310485_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental W6

Type of Visit: Uy�Zo=rme
Inspection V Operation Review U Structure Evaluation () Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z 2 % Arrival Time: 2 /S Departure Time: 2S County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ) a ,(p _,cTitle:
Onsite Representative: / �� 7 ko v� integrator:
Certification Number: 1 7 t 7
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Swine
Finish
1 te s i R nj I Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
Z Z
DairyHeifer
o Wean
Design
Current
D Cow
to Feeder
to Finish
EFa
1)r� l;oultr,
La ers
C•.a acit
P,o
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
e s Turke Poults
Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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 21412015 Continued

Facifi Number: jDate of Inspection: 1 IT
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 01No ❑ 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 he integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FTNo ❑ 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 [��IVo ❑ NA ❑ NE
maintenance or improvement?
Waste Application — /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �O ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
Excessive Pondin Hydraulic Overload Frozen Ground Heavy Metals Cu Zn et�
❑ g ❑ Y ❑ ❑ �'Y ( )
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
r
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
i
[3 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?
ID Yes
do
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[3Yes
F3/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
ffNo
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: 54 - Date of Inspection: 2114
•24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3' 'o ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C2 T
❑ 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
[Z N
❑ 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
UrNo
❑ 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
ErNo
[] NA
❑ NE
Reviewer/Inspector Signatui
Page 3 of 3
2/4/ 015

Type of Visit: O'Co 70ance Inspection O 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: Arrival Time: Z '� Departure Time: I County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J AY �U. S 3 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Region:
Certification Number: k-­7 �77
Certification Number:
Longitude:
Design Current
Design
Current
Design C•t{rrent,
Swine C►apacity Fop.
Wet Poultry
CIM
apacity
Fop.
Cattle
P.
Wean to Finish
I ILayer
I
I Dairy Cow
W 'to Feeder
I
INon-Layer
I
Dairy Calf
.,'Feeder
to Finish
D
,
Dairy Heifer
Dry Cow
Farrow to Wean
Design Current
Farrow to Feeder
ILavers
Non-Dairyk
Farrow to Finish
Beef Stocker
Gilts
Non-l.a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
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 Io ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �YNo
1; ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility -Number: - Date of Inspection: tS'
5."
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej"No D 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 0 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ 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 ETNNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZfNo ❑ 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 o
❑ 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 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
KI
❑ 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 eN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ 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 ❑ SoiI Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Date of inspection: qJ1, S'
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes ,rNo
❑ NA ❑ NE
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? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No EfNA ❑ 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)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:'1-4LA,
Date:
Page 3 of 3 21412015

(Type of Visit: UCot kiance Inspection U Operation Review U Structure Evaluation C) Technical Assistance
Reason for Visit: Routine C) Complaint ( Follow-up C) Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time:© Departure Time: 23 County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: -7c r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region:
Certification Number: 27 7
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dai Cow
Design Current
Capacity Pop.
can to Feeder
I
INon-Layer
I
Calf
Feeder to Finish
Farrow to Wean
Z 10 00
Dai Heifer
Design Current I Dry Cow
Farrow to Feeder
Dr. P.oultr, C•_a acit P.o . Non -Dairy
Farrow to Finish
Layers
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
ke s
ke Puults
tOuther
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 [�N
❑ Yes LJ 10
❑ NA ❑'NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilitv Number: .-I. I - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? P es No NA NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]rNo ❑ 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 E:fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑�N o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes L__ <o
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ 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?
❑ Yes
[%lo'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ 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
C3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3'1�o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o ,
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - `f & .r jDate of inspection: 5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3Yes ❑ Q No `NAS❑ 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?
Reviewer/Inspector Signatut
❑ Yes [110 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes []' l-o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No
❑ NA
❑ NE
[jN
ra�No
❑NA
❑NE
[] NA
0 NE
Date:
21412015
Page 3 of 3

Type of Visit: Q rRoutine
pliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1
Date of Visit: f d . Arrival Time: Departure Time: 1 �S County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Ic_ 0_.r-'/ 3 a 0 L" Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 11
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
C►urgent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
t?
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D.. P,oultt:
Layers
Design
Ca acit
C►urgent
P,oP.
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
iBccf
Boars
Pullets
Brood Cow
tither
Other
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes o ❑ NA ❑ NE
❑ Yes go ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure
h! Structure 2 Structure 3
Identifier: L
Spillway?:
Designed Freeboard (in):
Structure 4
❑ Yes
Structure 5
No ❑ NA ❑ NE
[]No ❑ NA ❑ NE
Structure 6
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 E3 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 environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Io ❑ NA ❑ NE
maintenance or improvement? 777—���"',YN
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
Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
° U
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[%NNo
❑ 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
I /( No
❑ NA
❑ NE
the appropriate box.
7"
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
[] 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 Inspecti;No,
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Vo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes jNo
❑ NA ❑ NE
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 to provide documentation of an actively certified operator in charge? Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Wo ❑ 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 2(No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [:a/No ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes f40
0
❑ Yes
❑ Yes go
❑ NA ❑ NE
❑ NA [] NE
DNA ❑NE
Comments (refer to question #t): Explain any YES answers and/or, any additional recommendations or:any other comments.
Use drawinPs of facility to better explain situations (use'�additional paaes`as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C r %_13%av
Date: A, A
14/ OI4

type of Visit: X Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time; County:�!/1 7�
Farm Name: Q)Ds.% 6 A Owner Email:
Ij
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region: L✓lR�
Onsite Representative:. Integrator:
Certified Operator: � Certification Number: ---_
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design
Current
Swine Capacity Fop. Wet Poultry Capacity Pop. Cattle Capacity
Pop.
Wean to Finish Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current D Cow
Farrow to Feeder
Dr, P,o_ultr, Ca aei P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef 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
R(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
2TNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 051 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes A6No
0 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 KNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes V No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes eNo
❑ 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 XrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes r No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes )Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes fZ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ONo
❑ 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 ❑ Maps ❑ Lease Agreements ❑Other:
2 t. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
F'1•
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes GErNo
❑NA [3 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a I- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes P3"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 ;!fNo
DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [7fNo
D NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 6No
❑ 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 E!�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes KNo
❑ 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
gfNo
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vj No
D NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gn 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 orany other comments. I
Use drawings of facility to better exnlain situations fuse additional oaees as necessarvl.
'�w i��r�C GD'►'n�1�9e.
Reviewer/Inspector Name: Oin/s� Phone: _ q
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

�DIViSlO_ oraw
ater Quality
=Rcillty Division of Soi[ and Water Conservation ✓�
Q Other AgencyARM
Type of Visit: R
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: N Region:
Farm Name: Owner Email:
CzC� M .-�o�ES q to-&- ► lcN
Owner Name: Phone:
Mailing Address: �33 F-_ /yC a95)8
Physical Address:
Facility Contact:
Onsite Representative: J GJUL� \L 14 d D E S
Certified Operator: %se �.k (►4 of>6 S
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Baia
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design C►urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pap.
Wean to Finish Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish 1 4
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
DrF P,aultr, Ca aci P.o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
'
Pullets
Beef Broad Cow
Turke s
EnIffo—iliel
Turke Pouets
11 Other
Other
Discharges and Stream Impact
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
P] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
7P`No
❑ NA
❑ NE
of the State other than from a discharge?
�
Page 1 of 3 21412011 Continued

Facili ,Number: - Date of inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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 XkNo ❑ 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 A2plication
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, et .)
❑ 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): 1Z es2— S
13. Soil Type(s): �"�t- SIra/ J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
IT 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
l9. 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
tNo
❑ 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 I No
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis qXaste Transfers
Q Rainfall ❑ Stocking 0 Crop Yield Q 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 tNo
❑ NA [] NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

Faci[i .Number: - Date of Ins ection: IN
+Y y
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �9 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
4No
[DNA
❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412011

IType of Visit A�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � County: (.1ARegion:
Farm Name: �l, ��� {� Owner Email:
QQ \L-h�C S 910- -3auC�
Owner Name: I l Phone: xg 10- �`n' 1 c�T $ Cw�
Mailing Address: C N C �y ut-A U 1 LC_E If ,/ Y c, oOE-S I
Physical Address:
Facility Contact: Title:
``
Onsite Representative: J��'��'D�S
Certified Operator: Q�
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
C
Operator Certification plumber:
Back-up Certification Number:
Latitude: 0 c = g 0 « Longitude: = ° 0 ` = "
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
11 WO I
Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
10 Other I
umber 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 lr3J No ❑ 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 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 01V
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): bo
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?
El- Yes ONo
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ 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 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) SC4 !
_
13.
Soil type(s)�S7a
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
o ❑ NA
❑ NE
Comments (refer to question #E): Explain any YES,answers an&tr, any recommendations or °any other enminents
Use drawings of facility to better explain situations: (use additional pages as necessary):
i
Reviewer/inspector Name S. Ali:,`,rsr.' Phone: 16-9. 3�
Reviewer/inspector Signature: Date: 42 ZZ Lf
Page 2 of 3 12128104 Continued

•—
I~acility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )<No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
El❑ ❑ Design 0 Maps ❑Other
the appropriate box. WUP Checklists X
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo El NA El NE
El Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis ❑ �te Transfers +YYYY1)(nnual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
';�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
kA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�j 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
4No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
lof
qo/o
lo�
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ! Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (�y 1U Arrival Time: Departure Time: County: C-1N Region.
Farm Name: 'oss �y� Owner Email:
M (� J14 (i10-09g-3�I}
Owner Name: 22 ` ! i �`l�C S Phone: w�91 - t s
Mailing Address: 3 �`� C- ItiLA L) Lc- E % Y C oI'P S ],'
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: S Integrator:
n ,, lU
Certified Operator: �`''TU��S Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= 0 01 0 I{ Longitude: = o ❑ i =
if
Design C►urrent
Design .urrent
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
JO Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I 1
❑ Dairy Calf
Feeder to Finish f7
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
NO Turkey Poults
❑ Other
10Other I
umber of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes XNo ❑ 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 Ad No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ANo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

K
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?
�S�t�ucture I Structure 2 Structure 3 Structure 4
Identifier: L4K00W
Spillway?:
Designed Freeboard (in): I11,
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 V No ❑ NA ❑ NE
ElYes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )� No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
'���•' \\\\\
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ 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) ��z ��) 'S�.'1 Cc�
13.
Soil type(s) C0qV_r_5TCW
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V�' 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 ?
ElYes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
['No
[INA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[ ,No
❑ NA ❑ NE
�.�� 'S :?�„is��F:
Comments (refer to question #): Explaiwany YES answers and/or any.recomthendatlons or anysother�comments i t s_
Use drawings of facility to better expjain situations,' (use additional pages as necessary) > ��0`�" a ',�` f �� 4 ,
WT �a, H mG
1]llr16q I,L-1 ).(0
i�
Reviewer/Inspector Name
rnAuDA A e s Phone:
Reviewer/Inspector Signature:
Date: L1 I Q
12128104 Continued

Date of Inspection C�
Facility Number:
_Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes'3�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes X No
❑ NA
❑ NE
the appropriate box. 0 WUp 0 Checklists 0 Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Cl Yes p4 No
)A
El NA
[I NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis [l Soil Analysis ❑ Aste Transfers✓❑ I/nnual Certification
0 Rainfall ElStocking ❑ �op Yield ❑ 120 Minute Inspections ElMonthly and V
Rain Inspections /❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes o
J'N
ElNA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yeso
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes t�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes kN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
k1A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �4 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?
❑ YesP No
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes , No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Gomrttents and/or Drawings:
A 1..1QUHv
AL
12128104

Type of Visit (XCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0,Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: (�1 �,� Arrival
Time: Departure Time: County: U Region:
Farm Name: 1; �5S 1 AQC . Owner Email:
Owner Name: _�i?_�De S Phone: c7 /l3?_3 70 Ex1r3y39
Mailing Address: WC-DLI paU ILLS DES)
S
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: �E(LpLk �t S Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = f = Longitude: = ° 0 d =
Ili
Design Current Design C►urrent
Design C*urrent
Swine
Capcy
Popuiatio�n �'4'et Poultry Capacity Population
Cattle
Capacity Population
Wean to Finish;!'
P
❑ La er
❑Dai Cow
Wean to Feeder
❑ Non -Layer
airy Calf
91 Feeder to Finish
�/0
❑Dai Heifer
El Farrow to Wean
Dry Foultry
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ 8eef Feeder
❑ Boars
El Pullets
❑Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
t
Discharges & Stream Impacts
I. 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
J,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r
Facility Number: 3 — r-j
Date of Inspection /ate
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
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 ANO
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes
IRNo
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes { No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No [:3 NA ElNE
maintenance or improvement? I \
Waste Anulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement? \\
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�
13.
Soil type(s) FoZR r , i o N
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?
El Yes
1
❑ NA
El 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
Ao
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
A v-1 C_QNc f_" F .D Cie_' F014- 'a
Reviewer/Inspector Name l _____ Phone: ,
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

I
Facility Number: Date of Inspection
Required Records & Documents
19. Did theTacility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[,No
❑ NA ❑ NE
the appropirate box. Q WUP 0 Checklists 0 Design [] Maps ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA ❑ NE
E] Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis
❑ V/aste Transfers
❑ /nual Certification
0 Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections El
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
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
Additional.Comrttetitsand/orDrarvings. g$I_i�
Page 3 of 3 12128104
Page 3 of 3 12128104

W Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit N 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 ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Ct%J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 3 e (Lit L\ o S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Do =f =g =a =- ="
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
Pouets
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
❑
Dairy Heifei
❑
D Cow
❑
Non-Dai
❑
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 f4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�Q No
❑ NA
❑ NE
❑ Yes
O�No
❑ NA
❑ NE
12128104 Continued

rFitcility Number:3
Date of Inspection 2 JM6 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (-6600AI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes R No ❑ NA ❑ NE
❑ Yes W 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 [9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes q 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA El NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or IO lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KA No
El NA
El 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
bqNo
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment'?
❑ Yes
.j 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):
f
Reviewer/inspector Name ,*rC S Phone: (3ZA
Reviewer/Inspector Signature: Date:
12128104 Continued

v .
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
( No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IVNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jj� No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
C4 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
5a 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
DZNo
❑ NA ❑ NE
E
12128104

" Facility Number `j
Division of Water Quality
Q Division of: Soil and Water Conservation
Q Other Agency
Type of Visit ffl Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit PrRoutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: :�� Departure Time: County: Region: w/'leO
Farm Name: �5� G' Owner Email:
Owner Name: �-rig �L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q F
Certified Operator: 2 /6 � 2. e)15
Back-up Operator:
Location of Farm:
Design Current
Swine .Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1/0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish I
Boars
Other '
Phone No: l
Integrator:!/.ecPr,�JN
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 6 = Longitude: = ° [� ` 0 "
Design Currents.
W,
et Poultry Capacity Population Cattle
❑ La er �' El Dairy Cow
❑ Non -La er El Dairy Calf
❑ Dairy Heifer
Dry Poultry El Dry Cow
❑ Ot
ZI
-
rs
Dischaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Non-Dai
ElBeef Stocker
ElBeef Feeder
I ❑ Beef Brood Cow
)esigm Current,-"
anacity Ponulation
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
El No
❑ Yes X,No ❑ NA ❑ NE
❑ Yes�gNo ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection 02�
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
t r l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: d
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ElNE
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 1Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo [3 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 E] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )ZNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 0No ❑ 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)�i�S�QiI!
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,ffNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes /JZINo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes �No El NA
El NE
1.8.
Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA
❑ NE
Comments (refer to question ft 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)::
LL F� yG
Reviewer/Inspector Name Phone /O —3 7—
Reviewer/Inspector Signature: Date:
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 ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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 ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
)zNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes ;"No
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )fNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NE
Other Issues
.51NA
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
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1zNo
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes,ZNo
❑ 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 ff 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?
El Yes Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes zEfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
w
Page 3 of 3 12128104

t
jo Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
IType of Visit 10 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 ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: I�/! "an
Farm Name: c� Dit- Owner Email:
r
Owner Name: , �Q RA 01) Es Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: (IuZ ` 914ML57
Certified Operator: / TFf-4t?d�F_S
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish Z D
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
Boars
Other
❑ Other
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = d 0 Longitude: =°= 4 0"
ig
1
Design Current
Wet Poultry . Capacity Population
❑ Layer
Non -La er
M
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeX 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. -To pulaition
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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 10 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
W1No
El NA
El NE
❑ Yes
JxNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — B Date of Inspection / D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?. -
Designed Freeboard (in): ��rJ
Observed Freeboard (in): 13.J
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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 XNo
❑ 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
❑ 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? /PlNo
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
❑ NA ❑ NE
/11No
❑ 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 ElApplication Outside of Area
12. Crop type(s) ^ �• rncrDA ��Rf�2�� Sof• a' L0062.1_15560
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
X
❑ 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
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ 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):
Nor;---.` of c��
Flla00
Reviewer/Inspector Name 1
f �� l Phone:
I
Reviewer/Inspector Signature:
Date: p
Page 2 of 3 12128104 Continued

Facility Number: 2 — Im Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ VrUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No )ZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ZNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No gNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )!fNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 1:1 Yes No ElNA ❑ NE
and report the mortality rates that were higher than normal? to
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 16
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12128104

L
Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
for Visit Routine 0 Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: rQ S Arrival Time: ,� Departure Time: ; © County: PCP Region:
Farm Name: lae, Owner Email:
Owner Name: _ ��� 7//7o/z-..5r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�R
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ I ❑61 Longitude: ❑ ° ❑ , ❑ `,
Design
Current
�y DesignLurre t}
°
Design CurrenSwine
CapaciWet
Poultry capittpulattan
❑ Layer
❑ Non -La et
Cattle
C•ap`acity Pop�[ation
❑ Wean to Finish
❑Dai Cow
❑ Wean to Feeder
iry Calf
Feeder to Finish
❑ Dairy Heifei
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
ElNon-Layers
❑ Beef Feeder
FGilts
Boars
El Pullets
ElBeef Brood Cowl
I
...
I SIMMONS,,"
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:ILI
a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
�Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
'Vej
12128104
Continued

Facility Number-._ —
Date of Inspection (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
Spillway?:
Ale
Designed Freeboard (in):
/f, ,_
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes IVNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 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 Z 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 XNo ❑ 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /'�iPP.STlJA�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 1 . No
❑ 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 acre
determination` ❑ Yes Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2fNo
❑ NA
❑ NE
�' d1?. "6'�: �L �! s.l: €�•n _.0 �4. i..f ., '.6 ,dPs ., ;e_.. a.,. s: ,_--�".-�, ES... .i-.:�, a. '�.-a::iai�i�dreiT'��"eF n?6YC�'3WJA�d&-�'"'�IR'6�;
2D45-
vier
t�Lld�B=L'Z�f O r( �G r U�/JGf �}� Gt/�f 4 5• /%%�/ A&B�.c�fT�
Reviewer/inspector Name .��,j ���.: '' ' s Phone: 9/Q r Z
Reviewer/Inspector Signature:
of5
Date:
12128104 Continued

Facility Number: % — Date of Inspection p,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
JZ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 7 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes XNo
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
IVNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes Y No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes] No
❑ NA
❑ NE
33, Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Ar�dditional Camrnents.'.;and/iir
T i)?614,qw 5 / iLiJ� CJ/Yl� �/S� D •F'GdL
���a �� ��cr lCdri'a �o/li✓E2s 4"C 117ce'a'/.
CDP � 4 �/�l��Gs� Gas
. . lely, A
fi7010�e.1'4 Aoo� 14dr4.1_10'ez)
12128104

Type of Visit Q(Compfiance 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: Time: ! !S d
Q Not Operational Q Below Threshold
�J Permitted Certified © Conditionally Certified 13 Registered Date Last Operated or Above Th eshold:
FarmName: .......... , . Ss......4o..& ...................... ............................ County: ...........�5,%,..........................................
OwnerName: ................................................... ........................................................................ Phone No:
MailingAddress: .................................................................................... . ............................... ..................................................................................... ..........................
Facility Contact:
Title:
Onsite Representative: 0..f- .F..z:.� .... j.................................................
Certified Operator: ....................... . ..........................
Location of Farm:
................................. Phoneme Noo:�y.�.................
......................
.............
,
Integrator:........... Ct�`-i�VL�ii....................................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JVNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If 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 140
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yesxel-I
o
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .............. I .................................................................................................................................................................................................
Freeboard (inches): TZ
12112103 Continued

Facility Number: — Date of inspection ✓! 1
�5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes �o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 0 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 7No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Pondingg ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes NQ
14, a) Does the facility lack adequate acreage for land application? ❑ Yes —p'!N
b) Does the facility need a wettable acre determination? ❑ Yes [N
c) This facility is pended for a wettable acre determination? ❑ Yes lo"
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes 7No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes NNQ/
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? El Yes 19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes7No
roads, building structure, and/or public property)
20. At the time of the inspection slid the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Air Quality representative immediately.
-7 ,)
Reviewer/Inspector Name 'd,
Reviewer/Inspector Signature:
use addition[ pages as'necessary):E€='i` Field Co Final Notes
`` �p ❑ Copy ❑
i.F K?'.� .n .Nn Ir`'4F i���iil��LSY�t�I�"�hu`4��_. 'rj
CA6t 6wJ &J A LUS ,
Date:
r7n7m7
rAntinuaA

Facility Number: —
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [No
❑ YesVN
❑ Yes
❑ Yes
2/0ZN
❑ Yes
❑ Yes❑
Yes
W
❑ Yes
NN
El Yes
[- 0
Yes
/No
❑
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

l
DiiisioR of Water Quality
Q Drvrsion of Soil and' Water Conservation
'r''�ra ' t ez p..i �s z>f,,�y+llzsiyl-n 41 OlerA enCy a�gir
Cf g s ,
I,ry
��
t
Type of Visit compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Vislt r Routine Q Complaint O 1=ollow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: Time: Printed on- 7/21/2000
Facility Number
Q Not O erational O Below Threshold
JKPermitted ACertified Q Conddii o^vally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: Q, lJ".f.T County:. .............................. .64)/k
Owner Name:........ 'J. 1e`....................... .......... Phone No:.......................................................................................
y
FacilityContact:.............................................................................. Title:...................... ....... Phone No.
MailingAddress:...................�...................................................................................................................................................................................... ..........................
Onsite Representative:.....(fl�t%fi�lr2... ..... ... Integrator: G 5.............................................
Certified Operator:................................................................................................................ Operator Certification Number:.....
.....................................
Location'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • 4
Criet Deign Current a%gn urrent
tWi4fte._r.:.. .. Ca ci .: Po ulataon . We CPoultry Ca ad Population 1 , "Potiatun
Wean to Feeder p ❑ Layer ❑ Dairy
G2 Ceder to Finish ❑ Non -Layer ❑ Non-Dairy
Farrow to Wean
Fan ow to Feeder ❑ Other
i3€ Farrow to Finish Total Design caoaciry .
Gilts
i fat Boars Total `SSLw
{ .... w .. .... ...... .. ... . . ...... ........ ,.. ,
rr
Numerbof Lagoons'
❑ Subsurface Drains Present
❑ Lagoon Area
❑spray Feld Area
ddii�g,Ponds'/ Solid Traps
❑ No Liquid Waste Management System
, iH
Discharees & Stream Impactti
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes /;2rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes XNo
Sll'uCtUM I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
identifier: .................................... .................................... ....................... ......................... I ..................... I........................................................................
Freeboard (inches): 3
5100
Continued on back

Facility Number: 3 --TOT Date of Inspection I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
VNo
12. Crop type e _e
0. 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?
El
No
P-1
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
/0 No
16. Is there a lack of adequate waste application equipment?
El Yes
�No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
INO
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
ILJ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
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?
(ie/ discharge, freeboard problems, over application)
ElYes
No
23. Did Reviewerhnspector fail to discuss review/inspection with on -site representative?
❑ Yes
I[J No
24. Does facility require a follow-up visit by same agency?
El Yes
X.
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XN 0
No violations or deficiencies were noted during this visit. You will received no further correspondence about this visit.
ri'. g:2' y r :.... _-mPerfl! 'n. `iT✓tsi$ ".. _. uy _
Comments (refer fq quesion#) Explain. any YES answerY4fs`undloe any recummendationson.any Cher commentsr ,,�•r
p aHuns(iise additional pages asnecessa.ry)
g
PUse:drawiags.of facdit to better ex lain situ17
Field Copy ❑ Final Notes
. �,.
��.�_ - P _ ..
6 Z41FZ-& 0)rw
FGDRQS .�� IR,pFQ, PAI�460-Z.�,�P�a�ty
4-
Reviewer/inspector Name
Reviewer/inspector Signature: Date: Z
05103101 Continued

•i
Facility Number: I — Date of Inspection
Jr
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes /No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not Iocated 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 dNo
31. Do the animals feed storage bins fail to have appropriate cover? Cl Yes 2fN0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
ttonaComments' an or ra ngs•
r
J
5/00

E t i
Et/�t�' i Al Waiter:
Dir<s'on,of
!€ i€
t E 1 !
Quality
-
! 3
E €
°€h
'' l.i t
Eg E I �I!
;1 t��,
Soil'and Wateobonserva'tiion
€ E
>>-�
1 ,, ,11 ,
'� 1 Eta
�Drv�sron of
6 PE
€ H€i p t Al i t I t
E { :1
{ i i.': �� �'� "
11 E
if F ., •E i 1 'iy ! F
p -! 311tt I-` I 6 S
OO flier A enc
�'.'
i
1` t) 3 L E K
i"iI
�
E
e.l
Type of Visit xCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number llate or Visit: Tame: �Printed on: 10/26/2000
O Not Operational O Below Threshold
Permitted [] Certified f] Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
'
FarmName: .......5.......................................................................................... County: ... 1 ..... .....................................................
OwnerName:........................................................................................................................... Rhone No:.......................................................................................
FacilityContact: ..............................................................................Title:.................................................... ... Phone No:
Mailing Address: ..................................................................................................................... ................................... :::....... ..........
. .................... ..........................
1
OnsiteRepresentative:!` Integrator: ................................................................................................ .. ...........
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 16 Longitude • 4 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
[I Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Ares
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Strum Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f� No
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
' \
a. If'discharge is observed, was the conveyanco man-made? ❑Yes ❑ No
h• If discharge is observed, (lid it reach Water o[ the State? (If yes, notify DWQ) ❑ Yes ❑ No
c, II'discharge is observed. what is the estimated flow in gal/Min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes )�'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 No
Structure I Structure 2 Structure 3 Structure 4 Structurr 5 Structure 6
Identi ficr: ........ :...........................
Freeboard (inches): '39
5100 Continued on back

J
r -
Facility Number: .4 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �I 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 4 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 eNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 4No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? kYes ❑ No
Waste Application
10. Are there any buffers that need maintcnancehmprovement? ❑ Yes )kj`No
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes kNo
t2. Crop type�V72-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
ig viola igris:o deficier�c�e •were h ed, Ring 00s'visic • Yoo wili-teeeiye Rio fu�t�er.
....
olrres} 6fidence'. about this visit:
❑ Yes �fNo
❑ Yes No
❑ Yes] No
❑ Yes ff No
❑ Yes VNo
❑ Yes XNo
❑ Yes XNo
❑ Yes KNo
❑ Yes �(No
❑ Yes No
❑ Yes j No
❑Yes No
❑ Yes , No
❑ Yes ofVo
❑ Yes Po
Comments (refer to,question #) Explain any YES answers and/or any, recommendations or any other comments 1 I:
n,
,Use,'drawings` of facility to better explain situations (use additiional; pages as necessary
�C� �C � � r��, ape .���- see c�►� •
Pr
Reviewer/Inspector Name i 1'' a^ 3'j
Reviewer/Inspector Signature: X�' ���� mm.- Date: ry, —1-1—G 1 5/00

Facility Number:e-3= Date of Iuspection 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 �dNo
roads, building structure, and/or public property)
24. 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 rail to have appropriate cover? ❑ Yes 'WN0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
and/or D rawings: :..: :,: ,
.
.&I
S/00

AD Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
s
Type of Visit J'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number
Date of Visit: l L1 Tune: ® Pf"inted on: 7/21/2000
3 $
rO Not Operation, Q Below Threshold
JZPermitted [3 Certified J3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
B4f 5 N Dad County: RV 1'
FarmName:........................................................................................................................... �......''?.........................................................,
OwnerName: r r%aG e S Phone No:....................................................................................... .......... ...................... ..............................
FacilityContact: ................. .................................................. ........... .l'itle:................................................................ Phone No:...................................................
MailingAddress: ............................................ 2.. G..L f :,.....Gl.a frQ..... J�..................... ..........................
Onsite Representative: �....................................................................... �
f Integrator:
7................................................................I..............I..................................................................................
Certified Operator. ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
]5Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �� ��� Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
129 U
► Z110
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I JE] Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-uon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ID No Liquid Waste Management System
Discharges & Stream Impacts
I. 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. slid it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in galhnin?
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'?
Structure I Structure 2 Structure 3
Identifier: .............1.............................................................................
Frechoard (inches):-
5100
❑ Yes JR�No
❑ Yes "RNo
❑ Yes No
❑ Yes ,'No
❑ Yes 0 No
❑ Yes 25 No
❑ Spillway ❑ Yes f? No
Structure 4 Structure S Structure 6
...................................... .................................... ............... I .... I...............
Continued on back

Facility Number: — f 51 Date of Inspection 107170 {Tinted on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �§No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 8 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
M No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
® No
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
f'No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
tffNo
12. Crop type Sy1 eA-eh•f, GJ All G-1�_
e(AWIbI_
13. Do the receiving crop. differ with those designated in the Certified Animal Waste Management Plan C P}'?
El Yes
00No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
C'No
c) This facility is pended for a wettable acre determination?
❑ Yes
EJ No
15. Does the receiving crop need improvement?
❑ Yes
O No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge`?
❑ Yes
O No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0 No
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'?
❑ Yes
No
24. Does facility require a follow-up visit by same agency'?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Q yiQlaigos;or dtlflcien6L,,9 *c► re pgted• ding �:his;visit' - ;Y;oir will-teceiye rio futt�er. :
corTes oricYence: about this .visit: . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ci l� -r q not .-•e cor-4S A r t we lse�
Reviewer/Inspector Name -5-�4 Wq / 44!A
Reviewer/Inspector Signature: Date: 1� �Q 5/00

Facility Number: 3 — y85 (late of Inspection I fi / AIG�J I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 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 FNo
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 0 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 f�71 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [Yes ❑ No
Additional Comments and/or rawtngs�
- - z, I ;;,, c n ¢': 'e .'ou a , s '.ie. � 3.it � � �� 1 :I l I al f,.: •:� � f � �
A.
7
3/23/99

1 � s
Division of Soil and Water Conservation Uperation Rev8ew "
'jj-C]DlVislon-[If SOIL and_iWater�COIASBrVAtlon ICDlnphanee In5peehon`f' ��� ;�,`;'f E. mil ��� i1�, ',:� rs'
E !
ivision of Water Quality Comphanee Inspection
- � �
Other
s
her Agency
O erataon Review
Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection v
Time of Inspection 1 24 hr. (hh:mm)
Permitted Certified © Conditionally Certified 0 Registered JE3 Not O erational Date Last Operated:
Farm Name:........... 5 .. 9 G.... County.......... .�?.4 •..rr...
............................................................................. ...... ........................
OwnerName: ....................................................................................... Phone No:............................................................................
Facility Contact:.............................................................................. Title:................ Phone No
Mailing Address: ..............................................
Onsite Representative 99% .S,,, Integrator: ....
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
................ I ....... I .....................................................................................................................................................................................................................
.................................................................... I .................................. I ................................................................................................ ...... I-, .............
.---�
Latitude Longitude �• �� �«
Design Current Design � Current Design Current
Swine w• r, , —Capacity P- opulation. ,Poultry,.,,.:; Capacity,, Population Cattle . Capacity Population
❑ Wean to Feeder
WTeeder to Finish
rZ n
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer 1 1 JE1 Non -Dairy
i,"' ❑Other
P TotaLDesign'Capacity
'TotaIiSSLW
i Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area
Sol Hoing;'Ponds I id Traps 0 " ° ❑ No Liquid Waste Management System E
Dischar;aes & 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/ruin'?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ............. ... D.. h.......................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes gNo
❑ Yes dNo
❑ Yes W(No
❑ Yes ONO
[]Yes Z'No
❑ Yes No
❑ Yes ZNo
Structure 6
...............................
❑ Yes P�No
Continued on back

1
Facility Number: 3) — �$� Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T 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 L] 4V A T' / 5 • Q >rA'j (2
RUIX
■ II •
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records _&_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) j
19. Does record keeping need improvement? (ie/ irrig n, 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?
io yioial iQrts'oi' ileCCie rie mere pote� d>4rririg ;this visit:... . . re. . .Rio.their. _ .
' : ' corresnoric�eince: a�atit this visit ...... ... ::... ' . , ..... '.........
.......
.
❑ Yes X qo
❑ Yes �No
❑ Yes XNo
❑ Yes �No
❑ YesXNo
❑ Yes '2140
❑ Yes rNNo
No
Yes ONo
❑ Yes �No
❑ Yes P No
❑ Yes 9No
❑ Yes ;.7No
❑ Yes
ElYes 'No
❑ Yes H No
❑ Yes ONo
❑ Yes No
❑ Yes �(No
❑ Yes No
Comments (refer to question #) Explaiti,any YES answers and/or any recommendations or any other comments .'i: " : +" ' ' ,
a� ., i.•. E � �:> r"�• E °€v31 3,sr>�ii,� � ,. "➢ t, `L�s.,� E lE
❑s`e drawings ofi"facility tolbetter,explain'situdtions.(uge additionalrlpages as;necessaity) ; t ,+E, s (I-� E U ',1 t�h `, ,3 'r ,�
r.
is f JK D�c�?v ATt_ uq►� �3 �s� FPS M 4P A^r CALC v1. AT,bn�
T�C 0 „Ir`CL
Ly 13.3 A
/CoL.
.�..,
Reviewer/InspectorName t
Reviewer/Inspector Signature: ���j 3— Date: f Zq cjq
3/23/99

Facility Number: it — g Date of Inspection
;y Odor Issues
. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Jz No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes INo
4
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, -etc.) ❑ Yes o
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �Na
2. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? 0/yes ❑ No
itiona omments an or rawings: .`: ,: x , 1_ .r, r.. ;;
�P�flt��Etx-- �r"Sc�rs� j--lo�l YcSu14Lly �/o'l-��'G ,p�'i'; arJ uF
r
� tr e uJ 5 r n! fi� � 4 cw S t( TA � <GS d*IJ /��-►,a.� � �SC.1-I �4 df��-� P �� �E. t ►`T ra
!. boa Ae-e-= VEA�l rr+u fbP_�A`r`I^�
J
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality,
,-Routine O Complaint Q Follow-up of DW2 in=tion O Follow -tip of DSWC review 0 Other
Date of Inspection
! (�
Facility Number
Time: of Inspection 24 hr. (hh:mm)
0 Registered #'Certilied [3 Applied for Permit E3 Permitted © Not O erational Date Last Operated:
FarmName: ......!.1.....3.............�.......T..�......................................................................... County: ........�Sr.,aP.��........................ .......................
Owner Name:... ��.. ... "�lr���- .. Phone 1'n• �.,,...
jj z�! D7� r
Facility Contact: ..,�1 -P r7 .. 'r:%.............................. Phone No:............,......,...............................
Mailing Address: Z .�� .....f...� - !............................................
................�.................................... ..
Onsite Representative:.... .h i"l `2.'4''^.�c y k4!lAe�!;#tE ................................................
�'.":................. Inte Integrator:
Certified Operator;.., r p
.. a..�:�-:........................:.j...:........................ Operator Certification Ntunber:.........................................
Location of Farm:
C
C
Latitude • C ° " Longitude 4 "
Design Current
;P' ' 4
Design Current Design Current
Swme` . '.
Capacity Pbpu�latron
Poultry
Capacity Populatiipn Cattle Capacity Population,
❑ Wean to Feeder
;
❑ Layer
❑Dairy
Feeder to Finish
IZ q D
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Y x
❑ Farrow to Finish
a,,'
Total Design CaaClty
❑ Gilts
'=
e
❑ Boars
Total SSL.W
x
Huber of Lagoons / Holding Ponds
❑ Subsurface Drains Present
❑ Lagoon Area ID Spray Field Area
.."'.
❑ No Liquid Waste Management System
General '
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallrnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes 9 No
❑ Yes W No
❑ Yes ® No
❑ Yes ® No
❑ Yes 9 No
❑ Yes U�No
❑ Yes NJ No
❑ Yes W No
❑ Yes 4&� No
Continued on back

ti
F4cility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 4No
Structures (Laaoons,I191dine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ANo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
I .............. I............ ............. ...................... .................................... ................................... ................................... ...................................
Freeboard(ft):......3... 5K . ............. .................................... ........ ........................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes E 'No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes R No
12. Do any of the structures need maintenance/improvement? ❑ Yes A� 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 j No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(1f in excess of WMPaaor runoff entering waters of the State, n
SS y DWQ)
15. Crop type 7..►.r.......................................(01,01"'.... ✓:..................................... ............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes In No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes KLNo
18.
Does the receiving crop need improvement?
❑ Yes ,J�3 No
19.
Is there a lack of available waste application equipment?
❑ Yes No
20.
Does facility require a follow-up visit by same agency?
❑ Yes No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,3 No
22.
Does record keeping need improvement?
❑ Yes 'I No
For Certified_ or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes A No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 4 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes KNo
No.vWaitionssor. dif ciencies.were-noted-during this:visit:• You.Wxill recei've•no•ftirtlie r..
:. correspi)6deirice, iilioijt .tbjs'visit::....:
7/25/97
Reviewer/Inspector Name
I Reviewer/Inspector Signature:
Date:

Facility Number:.... ....... —. Date of Inspection: L,/
Additional C Timents and/or Drawings: z
/j
L A G k
7i�• Ffa%�G.cr � � lips a� /�
To
IV. ate- Y "-e -c ; ? n)
>AW vw�' r tad` • /r� Awe-; ) tr6 Y 7 N
zq, At Lug..s vr•+,�( G nn i✓
t
4/3U/97

❑Division of Soil and Water Conservation 0 0ther Agency
Division of Water Quality
for Routine 0 Complaint 0 Follow-up of DNV2 ins fiction 0 Follo-A-up of DSWC review 0 Other
Date of Inspection A a Z
Facility Number 3 Time of Inspection 24 hr. (hh:mm)
13 Registered 13 Certified 13 Applied for Permit [3 Permitted 10 Not O =rational Date Last Operated:
Farm Nam e:....... E.I.S5....... ..,..F0. C. .. ..... County:.....,. ft.n............................................................
OwnerName:.......... krx.l..........�.1�1 ac!l........................................................................ Phone No:...��ts7� �".��......,........................................
Facility Contact I Title: ........ ¢.lWlttW. ........................ .. Phone No:..(i.le�:r"`i.� `.3�,1.1...........
Mailing Address:.... 7: :2.......Cas&y... L4............. l.c ... ..?$ l` .........
Onsite Representative: ......s.l:isrri...... ! 6js.�........................................................... Integrator: ....... jc�.Ylrojl ........
Certified O eratorc......s.,�u-xl....tt�-.........td.w.J. !1 ............................ "t� .7
p ....................... Operator Certification Number, ....................
Location of Farm:
Stu :../.....�51._...........W C........................ Qe apt a vi!! c :.....Fig <�.... f..�..... ..... .....o.:.�...,xt pits .....�.t�s .a.....�R..t��� o.0..
1 G....i. ...Y"4•:.............................................. ............................................. ................... ................................... ........... ..................................................................... 7
Latitude �• ®' �" Longitude E�D•
Destgn Current
DesignCurrent °� DesignCurrent',
Somme '. ,,Capactty+' Populafaon ,,"
Poultry
Capacity Populat►on,y Cattle Capacity Populstipn
El Wean to Feeder
y
Dairy
® Feeder to Finish
Z D
I
LI Non -Layer
I
�
1
❑ Non-Dairy
A
❑ Farrow to Wean
i:T
.
❑ Farrow to Feeder
Other
:s .�
, :. a y :' `-
❑ Farrow to Finish
a Total Desiin Capacity,
❑ Gilts''
N'
K
oars
❑ Boars
y
1 oV
NU"M' ber of Lagoons/Holding Ponds
JE1 Subsurface Drains Present ❑ Lagoon Area
ID Spray Field Area
yaS
"
❑ No Liquid Waste Management System
'.
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JP No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? N ,4
.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 JQNo
5. Does any part of the waste management system (other than lagoonslholding ponds) require ❑ Yes 19 No'
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 10 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (�LNo
7/25/97 Continued on hack

Facility Number: 3t — q
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La2oons,lfold in!Ponds. I'_lush Pits, etc.!
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes IgNo
❑ Yes W No
Structure 5 Structure 6
Identifier:
Freeboard (ft): .5
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 ('g No
12. Do any of the structures need maintenance/improvement? (f Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 10 No
Waste Annlication
14. Is there physical evidence of over application? ❑ Yes KNo
(If in excess of WMP`, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... 4A......................................................1�} .1...................... .................,.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [9No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes RNo
18. Does the receiving crop need improvement? ❑ Yes ® No
19. Is there a lack of available waste application equipment? ❑ Yes No
20, Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ERNo
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes RNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes W No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes EN No
No.violitions,or' deficieiede"s.were noted durifig' this visit.- Xou.wi11 receive 'no •further,:
- �. • correspondence about this:visit :.. : � � . � . ... - . . : .... . .
•, 'a- .., L -- .. ... vSY';.R ,' tYkEt ..'6� 'E, Y `. 3
Comments (te er;. o,question #) Explain any Y S answers and/or any rreco nations r'any nEher car rents
Usediatwings,ofIactltty,to laetter;explarn situations"use ad�rhonal pages as necessary)
£f'
;
�Y±'','3.�4 �T. d,9 .4.: .i $' c-x 3"irr 5.if R :'. �F:. "':E:v,. .a A''' 4
x - l O.re0.S e,, layor- t},14, Lill"( 1 sl„nuld tie rice t , Ov�W rar,il sVouj he mathJ ,Ir
•
Zz. ��uy a ►�, �1�. &J eOu iw - ��c� ica�ir:,5 sha�IJ b¢ �R u tJa� ��a�e.
•
waS�[. saw-Q�. �r ru,}c� s�c✓v{ evlru�C.
' I ,
7/25/97 .
Reviewerl�InspectorNaine vx Y1Ckjy� { �I1a )..
Reviewer/Inspector Signature: Date:

11
Site Requires Immediate Attention:
Facility No.-�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ��_ , 1995
Time:
Farm No
Mailing
County:
Integrat(
On Site
Physical Address/Location: e r.- , d[a kq & 4) t., y _
■ .. _ ry a .� � ..
Type of Operation: Swine ✓ PoultryCattle
Design Capacity: / �J �tsZ Number of Animals on Site: t Y Y
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:''°,617 ' 37 Longitude: �. * c.Tb' 3 " Elevation:, Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)6or No Actual Freeboard: _�( Ft. Inches
Was any seepage observed from the lagoon(s)? Yes ore)Was any erosion observed? Yes 06
Is adequate land available for spray? 6 or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: a r-tn._
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(5e or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USES Blue Line Stream? Yes orGtT
Is animal waste land applied or spray irrigated Within 25 Feet of a USGS Map Blue Line? Yes or6
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure; land applied,
spray irrigated on specific acreage with covencrop)? Yes or No
Additional Comments: ;Z
ame
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.