310516_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

It ype or vrsit: v I-ompuance inspection v operation rcevIew l.J structure Evaluation V i ecnmcal ,assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 5iKEFifl County: Region: W j
Farm Name: J GtM i t Dta j 1 Q'-, Owner Email:
Owner Name: V ���ts
I Phone:
,,
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
n
Current
Design
Current
Swine Capacity Pop.
m-aEaci
Wet Poulty
Pop.
Cattle
capacity
p.
PoIN
Wean to Finish
Layer
I
I Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
U . I!oult
Ca acl
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113cef Brood Cow
Turke s
Other
Turkey Poults
OtherI
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of 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 Q'll�o ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
[—]Yes
[:]No
❑ NA
❑ NE
[:]Yes
[E;-Kb
❑ NA
❑ NE
❑ Yes
1940
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

'v
Facility Number: -J, Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-Ko
❑ 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
8<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation Poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[JDlo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
QAo
❑ 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 g,<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z>o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes to ❑ 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-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q�No
NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
❑ _No
❑ NA
❑ NE'
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have'the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FtlKo
[] NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q "'o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 05�Pdo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ejble- ❑ 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 � ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 9—K' ❑ 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 ❑-blo ❑ 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/inspector Name:
Reviewerllnspector Signature:
Page 3of3
94110/ ❑NA ❑NE
E?<1'
❑ NA
❑ NE
EDAb
❑ NA
❑ NE
to
❑ NA
❑ NE
Phone: �'1 b 7414 Z3 N
Date: al
21412015

Type of Visit: Qvtompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
10
Reason for Visit: ORoutine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: �� Departure Time: County: / Region 6J l
Farm Name: r-- �� ✓1,Le- Q�cXA ,� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone: r
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet f'uultry Capacity P.
Wean to Finish Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder D , I;oultr. Ca aci P.o
Farrow to Finish Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turke s
Other Turke 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?
❑ Yes No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes tNo ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No
❑ Yes VNo
No
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storagg, capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes f'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes O 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 [2'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 E 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 e12-No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 12'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 PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff 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 E�rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ea/No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2,No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _[2-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 Z'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 7- Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes d 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 E'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PJNo ❑ 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 12rNo ❑ NA ❑ NE
D Yes ,f No ❑ NA ❑ NE
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑'No
❑ Yes [;3'No
❑ Yes 5yNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: (; lnplianee Inspection 0 Operation Review Q Structure Evaluation O 'Technical Assistance
Reason for Visit: 946utine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: UZ=2 Departure Time:County:
Farm Name: rn�roii/ r�,-Z Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ✓� zl—a /
Certified Operator:
Title:
Phone:
Phone:
Integrator: MA
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current
Design
C*urrent
Design Cur -rent
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
2--4CO
Dairy Heifer
Farrow to Wean
Design
C**urrent
Dry Cow
Farrow to Feeder
Dr, P■onitr,
C*_a acit
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes [�o ❑NA ❑NE
❑ Yes ❑'No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
LNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (galloiis)? r .
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
�5No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the,, aters
❑Yes
E(No
❑ NA
❑ NE
of the State other than from a discharge? 1r
Page 7 of 3 21412015 Continued

Facilit Number: - Date of Inspection:ZA
Waste Collection & Treatment
41. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes J'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T ]eNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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(,EI"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 ,,Eallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J[D 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?
'J�o
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes '❑'14o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes AD' -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-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes -M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes -E:r—No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ YesQ-No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E-No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _ED-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes E ' o
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ NQ
[] NA
[3 NE
El Waste Application ❑ Weekly Freeboard El 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?
❑Yeso
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E3-Ne ❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: ZCi
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 oNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;],No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ETNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑" No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ENo ❑ 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 CZNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o ❑ NA ❑ NE
Comment's (refer to question #),: E`xplainariy YES )er'sa�nd/oriany additional recommendations or any other comments.
Use drawines of facility to bett_erexplaiiisituai a#ntuse,,addtiona[.'pages.as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �&
W I
Date: 11 1-d
/4/2 15

i ype of visit: Av t;ompuance inspection lJ tlperatlon ttevlew u 6tructure tvaluatlon U t ethnical Assistance
Reason for Visit: �Pkoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: i 1b Arrival Time: eparture Time: County: Region:
Farm Name: r t (� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
tle Capacity Pop.
Wean to Finish
O i
11
I
ILayer
Dairy Cow
Wean to Feeder
INon-Layer
I
EEJ
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Fsign
Current
D Cow
Farrow to Feeder
Dr. P,oultr,
aei
pop.
Non -Dairy
Farrow to Finish
ILavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t7ther
Turkey Poults
­7m
Other
Other1
1
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 [2No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes J' No
[]Yes No
[:]Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 3 - Date of Inspection:
ti
W:t'ste Collection &"Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ 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 ;3TNo ❑ 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? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �io ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes J:�PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes; check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [,—],No
❑ Yes ❑"No
❑ Yes � No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes �allo ❑ NA ❑ NE
❑ Yes C;rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ;jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - 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 [Z 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 JZ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C2f No ❑ NA ❑ NE
❑ Yes V' No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes P"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes d No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [] Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments; refer to ' ue.:stlori,#) ; Ex' lam,an``°tYES�ariswersaridlnr�agydditinnaCi,recorifrieridations'o 'ny otliei""corirtiiients,5$
'e,:;,t,�e��?�ax�.a , p.,..,.:.+['1$...
Use' drawings:of facility£td,better explain situations (use _add�tlonalpages, ash necessary); t. i t (; � .k
7/.
Yf1.3 f. tr7
Reviewer/Inspector Name:
f�vrM 0- `' Cjr-CA 10ate 00�aa!
Reviewer/Inspector Signature: �—�� '-4/
Page 3 of 3
Phone: /Id 7,fe r�.2
Date:
/4/2 14

Type of Visit: PAMmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Kouline 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �.yfy�l p ,�� r ,ram Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: AL � Integrator: />
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. @attic
Design
Capacity
Current
Pop.
Wean to Finish
ILayer
Dai Cow
Wean to Feeder
[Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
1DrvCow
Farrow to Feeder
Dt. P,uult , Ca acity l;o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ke s
er ke Poults
er tOuther
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[:]Yes �allo ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El Yes 5/No ❑ NA ❑ NE
Page I of 3 214120.11 Continued

Facility Number: Date of Inspection:
Waste COIlLction & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �2r No
a. if yes, is waste level into the structural freeboard? ❑ Yes G5`N0
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): -7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
0 Yes :rNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
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
[214o
❑ NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Wo
❑ 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
2fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
Wo
❑ 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
[Er'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
jo
17. Does the facility lack adequate acreage for land application?
❑ Yes
C2,*No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the *acility fail to calibrate waste application equipment as required by the permit. [] Yes [2114o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
- 28. Did the facility fail to property 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes PNo
❑ Yes � o
❑ Yes PNo
❑ Yes y No
❑ Yes ZNo
❑ Yes ff No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
-- - /V r< L
'eG
I aQ
�- �l�Vj't �- d��
�al�f3 [ram �J
Reviewerllnspector Name:
Reviewer/Inspector Signature: L
Page 3 of 3
Phone'?W Z? C 7 It/
Date: l�
214.12011

Type of Visit: Q Coltipliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: PILQ2 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:3�
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
WeMul-Gapaci tyPop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
INon-Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
Dry P,oultr,. Ca aci P■v Non-Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes VN,0
0 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4 'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
Structure a Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: LAr; j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fNo ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
134❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
gNo
❑ 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
❑ NA
N�Zo
❑ 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 o ❑ NA ❑ NE
❑ Waste Application [:1 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 �N ❑ 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 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
[�No
' ❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other lssues
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.
❑ Yes [/No
❑ Yes /No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. 0 Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
0
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any -additional recommendations or any other comments. I
Use drawinns of facilitv to better explain situations (use additional naves as, necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I t A (YJ,074,
FA G . W. Date:
21412
!r

(Type of Visit: Q ZRoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: l Arrival Timer Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
OnsiteRepresentative: PA4-r(2=_ FuSS�_-[,L Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current it
Design
Current
Design C*urrent
am
Swine Capacity Pop.. i'� "
; 'l
Wet�Poultry
C►'apacity
Pop.
Cattle Capacity pop.
Wean to Finish
i92D
er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr..Ca
aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Puults
Other
,a
EL
I Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: 31 - .51 P—i jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ 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: t,hGvQtj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
dNo
[] 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes yp o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Yo
❑ NA
❑ NE
Required Records & Documents
,,�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ es E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
es ❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 'ZNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection.-
2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25!ls the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F3/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 ONo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes &No
❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 E�/No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes e� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes dYNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer;to question ft Explain any YES 'answers andlor:any additional recommendations or any other comments 5 `�
Use drawin s ofifaeili to better=ex laipisituations use additional a es as.necessa g tY' ( p ry)
�PDr6P 009,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — 0
Date: /� 1,
2/4/202I

q" 4`
aFagk Number1.3
vision of Water Quality.
Division of Soil and Watcr Conservation
(.:Other. Agency
Type of Visit ✓Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit.,611outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: - Departure Time: County:
�-
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Swine
❑ Wean to Fi
❑ Wean to Fe
Mn__a__._ r.
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:�l/&-
Latitude: = = Longitude: = e =, = 1
1
Design Current .
Capacity Population' , Wet Poultry
Design Current
Capacity Population'; Cattle'..:;
❑ La ers
vision of Water Quality.
Division of Soil and Watcr Conservation
(.:Other. Agency
Type of Visit ✓Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit.,611outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: - Departure Time: County:
�-
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Swine
❑ Wean to Fi
❑ Wean to Fe
Mn__a__._ r.
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:�l/&-
Latitude: = = Longitude: = e =, = 1
1
Design Current .
Capacity Population' , Wet Poultry
Design Current
Capacity Population'; Cattle'..:;
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
L,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
.12128104 Continued

li
Facility Nu ber: — G Date of Inspection
r i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 101
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
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):
Reviewer/Inspector Name l t yj - -_. - Phone:
Reviewer/Inspector Signature: Date: / C6
Page 2 of 3 12MI04 Continued

Facilt Number: 1 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. ❑ WCP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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?
ayes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
)z 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
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
sj 60 11 bl-a � I C vus S t VA15
dLd-
ai, ,S ego✓' G�• eG 5 S
Page 3 of 3 12128104

Mr_llw
Type of Visit Compliance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 US Arrival Time: /0 Q Departure Time: County: 0414 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
u Onsite Representative: ANUDC � n AIL
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Design Current
Swine Capacity Population
Wean to Finish 3d
e �
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other 111
Latitude: = 0 = = Longitude: = ° = 6 =
Design Current
Wet Poultry Capacity Population.
❑ Layer
❑ Non -Layer
Dry Poultry
Tu
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle. Capacity Population
ElDai Cow
El Dairy Calf
El Dairy Heifei
ElD Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
a
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 LI No ❑ NA ❑ NE
❑ Yes
a
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(o
El NA
El NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -- 7
Date of Inspection I oS
Waste Collection & Treatment
�
4• Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L'] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: I-A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
[]NA El 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
El Yes
,,__,..,,//
LdNa ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) ma_(' CT 5 C b
13. Soil type(s) r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZ'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0Yes
No
❑�O_
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination, ❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L] No
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L
❑ NA
❑ NE
WCrCl- 9 CON r(LOL. C_t-EA W TRPE S id Figt4_ "C_Q6YJ
a j, 2A�J�Aw AiJ� I''zoft C eE
Reviewer/Inspector Name x l ,w ,fit, Phone: r1'10 7
Reviewer/Inspector Signature: Date: 1, l
12128104 Continued

Facility Number: — Date of Inspection S 1
Rdguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes hZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑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 nalysis El Waste Transfers ❑ Annual Certification
24Rainfall El Stocking El 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 C No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No fN
A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No
[I NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes El No ❑ NE
26, Did the facility fail to have an actively certified operator in charge? ❑ Yes LI No ❑ A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ No ,NA ❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
21 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?
❑ Ye.s
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L✓J Nc
❑ NA
[INE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit QoGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit
O Complaint O Follow up O Emergency
t Date of Visit:
Facility Number 3/
errnitted Certified Q Conditionally Certified © Registered
Farm Nome: .. Q�l ll�w ..a`. ._4�..�......`�%.! 1....................._
OwnerName: ...........»................ ».................... ... .......... _......... ....... ........ _....... ..._..............
MailingAddress:.................»........................................_._._..»_.......»._.......»....._........_
Fac*i►ty Contact; ....................................... __.... ... Title:.._............_. ,
OnsiteRepresentative:.. _ .................................. _..._ ..
CertifiedOperator:....................... ................... ......_...»._.» .._.._ »».»..... . _......... .
Location of Farm:
O Other ❑ Denied Access
Tune:
Date Last OperategLor Above Threshold: ..... ..........
_ »»..
County:
Phone No: -----
I .......... Phone No: .__.»._.....»_ ___ ._ .......
Integrator: _..�..(,,a » .........
Operator Certification
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 499 Longitude Oe Q4 0"
Discharees & Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes 0'&o
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 ,BNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ofio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesJ21<o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...»...._._t/. .... ...».. ----». .. » .....».».. _._ »..... .......».................... .... _. ..__... ......».» ..... . ».»...
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures obs ed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ YeS-0110
❑ Yes,,�0
❑ Yes 930&0
❑ YeI I.— "o
❑ Yes ,G{-?
❑ Yes j!!fNo
❑ Yes/,2'No
❑ Yes _P-Ido
❑ Yes Pm
❑ Yes 'EM
❑ Yes ,2 No
❑ Yes -43No
❑ Yes 0 I'90
❑ Yes Nip
❑ Yes ��No
❑ Yes ZrNi"o
❑ Yes "ZKo
rCo..F.K... ""s .SI:. her} �.�. .i'.',!ikl�.' "�',"I "•U.s:t" d'�'�,iy"i�4oiF [«iSll!'YIRiF3'1 'FF i:L- iSi'®9.x: W.9��' ,'k'+fc; z �.....A.
mnasrlts{rerNto�quroin #) ;Tiam sny YES:aiswers!and/or,y'ranmmendabo or,any otler.comiacnts�ii1
„t,€..,ua;a,si d 'alil.9 trt" 1'!:'+ �.tl§.=',fi4.'?6€7E683$14 a'<•�s�!f:iilil3. ' ' '9�d9,e c §-4»dFuri'aiiidl�i tsss;G+!i¢Yurgib. �E! r�tk 4 .�.�:... C
Use drars;afcility to lbetter exglsun s�buations,(use addinal pages as aesgaryl r. ❑Field Copy ❑Final Notes;
k aoie rrs i ii jEi ti h s t;�a ;'k . - ';'r,' —s° f
t€ g p.t d gE` aiP �!°� Ji; >i't;i ?:1:3,! > I s< _!<3;
1,E.d �Si;x d€i .�3, 6i.t�i€R@i£ �d . a,l. ¢�.,�r.�. ., :..�i� ? ,, ��nu is u }: � h��LtF�, 9��a �? �s E�� dFr@E3Et E�Su is
Cc, n4l av, -etR'__0r 4-�s 4r) -e- m nc,�e-
f'br, s fle)js,
Ipecorjs Y)eC A- d1 Qrdkrl ,
Hv
Reviewer r Name �� �_ F �r ii'= n, ',
.eF'3 iw
Reviewer/lnspector Signature: Date:
lwicrva 6.v+��sYrr

Facility Number. Date of Inspection
Regbired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
10140
Does
23. record keeping need improvement? If yes, check the appropriate box below.
�es 0 No
Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes IETNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes Z No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes F,0'
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
.o
❑ Yes a
28. Does facility require a follow-up visit by same agency?
❑ Yes ZKo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes P4Ko
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
❑ Yes
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number
Date or visit: � Time: l 9 ;__1
3i T
rO Not O erational D Below 'Threshold
® Permitted ® Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ,,,.. TAth", 04, / Fdem County: Add
Owner Name: .- T&MiL 1 104,1 Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 0AA/ e./
Certified Operator:
Location of Farm:
Phone No:
Integrator: jou
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �6 0 « Longitude 0' ° 0 µ
r Design Cur ent v Design - • Current':.besign Current
S,wme Ca aci P,o ulation P;oultr.. Ca aci - : P,v ulatlon �Qattle, . Ca "aci P.n ulation
❑ Wean to Feeder ❑ Layer ❑ Dai
® Feeder to Finish 26DO ❑ Non -Layer ❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
r
❑ Farrow to Finish Total Design Capacity
❑ Gilts � �
❑ Boars ToAN
tal SSLW
Number of Lagoons © ❑ Subsurface Drains Present ❑ La ooa Area ❑ Spray Field Area
Holding Ponds l Solid Traps ❑ No Liquid Waste Management S stem
Discharges & tream ]mnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches):
2 !'l
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes N No
Structure 6
Continued

Facility Number: — , j Date of Inspection 3 Z
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 C&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 ® No 1
12. Crop type Z;P1*lL4,L r�UZl� .�;W,1f'L111Xln a*'A"l )G[ue elt4rte svanapV A4.0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 59 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ERNo
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes W No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ®No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
� Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
K.No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to questlan #) lfitplainiatty YES answers.andlar any reeammend$ttidnii or any Ether comments.:
Use drawings facility to,6etter additional
of explhln gttuhtlOhs. (use a es asriiecessar
p g Y) ❑ Field Copy ❑ Final Notes
/
-#/g " 41IN!' AI.CS ovo IEvs� rbj�e- .�f 44 W heeA J;-,e /A J� ��A�/1 r-P 4e. /�ll�lfil�[, r►� �tu?y
w;41 r*e oleurA 11c .ell mimeo,
ArtA e- boa rl /e cords -/a rh 6, ov& brt,
,tee sii / ssi e�0/a rem %fF Z- t O d 1. %, o? k PAO -A,�Ay 1041W ":$p/n
Reviewer/Inspector Name I e�;�{� r
Reviewer/Inspector Signature: Date: 3 Z
05103101 Continued

Facility Number: 21 —=a I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes [Z No
❑ Yes No
❑ Yes No
❑ Yes F] No
❑ Yes �9 No
❑ Yes ® No
❑ Yes No
Additional Comments and/or Drawings:
�D 7tn,�Gn 6 aft ea/l,'e r h6it r� `rT17 Pjve ,
4MLAI d 004,7. Va e fe#&7 Very d los a 76 fie /91'4%9.` . 7AL-
JG w.t� low/'
T�Gr`i<1�y Jte�eA -epe GSSST, 1 o 76(s'f' z e,,el ear he-
_,jv
�jRi/�7�c1%1 +e-' iK T�td Agee -
- 3v7,1 samole- lime, 4 .teldd ;,% 41W o v►- ��, a�-
A, t
ffieb) 1 40 W/o/es 0/1 6y 6lWe i471- 'Jeer h 1.e- -91At ,
6'11O6boi, �44 6,5 Ad dew ele u-Ae,( iy l r rc% ae �0awi44P
gxPeclir Am hT 4Vt-.
05103101

#� Q Division of Soil and' -Water` Conservation Operation Review '
1 , r .,
Q'Division of Soil and Water=ConservatlOn Compliance bis tlon',"I,.`a,
p, 3 Dlvlsio[1 Of Water Quialaty COm Nance iii art 1 !' r 3 ;4i I
p pectloti tt, E s! , i
j1IOt]fAerAgenet';-i0perati6nRCVi w�`€.' �!�€1� �I i 'r��€€t.�..,i 3�f� �gAr�4�Yi r � €
0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review a Other
Facility Number Date of Inspection
Time of Inspectloll / 24 hr. (hh:mm)
I] Permitted [3 Certified [] Conditionally Certified [3 Registered JE3 Not Operational Date Last Operated:
FarmName: ........i 1i].......1 {.................................................. County:............ �1.n......................... .......................
OwnerName....... mj..fe ...� . Phone No:....................................................................
Facility Contact:.............................................................................. Title:.......................... Phone No:
MailingAddress: ...........................................................................
OnsiteRepresentative: ........................................................................................................... Integrator: ....... .Li..f.iF.j...........................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Nulcaber:..........................................
Location of Farm:
Latitude ' ' •` Longitude ' 4 46
Design
Current Design Ctirrent Design Cilrrent, t ;
Swine Capacity
Po ulation, ! I?oult tT �: Capacity...iPo 'illation`: Cattle Ca acity _ Po 'ulation I'
❑ Wean to Feeder
JE1 Layer
I
Dairy
❑ Feeder to Finish
IF-] Non -Layer
°'t`
❑Non -Dairy
❑ Farrow to Wean
; • , , :,, : ,::.,,
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
,.❑Gilts)
.. � � � E`• ...
❑Boars
Total SSLW
�r
it
1Vutnber of Lagoons
0:
❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Area
Holdin €Ponds3/ Solid Traps
€ ;
Y
❑ No Liquid Waste Management System i.
Discharges & Stream Ilna
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon [I 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. li' discharge is observed, what is the estimated flow in gal/tnin'?
d. Does discharge bypass a lagoon system? (If yes, notil'y 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
Structurc 1 Structure 2 Structure 3 Structure 4 Structure 5 Str ture h
Identifier:
14.
Freeboard(inches): ...................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

C:.
Facility Number: — Date of Inspection
�-
6. Are th6rc structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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 ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reuuircd 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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 yi9laiipris'or deficiencies re �Qted dirrir►g this:v..... it :wii� ee lye o• fufth�
CO'orrespondence. abouf this visit
9i���� 1�j /a�a� u�il l�" o-F�%�r�a�d �s ryr� Please
r1o�i�t �1�7Q anew /i � /fie/ is � l9 `o-F �ree a�.
Reviewer/Inspector Naide Z
Reviewer/Inspector Signature: _I A4 MW Date:
%/`1 2 T5 3��� iz
e) (1)w0-) 3/23/99

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1 V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Lagoon Dike Inspection Report
Names of Inspectors
L7 Freeboard, Feet
e- e C c k- Top Width, Feet
j 7 lr
04 1f
Downstream Slope, xH:IV __
Yes No
Yes No _1V 6'_^ e �. �Tx C t,�t
Yes No
V ( ,-V noc' r, I i r),I c,_ A 01kP_.
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes No ' d Uv
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
�� c Qrn n, f
Other Co ents Al
�� i ffC � � � � 7`
6y
eQe-;
C
we,
C

C/-1-15
!
f • - - , , °`: ia4•; w fir' " ?'•:rr:. , rx -• .i�M�.

a-
f Divisian'of Water Quality
t ', A Division of Soil and Water Conservation
! s
f t 1 1 i
,i ° � OtherAgency
!
t 3 F 1
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: Time: CJd Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Conditional) Certified Registered Permitted [� Certified y ❑ g Date Last Operated or Above Threshold: .........................
Farm Name: J G1r~Ti� .5.L��J.... ..... County 1..1.!'�..................................................
t
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact: ............................ .................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: , tom+ ' Integrator..............I.............................
........................................................................... g ......
Certified Operator: ... Operator Certification Number:.,,,,,,,,,,
Location 'of Farm:
[] Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' t 69 Longitude �• �t 64
Design ' Current Design Current DesignCud
�?.....
Rocky, PPoultry Cattle -:Ca c..Po illaton Ca aci Pa ulation C
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish U 0 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total skw
�µNgm�er of Lagoains R ❑ Subsurface Drains Present ❑ Lagn Area ❑Spray Feld Area
YI ti:
',�s�F�#e►i� htling,Pontls / 5olfd Traps). ❑ No Liquid Waste Management System
Discharges & Stream Imi2acts
1. Is any discharge observed from any part of the operation? ❑ Yes k�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. li'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 VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes I�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
SuYucture l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...............................................................................................................................................
Freeboard (inches): y
5/00 Continued on back

Facility Number: 3 — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to Elie integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O(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 RINo
(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
S. Does any part of the waste management system other than waste structures require maintenance/improvement? KYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes NrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic verload ❑ Yes 9No
12. Crop type o� �..s tr-arZl-_ Q s Q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
'] Yes
P! No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
f(No
b) Does the facility need a wettable acre determination?
❑ Yes
WNo
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15, Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
I�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(fe/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
MYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes gNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 1�(No
24, Does facility require a follow-up visit by same agency? ❑ Yes J4No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
1ci yiQla[tQ�js;oi' d��ciencie rr re potecl ditritig 0Kvisit; • Yoil wilI-te0iye tio: fuartl��r ; ;
'corres• oridehc' e: about: this visit: .
I,- $, � � .�i ' �R•PE 1Op,fie�oquesor
X 1�+ti# Ex Iai
) p n-any YE5 answers and/or any,irecomtnendations nr any ak�ercutmments'; ?+ tt�w.-
t F Iif I¢f r 7I ��,3. c -I.p�i&..�rtb"f���"se drawings of facilityito better explain s'theahons (use addztl6nal pages as necessary) !�,$t 'tom i
'Q [.
T[ a
s't�- � 1-�.�e�l ►-..e e� �► Abe ���c��-.e� <<��t -.�i_ � �
ReeA, �V rt

I AN
eaciIity Number: 31 — Date of inspection Q Q'
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. Arc there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes #No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes #No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1KNo
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes ,O No
Additional Comments an or rawtngs: t7(?l'."r+_'.':.,". u[.`'. ' ._ .. ,
$,)
l �)
ICO
r,
�Z � � v c�v� +-�c�-�.r `tom e • t (
1 v�� L 1 C \
�J

i - Di'Visidn of Writer Quality
O;Division of Spit andzWater..Conser`vation.:'
Other Agency ;, k t: A
Type of Visit /kCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date uF Visit: 4t� 7 fine: Printed on: 7/21/2000
Facility Number� S'1(o
NNot Operational Q Below Threshold
*P—ermitted Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
r .7
FarmNume: .......Jo`...:..5...... ........ .. ....:.......h'YJ..r........................................ County:.....D�r..............................................................
�...i
OwnerName:........... ......`".................................................................................... Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................... , Phone No:
Mailing Address:
Onsite Representative: G Er {'� IJr r ... Integrator:.......... A/1.1.....................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° 4; Longitude • 9 <<
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ W n to Feeder JE1 Layer ❑ Dairy
,EgZeeder to Finish Zcg ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lag•+am Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ 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 nian-made''
h. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. II' discharge is observed. what is the CStin1H1Cd (low in gal/nun?
d. Does discharge bypass a lagoon system? (If yes, notify DW'Q)
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
String ire I Structure: 2 Structure ; Struclure 4 Structure 5
Identifier: ......... ...... ....................................................... ......... .............................
Freeboard (inches):
5100
❑ Yes KNO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes %No
❑ Yes 'J No
Structure 6 f
Continued on back

)Facility Number: 3 — Date of. Inspection �- 1 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 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If an❑Yes �"o
y of questions 4-G 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 $CNo
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 III
elevation markings? ❑ Yes o
Waste Application ((((
10. Are there any buffers that need main ten ancelimprovement? ❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 7No
12. Crop type CS l', ✓c (C-,_c'2e 5^.4 & L svo .-7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes o
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes o
16. Is there a lack of adequate waste application equipment? ❑ Yes o
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, [naps, 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?
Rio • . iolaiidtjs4- defleie dL- •mere ingted. cutting 4his;visit; - Yoit W, •reeeiye do further
correspondence. aboi f thi.s 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):
❑ Yes YNo
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes o
.'9
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: AL 0— -0 5100

Facility Number: 'J -s Date of Inspection --Uri 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 helow [:]Yes KNO
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 ro
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yeso
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 KNO
31. Do the animals feed storage bins fail to have appropriate cover? ElYes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments and/orDrawings:
f
T
5100

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Lagoon Dike Inspection Report
Names of Inspectors
(A clk
Freeboard, Feet f
l
S @ r- Top Width, Feet v
� ' 1 Downstream Slope, x1L1V q
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No _�-_r 1 ^ e ��_ �T� C
(Check One, Describe if Yes) - t
Erosion? Yes No
(Check One, Describe if Yes)
Condition of a j, r L� �1 e—
Vegetative Cover
(Grass, Trees) -
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Fallow -Up Inspection Needed? Yes �( No
Engineering Study Needed? Yes No 1 ec1- kN A,
g g C
Is Dam Jurisdictional to the Da,fm� Safety Law/of] 1967? j Yesj No
Other Co ents �J i ! i' trC C 1 !� ��C !' Q n
/ llArPrSt?_•P�1Aa�'r+rNS

a
,ZIA

of Sml and Water Conservation ❑Other Agency
Lp�&V,F�IDivision
DIV►SIOn of Water Quality
a<
of DS W C review
Facility Number 3 I I Date of Inspection 2a
Time of Inspection 24 hr. (hh:mm)
E3 Registered 0 Certified E3 Applied for Permit E3 Permitted [3 Not Operational Date Last Operated:
ni.. County:.....i!.4.��.;^.............................................................
Farm Name: ............... tiin.:.`........ \.......rb..........................................................
s Z...................................................... Phone No:......?. d..
Owner Name: .....................�»!-ti:�n....4........ � .�(.�..,:Z.....�._ll,�l............................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ......�&.Z.1........ 5... k.....HV.4....50......................................................... W.U(rUe..t.... ucC........................................ .z..Iq &........
Onsite Representative: ........ _4hwi.L.......... NAi�............................................................. Integrator: ......... MLOr..pint.........................................................
Certified Operator; ..................................................
Location of Farm:
Operator Certification Number :.........................................
Latitude 0'0' 0" Longitude 0• =' =11
Deis►gn �, Current
" '
Design Current '
Design 'Carrent
Swme Capacity Population
r,. ..,
Poultry
Capacity Population Cattle.
Capacity Population
❑ Wean to Feeder
�` ❑Layer
❑ Dairy
Feeder to Finish ZoZ
❑ Non -Layer
I I JEI Non-D iryl
I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
t ❑ Boars
-.. Total SSLW `
Number of Lagoons'FHoldmg Ponds
❑Subsurface
Drains Present
❑Lagoon Area
10Spray Field Area
❑ No Liquid Waste Management System
� �a�:,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. 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 Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flow in gal/min? N _
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ®No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 19 No
Structures (Lagoons.11olding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes b No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(tt): ............:L..................................................................................................................................................................................................
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
C%No
12.
Do any of the structures need maintenance/improvement?
M 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
No
Waste Anntication
14.
Is there physical evidence of over application?
❑ Yes
LP No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type r►nul w..,....... S1i I14,t....�1.. .. (,qrA... slew,. ... FSrr U.U...................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
(N)Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[3 No
18.
Does the receiving crop need improvement?
® Yes
[FNo
19.
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
0 Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
M 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
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0" No:violations•or. deficiencies.were noted•dt.rring this, visit., You,4411 �eceiveno•further,
correspondence about this.visit. .
fZ_ co ,roue. QUA-) dry L&-t Nt", Iayown. d t kc Lao & lkotAj toe yKowed •-
..►�e� �cskrl ►� Wva.
U. oov��lts:g,, fi u��a i,yg,1c. sar (� s{r�ul� loe. ;� h riermlS. IU�t��" tbwU�� loc c�Jc�
40
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 15e_ f / 1L- Date:

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number (,
Farm Status: Registered ❑ Applied for Permit
Certified ❑ Permitted
Date of Inspection I IIVg7
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex: L25 for 1 hr 15 min)) Spent on Review �-
)r Inspection (includes travel and nrocessinv)
❑ N\ot- Operational Date Last Operated :..............................._._......... ..... .................................... ......... ........ ..............................................
FarmName: .........-? i�:W.....1�.a�. ....... 4�^................................................... County:...... �3h,...................... .................. ......................
Land Owner Name:....... lhri1 ....... ........................................................... Phone No- Ll!a...»............
Facility Conctact:..... !.4:........ a.l................................... Title: ......... .......... .......
r.............. ... Phone No:. No) ........ .QQ..............
MailingAddress:....... Z.3.... ...(fit...SD.......................................................................f..... .. .......... ........... f.�3.74 .........................
OnsiteRepresentative: .....�.4,�'a .i r................................................................... Integrator............................................................
Certified Operator: ........�Ali4>;gr....... Gli. �.............................................................. Operator Certification Number:... jhn ............. ..... ....
Location of Farm:
Latitude �•�' ©" Longitude ©• ®• ®"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
2. Is any discharge observed from any part of the operation? ❑ Yes 14No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 1)0 No
c. If discharge is observed, what is the estimated flow in gal/min? NA
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes P9 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
4. Were there any adverse impacts to the waters of the State other than ffcnr a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
4/30/97 Continued an back

Facility Number:. .�.......—..�1�...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
`M No
Struct ues (Lagoons -And/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.. . ........... ............................ ............................ ............................ ............................
I—
............................
10. Is seepage observed from any of the structures?
❑ Yes
KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
K No
12. Do any of the structures need maintenance/improvement?
UYes
❑ 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
M No
Wastg Application
14. Is there physical evidence of over application?
❑ Yes
%No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......................... C. o C.n............................................................b. xX=Vl .,1....................... ..............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[[No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
[ LNo
18. Does the receiving crop need improvement?
❑ Yes
Eff No
19. Is there a lack of available waste application equipment?
❑ Yes
ONo
20. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
WNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
24. Does record keeping need improvement?
Yes
❑ No
Con ments`{refer to question' Explain'ariy YES answers andJor,any recommendatrons.or any other continents
Use drawings,of,facility to better explain situatxoris: use. addpa �tionalges as necessary
4
Iz- (,-.a%par, wars S60a 6e fnawe3- Barr Skis s6uW be ft sedeJ. Lj ffWS5 lojor,
`6 ""Wk6 )a,� Q-1tins"an-
Z6 S�ro.,,t f` orc� S'�n ot:1� b- W MOr'4 0 oh kva —It . LOttmse or 11 A-4
%e- t 0."1 U S'Y�s c A jyvArvr& Pl e, Y-6 Sr' lbr,
Reviewer/InspectorName
Reviewer/Inspector Signature: Date:
IIII I 1111 II��PII�I�I 11�1 _-
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

W
N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received by: C�^� Date/Time:
Rnesgency: C'laint: ✓ County: L- P4' —
Report Received Fam:
Agency: Phone No.
Ccupla4nant:
Address: P--hone No. /L/) 095- Y,11V
Complaint or Incident: S - t n�P,G (r- -_v [ _ 7` !c/ � rL e. c-VO-e�
Time and Date Occurred: /0//4 1/ G
Location of Area Affected:
Surface waters Involved: Groundwater Involved: Other: 1
Other Agencies/Sections Notified:
.Investigation Details: vJ)1tW �[ liy� i�`Pj/ e)1L- S�
Investigator: Date:
EPA Region 1V (404)3474M2 Pesticides 733-3556 8mergency Management 733-3867 W"Ve Resources 733-7291
Solid and Hazardous Waste 733-2178 Marine Fisheries 726-7021 Water Supply Snatch 733-2321 U.S. Coast Guard MSO 3434881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] + Fax [phone]
An Equal Opportunity Affirmative Action Employer

Facility Number; 3) - sy�Q
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: /a a 9 4
Time: Q. v 0 /�"�
General Information: ft
Farm Name:TAIY <_ a:1 County: 1; "
Owner Name: J�pm..,,j 1, L • .'SP, Phone No:—S'_a !3 t
On Site Representative:, o 133 Y 346 F Integrator:Ali-eg
Mailing Address: 1/?7_A A;C
Physical Address/Location: _ � } '� _ _ _ ��2 —jq7;& S._ 4. A`
Latitude: 1 1 Longitude:--- 1 I
-Operation Description; (based on design characteristics)
Type of Swine No. of Animals Type of Poultry : No. ufAnimals Type of Cattle No. of Animals
❑ Sow D Layer ❑ Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
&'Z+eeder ✓DYt{
OtherType of Livestock Number of Animals:
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon ,
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes ❑
No �—
Is seepage observed from the lagoon?:
Yes ❑
No Q—
Is erosion observed?:
Yes ❑
No Cdr
Is any discharge observed?
Yes ❑
No Q"
Q Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No CiY
Does the cover crop need improvement?;
Yes ❑
No Gr
( list the crops which need improvement)
Crop type: Acreage:
Setback Criteria
Is a dwelling Iocated within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI -- January 17,1996
Yes Mr No ❑
Yes 5/ No ❑
Yes ❑ No
Yes ❑ No il

I
Maintenance
Does the facility maintenance need improvement? Yes ❑ No GY
Is there evidence of past discharge from any part of the operation? Yes ❑ No U�"
Does record keeping need improvement? N/f}' Yes ❑ No ❑
Did the facility fail to have a copy of the Animal Waste Management PIan on site? IriIA Yes Ct No ❑
i i • is :r.a_.-!.. tom_ %4/��
jam" PO ' T1G`S • ' —ass a:
mm
Signature: LZI,
Date�C3
CC.* Facility As ssment Unit Use Arrachments if Needed
Drawin s or Observations:
AOi — January 17,1996

State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr. Division of Water Quality Jonathan B. Howes
Governor Water Quality Section Secretary
October 28, 1996
, C.Certified-Malt#_P-146.525--273�
Return Receipt RequestL,d
Kenneth L. Dail
Rt. 2, Box 300 E
Wallace, North Carolina 28468
Subject: Jamie Dail Farm
ti Facility Number: 31-516
Duplin County
Dear Mr. Dail:
On October 22, 1996 staff from the Wilmington Regional Office of the Division of Water Quality
inspected your animal operation and the lagoon serving this operation. The purpose of the inspection was
to respond to a complaint received on October 18, 1996 involving the overspraying of wastewater onto an
adjacent property owners residence. Specifically, the complainant stated that drift from the Dail Farm's
spray irrigation system was blowing in the windows of their residence. Mr. Jim Gi-egson of the Wilmington
Regional Office met at the Jamie Dail farm with Clay Carter, the farms service representative from Murphy
Family Farms. Mr. Carter stated that on the afternoon of October 18, 1996, Mr. Dail noticed drift from
the irrigation gun was too close to the property line, after which he throttled the tractor/pump down and
increased the reel speed to pull the gun back from the property line. During the inspection it was observed
that the gun had again been pulled very close to the property line but was not spraying.
USDA-NRCS guidelines require that animal waste be applied in a manner which does not cause drift
from the site during application; that animal waste not be applied closer than 100 feet to wells; that animal
waste not be applied closer than 200 feet of dwellings other than those owned by the landowner; and that
waste shall be applied in a manner not to reach other property and public right-of-ways.
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

Kenneth L. Dail
October 28, 1996
Page 2
It is recommended that you take immediate corrective actions to comply with these guidelines.
To remain a deemed permitted facility, all corrective actions must be made within fourteen (14) days.
Failure to do so may result in the facility losing it's deemed permitted status, requiring a certified waste
management plan and certification form for the facility to be submitted prior to the December 31, 1997
deadline, and being required to obtain an individual non discharge permit for the facility.
Please be aware it is a violation of North Carolina General Statutes to discharge wastewater to the
surface waters of the State without a permit. The Division of Water Quality has the authority to levy a civil
penalty of not more than $10,000 per day per violation.
When the required corrective actions are complete, please notify this office in writing at the address
below. I you have any questions concerning this matter, please call David Holsinger or Jim Gregson at 910-
395-3900.
4
+
P� 146 525 273
US Postal Service
Receipt for Certified Mail
No insurance Coverage Provided.
Do nqt use for lntemational Mail (See revers
:' rr
CertMed Fee
Spedal Delivery Fee
Restricted Delivery Fee
&' Return Receipt Showing to
_ whom & Date Delivered
Return Recut S vAV to Wham,
o� Date. a Addn� Address
II g. TOTAL Posts Fees
j Postmark o
o �O ai
O
0-
' `�
Sincerely,
Rick Shiver
Regional Supervisor
DER:-� II
• CA rAPIe]e Itame 1 and/or 2 for additional earvices. I also wish to receive the } m + ■Complete items 3, 4a, and 4b. following SBN1Ces (for 8n
■ Print your name and address on the reverse of this form so that we can return this
card to you. A. extra fee):
■Attach this form to the frarit of the mallpiece, or on the back it space does not permit. t , ❑ Addressee's Address
V • WnRetum RBcG1 f R ar p aqueato on the a artlde below the darlicJsand number. Q, ❑Restricted Delivery
� •7he Return Receipt will show to whom the snide was delivered and the data
C delivered.
o Consult postmaster for tee.
a 3. A ' le Addressed to: ,i..,_,_ .....__..
Sr2s-�.
o wu. aerwae i ype
❑Registered Certifier
' ❑ Express Mail ❑ Insured
❑ Return Receipt for Mardiandise ❑ COD
7. Date of Dellve
5. Received By: (Print Name) S. Address 's Address ( Iy rl r esiid
and lee is paid)
Ig a re: (Addre a Or t
�• X
P5 81 i, Dec mbar 19 4 i7nmacfir Rntr „y, Qe,.,,:..

P,� ',•J '1�'�' PL�B.S'
�6 8 77_____._...______________
I AON
11Lr Tu I

•
•
Site Requires Immediate Attention: Ab
Facility No. - l
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERAnI N SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address: G -11GL J C/ r_4,CN_
County: % 1) 1-1 A
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location: S42-0Y"/71-1
2- 7 a•✓ 6-SE S,,be, ay Ak- a.
Type of Operation: Swine Poultry Cattle
Design .Capacity: � � % � �r � � Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: l� Longitude:" ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes No Actual Freeboard��Ft. Inches
Was any seepage observed from the agoon(s)? Yes No Was any erosion observed? Yes N
(0. 09
Is adequate land available for pray? Yes or No Is the coven cro adequate? Yes or No
Crop(s) being utilized: ,) �_A/ �
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? es r No'
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USES Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Ye r No' If Yes, Please Explain.
Does the facility maintain adequate w management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
S
cc: Facility Assessment Unit
Use Attachments if Needed.

r
Site Requires Immediate Attention i11-1"
Facility Numbe ,3 l —
• SITE VISITATION RECORD
DATE: — , 1995
Owner: n c L-1, L_ . ; _-- Farm Name: —,Fa ,•, i e a,' 1
County: 1; .q _
Agent Visiting Site: Poarloz Phone: 910 —.7-9 b -212=o
Operator: Phone:
On Site Representative: Phone:
Physical Address: 0y, N t -12 a p�ilx L ; Ig __So,+A p f 11, 19ooL
Mailing Address:
Type of Operation: Swine _� Poultry Cattle
Design Capacity: U2- 4 Number of Animals on Site: .2, q-14,P-
_
Latitude: 0 Longitude: 0 "
Type of Inspection: Ground _ c�� Aerial
• Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or f I�C Actual Freeboard: __�_ Feet � Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: L-,a o r%o+- %14- _z
0 AiL iLrv�-
Fax to [phone]
ignature of Agent

A I
N
s n O
D
s I • I 'Nrr ¢o sr NMOHS savoa
1
srrOHA NO NMOHS LON 3ov311M+
os L,;.t•
YON W31SASt{ON lWi*CL MPI NO
1
-"��;vy�-�.��.�
-�-�-�-~�-~•.
IINww 3ivis A1No S31MIDM J" 9lON
s63Yt57vrrMostr
I SH3IlMnN
rim
¢ rre
Of MON ALKW3 of A3)l
Q N 'd 1
M
rl Tsl
�T1�'d
9
V 1 O
iiiT-�
b[iI
>f.uJ C%MT
f
I r• ZBI
,r.
'�'u
fv,rt
gooH wd f7ti1
fm
1 ZtiT
e-,
! fZdT
rlYti
b'FA
. � v
tit
r
- am
�.
aifi - MT
7trr mr
_...^.as
azrr arar
Uii
up fist
o.
v.r
ou — sat tFt-'ma
f
L
N3AfN
�i
I kjO6
i1T
r't
�t r
z
'
y
rrn
Un
f�
O
1
TM C
1 r
-D
1
po-
�
ri
iTlf r•
TC�
C ifiT r
[ill
rw
Jlrot
vid i t dTi
-4"utv—1
�':
'
[-ii i
�
i
I.d-bwC
rIL
Ol
�i
19
_
• art
u
S
+C s
^2
.IuMrad
i YM°IYIa11.Wd
['f
� 111
dl
�r
I CfI
TSB
W-1
� L
f
� tlt �\
FQ
�y r76T
r
CIL CL
T i .T 1•a41.Y ti
[" T ~'
+
1
silt Ipinlp TM
II�T
n MT Zbfi
I r
i.
r.f �IOi 1°pwt�
rr
+
t ,
l �.
Z
azT
TMrrrt c rrrt v �
Y
ifRT �J •epq
a3i7
y
3 1
� `
d w
y
3 L
LI L CI �t Wi
mu b
'15
iCi
O
Twi
I
IaT $
b6f
1
tt!UFrmull
t:
...1`
TT
r
1 CI Tty1 Ids a FLAT
fi d•l�:,y t
'll!u11°H
I
CI A.IPYH
t•.w
fwL
_ 1
''
i3, �
d9
.. LI
+
.'ir
an,u,9
iitl
1
Y RZT
K)w y
� _TM
(�
CILI
ITUMIVY
r'' t' ZdZi`
4v4
7ST i
L -
Iil
M
a TI
Y.
1
Ill
41
.t. fm
T�
dr•
L
Wb
IAl1alQ YwJIt
a
f [
qI
1
bl�f SST
! alga,
�
ulua
S
f—ldi ;
r `•' L
^
+1
IiLI
L 7TU
F� �1y C2
FMtr
1.
/ •
b
� 4
O N
-Lvo+wo3 of IPr
�'
IN it 11
5�,♦•

E
��

IF