures need maintenance/improvement?
yes
[I 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?
[I Yes
�No
Waste Application
14.
Is there physical evidence of over application?
0 Yes
14 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .... ...t. ..................... r ................................................................ ........................................................ .............................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
0 Yes
JKNo
17.
Does the facility have a lack of adequate acreage for land application?
0 Yes
CrNo
18,
Does the receiving crop need improvement?
,Yes
0 No
19.
Is there a lack of available waste application equipment?
0 Yes
MNo
20.
Does facility require a follow-up visit by same agency?
0 Yes
ffNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified_ or Permitted Facilities Onl
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
0 Yes
too
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes
JKNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
04 No
13-No.vi61a'ti4ns'-Gr &Acie6Cie's'W'ere- ii6teid- dudfig'this, visit. Aoiti4ill i&eii've,iio'Airiher
cOrOgpimdeiko about -this'. visit'.,',
4 - J6
Lt�
0_5C1rj1%fl
C-C
Id—
k1Z LAJ
lle5T 7/25/97 H
Reviewer/Inspector Name
Reviewer/Inspector Signature: �_) Date: k 6 1 'XI

.... .... ....:.... _ m.,...w._
�❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
M. r,
«
Routine •'0 Co►u taint 0 Follow-u of I)N'' ins ctition 0 Fallow-u p of DMVC review 0 Other
Date of Inspection
Facility Number Time of Inspection 0�2n 24 hr. (hh:mm)
0 Registered 0 Certified © Applied for Permit 0 Permitted 113Not Operational Date Last Operated:
Farm Name: 14.... ram,^ t.?�V..... ._ ..... ....2.r... C:ounty......
�sU.�.L►.,�...................,......,.......j,A,).t..
ll,�l�.w... .............
OrwnerName: ...... �..r.k.. .........................�sfa.. �..Q� ..................................... Phone No:.... `i.1.17.).. .. ..�..J�. +.U...............,.....
Facility Contact: .............................................................................. Title:........................... Phone No:
Mailing Address:.... R..Q�..,......C— 'C',- .....�r.�. ....9,d.,,.........W.k.11kc. .�...,.h�. , ............................z Z.`�J...
Onsite Representative:..KxA..t,.V............ ............................... Integrators....... .r.. ..� 4q................................................
Certified Operator;............................................................................................................... Operator Certification Number..........................................
Location of Farm:
Qh,... C.r..tR&.....d........ K.1..r 29.) ............... ►.1a3....,.,.laz..v..... t.{...... A,
►•n%.S n........
..............%I .SO..
Latitude 13U•I Longitude 00
Design Current Design Current
Design Current
Swine Capacity Population Poultry Capacity Population Cattle
Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
E.Feeder to Finish I0 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
C#
Number of Lagoons 1 Holding Ponds 0 ubsurface Drains Present ❑Lagoon Area P&Spray Field Area
❑ 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 I$No
Dischar-e ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes El No
b. If dischar-e is observed, did it reach Surface Water? (It via, notify DWQ)
❑ Yes ERNo
c. if discharge is observed, what is the estimated flow in gal/min?
014
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 IR No
5. Does any part of the waste management system (other than lagoon0holdinb ponds) require
❑Yes RNo
maintenance/improvement?
6. Is facility,not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes KNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes VqNo
7/25/97
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 09[No
Structures (Lagoons,tiolding fonds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes allo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):..........Z..:.....................................................................................................................................................................................................
10. Is seepage observed from any of the structures'? ❑ Yes &No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? ElYes ❑ 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 KNo
Waste APpliration
14. Is there physical evidence of over application'? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
c1- ..S.ru a..a.�.��..'' .�. �'4..................... ......
15. Crop type...............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ®.No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
K No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
R No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
l$ No
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement? Q Yes ❑ No
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 51No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes RLNo
®: No.violations' or. deficiencies. were no' te'd-dnring this,' visit. - You.rWill receive no further
correspondence about this:visif.,
Comments (refer to question #): Explam any YES answers and/or any recommendations or"any other continents.
Use drawings of facility to better expla�if situations (use additional pages as necessary):
a
1 N ✓�-Or+r' 1°� p 0 �^ a I 1 ✓v�^O t�� Q
i W o r K 0 - Co �
. S� L L t kA-r�-
Z2. �.i a . v�R _k t-. c. ��. a 2 `�o r w e!t{�-L v,£ c�t� lw lQ_ 0-0 Y' c
L`}r�e...,.r-e'er
�, c o �Jy p f"►� v� tl�! �V t o�,^ w in s L In 2. G �2 /S V r-� t f Y h i 1-
E- r r- p o —X �Q t;r o -„ �.R i �J4� v�_ o ✓� 4_e_ � o .-L
Sr raw _� f • I
ded-� bv�.
7/25/97
V*•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: - q i✓ t L n "I

,•.
i
I
1 y
.� � i �
.t-
-�-� . � �
• � I
�l f
:;
4

DSWC Animal Feedlot Operation Review t
a
4.
y ° M DWQ Animal Feedlot Operation Site Inspection
l® Rotitine Q Complaint Q Follow-up of MVQ inspetion O Follow-up of .DSWC; review Q Other l
Date of Inspection
Facility lumber �{
Time of Inspection 24 hr. (hh:mm)
0 Registered [3 Certified [3 Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated: p �
Farm Name:..4��..i+ c: ...�-P-Y?.t r:.. �l:.,w}.... ........................... .... County: ...,D.. b.�.Ai.. a...................................i ......
0-wrier Name:....... C'.4,ia t,.. ...................... .... �.� ? rY1:a. `.................................. Phone No:... C.%.1..% .11..,.2.Ks........ 5 z.i.. ,.............
FacilityContact: .............................................................................. Title:................................................................ Phone No:.............,
Mailing Address: ....�i,.,........ Cr..y.,..?.Y-4r.,..,.......................... .... !1�A.S..�.�...Q. ,....i. .....................,
Onsite Representative:... .p .c..j4-......-,-0...✓! .?..-r................................. .. Integrator:... S.� e...............................................
ficati«n Number:.. ..Q.
9.�.6............Certified Operator--.M.t�,c.},.......D_. ...... Q.,r...................... Operator Certi
Location of Farm:
Q.,n...airs..t*j.,". ...... .?.s1�.t.......C.Y�I.$7r�.t..Es$.�..,�nF...n<.a. ..��.....u�a� .fry........Ru..�,�a:.S.E....e.�....a�f►.�4'r.�C:�4,.v �
Ml.l... urj.�IJ..s........ {.................................... .....................................................f .. ...... ...... ... ......................................... ...........,.............................,
Latitude • ©� ®�� Longitude �7 • �� ���
Current
Nwme Uapactty ropulatton
❑ Wean to Feeder
ER Feeder to Finish C)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity,, I Zq O
Total SSLW ► . E s —7-1
Number of Lagoons / Holding Ponds © Snl)surface Drains Present ❑ Lagoon Area WSPray Field Area
❑ No Liquid Waste iV1unagement 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
[&No
Dischar-e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M No
b. li'discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
❑Yes
E9.No
c. If discharge is observed, what is the estimated nov., in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
mai nten a n ce/i m prove men t?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ENo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ELNo
7/25/97
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes kjTNo
Structures (LaLoons,Ilolding Ponds. Flush fits, etc.).
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9,No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
................q..................................................................................................................................................................................................
Freeboard tft): ........�. 1...................................................
10. Is seepage observed from any of the structures? ❑ Yes ®No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate mininium or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................................... S.k.N^...VLJJ...Pa,,;,
Y-,u.:�..�r. ...........................................................
16. Do the receiving crops differ with those designated in the Animal te Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
®, No',violations or deficiencies. were noted during this visit. Yott.will receive no farther
correspandence about this'.visit
Yes ❑ No
Yes ❑ No
❑ Yes 0 No
❑ Yes 12-No
❑ Yes
EN No
❑ Yes
C9 No
Yes
❑ No
❑ Yes
ff No
❑ Yes
® No
❑ Yes
JR No
91 Yes
❑ No
❑ Yes Ej No
❑ Yes E� No
❑ Yes IS No
Comments (refer,to question #): <Explatn any'YES iitnsKers and/or tiny'recommentilations ar`any. other comments.:
Use drawings pf fs�cilriy to better explain situations (use additionitel.pages as;necesstiry) „ .H
11.112. OtQm- ov- vcca..-.:. CA w4v % 8tu.Hov. - t a tF-�gyanv� toctlf.A
0 �"S
+ra csz s x 0 coo v ,r mac. �� S i � a,H 0 � . ; S vi o
ai �co dC
tv.z c.v-e� will �at
it. r6 l�
W v r � 0 �'ti Gorr I. LE ice{ tin/- 4 5 1 � w� v G� � �'�^-� �
LZ o..,r.-ti.
S f �id(d t Ll I
V,e 4r
qLO ...� i la �..e... rt��vT. I a�O C�1fJ�,� L'� i p&+0
elv^WA
V% U
V% v V.,% twvv5 0, S 1 to c-o %,44 - 7/25/97 ;
Reviewer/Inspector Name t
Reviewer/Inspector Signature: Date: 1
d�
aL4

Site Requires Immediate Attention: / �d
Facility No. d
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATI N SITE VISITATION RECORD
• DATE: , 1995
Time:
Farm Name/Owner: )YA-e, Z
Mailing Address: P6.1 w
County: L�
Integrator. Phone:
On Site Representative: Cam, lv Phone:
Physical Address/Location: 1914 AIL S ZE 1)e
1,q 7 5 Type of Operation: - Swin Poultry Cattle
Design Capacity: l d f 3 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Z'�Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ffcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Actual Freeboard: �Ft. Inches
Was any seepage observed from the-Iagoon(s)? Yes No as any erosion observed? Yes r N
• Is adequate land available forWray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? P
r No
100 Feet from Wells Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?_ /Yes or No l j
Additional Comments:
._ -- Ip . i
i -bv/
Inspector Name
1"nX
S
cc: Facility Assessment Unit Use Attachments if Needed.