310711_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

Type of Visit: Q'Co ance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: l 9 9 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: r rr Title: Phone:
Onsite Representative: 11 4 c- S F� '� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Desigu Current
Capacity Pap.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
C►►specify
Current
Pop.
Wean to Feeder
Z1009 - 2-3 9q
I
jNon-Layer I
iurrent
Dairy Calf
Feeder to Finish
Design
D , P,uult , Ca aci P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Soars
Pullets
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 ffNo 0 NA ❑ NE
❑ Yes
❑ No
DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑No ❑NA ❑NE
[-]Yes
NN - ❑ NA ❑ NE
[:]Yes LJ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Faciliq Number: jDate of inspection:
Waste Collection & Treatment
4. Is torage 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ONE
❑ Yes ❑/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q 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 ❑ HydrauIic 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):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
i
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2]No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑/ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
/ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
ON I,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[::]Yes
6/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
ff No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
C]�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: 3 - 7 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N NA ❑ NE
25. A the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No ❑ 7NA
❑ 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 VfNo ❑ 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?
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 No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
F]"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 explainsituations fuse additional paces as necessarv?.
21 , Co
r
4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f A `'_
Phone: ? 49 G 7 Q
Date: 3
21412015

• Div`i'sion of Water Resources
Facility Number "�—� - �j ( O Division of Soil and Wa#er Conservation
� Other Agency
Type of Visit: Co lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 J r County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G 4c. C_ k S �a on
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 q 6 L 33
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Gattie
DairyCow
Design Current
Capacity Pop.
Feeder
Z 7
Non -La er
DairyCalf
o Finish
DairyHeifer
o Wean
rFarrowo Feeder
D , Ploul
Desigu
Ca aci
C►E3
urrent
P.o .
D Cow
Non -Dairy
o Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
I LEI
Boars
Pullets
Beef Brood Cow
Other
F-Tither
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes,. notify 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 ', "" ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
4n—No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - / Date of Inspection: (,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No 0 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): }
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L d o ❑ 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 Q 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes 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 KNo ❑ 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. 0 Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
� No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
To ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:)Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rN4o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes V No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
Page 2 of 3 214120I5 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No 0
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:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CETIio ❑ NAB❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑11A' ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 7 No D 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?
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 [r No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [2'Flo DNA ❑ NE
❑ Yes qo ❑ NA ❑ NE
Reviewer/Inspector Signature: 1 �( Date: �� Q
Page 3 of 3 21412015

Type of Visit: Q Com fiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: <�"' 5 k f —e)
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pap.
I
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
JLayer I Dairy Cow
Current
Pop.
can to Feeder
? 2P
I
JNon-Layer I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Dry Cow
Dr. Poultry Ca aci P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Putlets 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 CI"IT5 [ ] NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

I
Facili Number: - Date of inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C]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): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes C5 1IT&
❑ 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 ETNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes L'7 1VO
❑ 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 E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or comp]iance alternatives that need
❑ Yes Ej<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes D,'<
❑ 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
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfrNo
❑ 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
P—go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑V 'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
ErYes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
To
❑ 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
B es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 6soil 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
❑-ado
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L3 o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

4
Pacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Ye No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ld o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [�-Mo ❑ 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 LJ 1To ❑ 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 [3 1qo ❑ 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 Q'1 o- ❑ 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 ❑' i�❑ 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 [E]No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E�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).
C_ C . le
5k JJ
�p�L-ttj©(f-A 01.1
Reviewer/Inspector Name: (/ ",, r�[ r 1j "X Y.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1(0 _;% 770y
Date: 4;�
21412014

Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: Con
zs V/
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��� ifi"i5�t•y _
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
nty Region:
Phone:
Integrator: m
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Castle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
1) . P,oult . Ca act P,o
ILayers.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ED 5o ❑ NA ❑ NE
❑ Yes jErNo ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes o ❑ 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 - o ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3_
21412014 Continued

Facility Number: jDate of Inspection: %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes,,0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [l Yes tC31L ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
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 j2l�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 J2'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J2-;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 )2TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Excessive 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 J2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'LD-Nio ❑ NA [3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes �- o ❑ NA ❑ NE
❑ Yes [ 'No ❑ NA ❑ NE
❑ Yes ,D-No
❑ Yes ,❑"No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] o
❑ 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 �+T0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes '0 No ❑ NA ❑ NE
25. Is the'facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ONo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ 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 �" o ❑ NA ❑ NE
❑ Yes 'No ❑ NA ❑ NE
❑ Yes �no ❑ NA ❑ NE
❑ Yes L21'No ❑ 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 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: p�Z
Date: O /
2120r

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: Q,' eparture Time: County •
Region:
Farm Name_
S'�J
���y�I Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: -ze
Certification Number:
Longitude:
Design Current
aaciWet11 inish
7Feeder
Design Current
La er
Design Current
Dai Cow
eeder
Non -La er
Dai Calf
Finish
Farrow to Wean
Design Gur en
Dr, P,oult . C*_a a_ci ,o ,
La ers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
)2TNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes gNo [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes �� o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes TZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -71= jDate of inspection: Q
Waste Collection & Treatment
4. Isbtorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes --n No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes JE!rNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: (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 CI^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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ o
[DNA
❑ 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?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2rl4o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'j2'No
17. Does the facility lack adequate acreage for land application?
❑ Yes ):a -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _[:],No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes :jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes J:?eio
❑ 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 jve�o
❑ 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 ,E:f]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'd No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: -271 jDate of Inspection: 1,2
-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZfNo D NA ❑ NE
25.1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yet ,EjNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes U]rNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ 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 ,EfNo
❑ 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 4No
❑ 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/lnspector fail to discuss review/inspection with an on -site representative?
tq
[:]Yes ONo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes Ca To
❑ 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).
him 5 311,C 1�
�119all L,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
11 40 c4e-j S4&s Or/"
—,A'a 2012
A.%q,,-ln 1-C
Phone: 'f "7"- —7�
Date:
'121411011

FAdli Number;
Dvision of Water�Qabty„-
Division oFSoil an[I Water Conservations
OtherAgeiiey
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .04foutine Q Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �7 - � Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: If Zx?
'J
Certified Operator: Operator Certification Number:-qu
a,r Qct, v S'
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o [= 4 = Longitude: = ° u
,..ate .„.w
Design -".-,--,-Current Design Current
in r y ri Capac>h, , Population Wet Po.ultr} ;Capacity Populahon
] Wean to Finish ❑ La er
] Wean to Feeder ❑ Non -Layer
] Feeder to Finish
] Farrow to Wean
DryaPouitry
] Farrow to Feeder
] Farrow to Finish ❑ La ers
] Gilts ". ❑ Non -Layers
] Boars ❑ Pullets
1-— ❑ Turkeys
T ,❑
th'er
Tur
key Pouets
] Other '� ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cow
Heifer
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑'NA
❑ NE
❑ Yes
po&o
❑ Yes
PMo
❑ NA
❑ NE
❑ Yes
ON.
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
dNo
❑ 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
)2jNo
❑ 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
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
[�:rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Po
❑ 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
,fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
jZrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
ONo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EINo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ET'Vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
re No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ElNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall S cki QErop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the face ity fail and maintain a rain gauge? ❑ Yes IDNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J:3'No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: 3 - Date of Inspection:
24. + id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑^No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes k] No ❑ 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
V"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
P�No
❑ NA
❑ NE
Comments (refer to question ft 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).
dq'4 e* 4rL i 7 4- �Tj) ?off
1 t I G - c5q +�f,
k4S rcce,-H9
,-%en ouu 44-t.
farms. waet 4 ouar
fePorh� 601-rns
r— r e Q Lc f 'i-S
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
i-e c'ev�k l s, b dv% l { ed .
a.� l� 5ar 1 1'(2fOd 6u� is
t��fefsl�n F A//P✓1
/P%.-
74 '04 /-
- • P'j cy , a-c— 0o.11 s 1 ��5� s u r �
J
�►� box .
• M e e'C� Aft t + to CC 11 b coat cjn 0 s y
' ViLelo (4 p w 14— Cc c1 P 9 (-etd S d- n1 a r 4-R j
Phone:
Date:
14120 1

:Division of Water gahty
F. aciliNumber O Division of Soil andWater Conservation r'
ty Ors
'Other Agency
Type of Visit ,4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ir% S Integrator: m Z'e'
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c 0 t = Longitude: = o
Design Current Destgii. Current i ,aDestgri Curre
Swine Capacity ,Population w Wet Poultry Capacity Population; Cattle , �, .Capacity Population e
❑ Wean to Finish
I
❑ La er
[❑
Wean to Feeder
jr.
❑ Non -Layer
U Feeder to Finish
❑ Farrow to Wean
. ❑ Farrow to Feeder
" ❑ Farrow to Finish
Boars
j Other
Calf
lJ Dairy He
Tlry Poultry ❑ Dry Cow
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 2<0
❑ NA ❑ NE
❑ Yes -
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo ElNA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — % Date of Inspection
Waste Collection & Treatment
4:-Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes /ElNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No ❑ NA ❑ NE
(iel 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 17 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 Pe-io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JVNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes O'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes j!jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes 0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes VNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes TNo
❑ NA
❑ NE
.Comments (refer to"question:#). Explain any YES answers and/or any;recommendations or,anyother orrinients "-"
Use drawings, of facility to better explain situations (use additional pages as necessary);
f �
.,
Reviewer/Inspector Name=� Phone: VC
Reviewer/Inspector Signature: Date:
Page 2 of 3 12 8104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ON" 0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;! No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. j2ryes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Owaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield E2120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes & ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 2fNo ❑ NA ❑ NE
Oid 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 Vf NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �lo ❑ NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Po ❑ NA ❑ NE
and report the mortality rates that were higher than normal? /'N
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes .0'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,,dNo ❑ 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 ZfNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes �No ❑ NA ❑ NE
Additional Comments and/or Drawings: s
ll0 r(' GcI �5 C�l'1Q I s , lUe ed v 1 kCA,
i
Page 3 of 3 •' �% / S .P1 �a /1� /L 6i�ld'l�/28/04

l
Type of Visit Compliance inspection 0 Operation Review 0 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: G Arrival Time: ! Wu Departure Time: County: Region: 'K1
Farm Name: __.sC
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
&4/,2
Onsite Representative: tL_Z .1 '
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
integrator: %-A 14es _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—] o [—] ' [_] Longitude:
Design Current
Design C►urrent
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle C•'apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dair Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry oultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
❑ Non -Ls ers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cow
El Turke s
Other
❑
10 Turkey Poults
JEI Other
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
p'rio
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
;Ef,(
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,_No
�J No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection d
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
❑ NA
El NE
a. If yes, is waste level into. the structural freeboard?
El Yes Zo
❑ 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 �TNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes XNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [io ❑ 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 �rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 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
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6 No ❑ NA
❑ NE
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
No
❑ NA
❑ NE
Cotnments'(refer to question#) Ezplatn any YES�answers and/or any recommendat,6 1 ar4any other comments.;
Use drawings"offacility`to'beiter.explain situations (use additional pages as necessary)��v
s
'' 4
Reviewer/inspector Name �—
- - Phone:
Reviewer/Inspector Signature:
Date:
Q
12/28104 Uontinued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IV
❑ NA El NE
the appropirate box. ElWUP ❑ Checklists El Design ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. /Yes ElNo ElNA ❑ NE
ElWaste Application ❑ Weekly Freeboard ElWaste Analysis oil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2rNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
XYcs
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PrNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VPNo
❑ 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?
ElEd Yes
Ed'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
#J No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
Additional Comments and/or Drawings:
e-v�-
3l/��°�
11alle,/e9)
aC�O� •
VVI
12128104

it -
rR
ype of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit�Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 G7 Arrival Time: / Departure Time:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Title: Phone No -
integrator:
01
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = e 0 g a Longitude: = ° 0 d = Lf
Design Current
Swine Capacity. Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PE]Gilts
Boars
Other
❑ Other
Discharties & Stream Impacts
Design' Current
Wet, I- ultry,.,. C^apa�cif - Population
❑ Layer
❑ Non -Layer
DrY Poultry II
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
wMe.Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood -Cod—__ I
Dumber of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. _ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

1
Date of Inspection 2 7
l;'aeility Number: ;3 -- 7!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(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 4-5 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)
t4. 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):
7 du 0 fiJ/H d/- C�
t-
�rla�
517 PuR"p/.S l
A e 41/
c.co ,j �e
l y s/r 1Ces It
w
Reviewer/Inspector Name
Phone-
//-�
Reviewer/Inspector Signature:
Date:
J-7 0
12128104 Continued

Division of Water Quality
.Facility Number ,3 % l Q Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: %�0 Departure Time: County: Region:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: l 21,115, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o =, = As Longitude: 0 o Q 4 =
is
Deli n g Current , Design Current Design Current
;.Swine Capacity Population Wet Poultry '.Capacity :Population Cattle Capacity Population.::
] Wean to Finish t:.❑ Layer
21yean to Feeder (-2 a do S__0 JE1 Non -Layer
] Feeder to Finish I-
] Farrow to Wean nry Paultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
`` ❑ Boars
'Other;.
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
k 0 Other L— — —
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes en No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ,f No
❑ NA
❑ NE
❑ Yes,,2No
❑ NA
❑ NE
12128104 Continued

.) .,/ Z
/ FacilityNumber: —7LI Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Y No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes] No
❑ NA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes V:fMo
❑ 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 ONo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;3 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 ,ONo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 2"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable `Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C/ mot/ r S
13. Soil type(s) A-k'41
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,ONo
L�1 No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
lo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�
v
Reviewer/Inspector Name �.h ✓ G� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

;llfFicility Number: — Date of Inspection G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. es 0 No ❑ NA ❑ NE
l I "zlli�
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste "transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking op Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and ma tain a rain gauge? ❑ Yes ,.fNo ❑ NA ❑ NE
❑ Yes Ef—No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,fn—No ❑ NA ❑ NE
❑ Yes
❑ No
E' NA
❑ NE
❑ Yes
❑ No
JaNA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ja'No ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes _ffNo
❑ NA ❑ NE
❑ Yes No
1�14❑
El NA ❑ NE
Yes ZNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
�p�a yC/
a
i w
`leL6r� CCG /ells Dr �o ,rmS.
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Page 3 of 3 12129104

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit S)Aoutine O Complaint O Follow up O Referral O Emergency 0 Qther ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Namc: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 6Integrator: AjAal
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = ' = Longitude:
I Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
260.0. 10 Non -Layer -`
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifet
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number. of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
❑ Yes
P"No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
I2/2"4 Continued

Facility Number-3— Date of Inspection
Was 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 1� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: K
Spillway?:
Designed Freeboard (in): .,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ll 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 [TNo ❑ 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? ElYes .CJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes—D^No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ;�INo ❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,O10 ❑ 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)
�/� ,/ ✓ r
13. Soil type(s) � li—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes El -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2No
❑ NA
❑ NE
Reviewer/Inspector Name ' - Phone:
Reviewer/Inspector Signature: Date:
l cicwvt 4VI9lili"V

Facility Number: 3 — Date of Inspection
Re 4ed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D I o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 12'No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
'�es ❑ No
❑ NA
❑ NE
Waste Application ,Weekly Freeboard Waste Analysis El Analysis El Waste Transfers El Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 2/ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes L�PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes,lo
gNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
7fNE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes „0-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes [:I No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes P�qo
❑ 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 J2<o
❑ 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 �Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes �o
❑ NA
❑ NE
Additional Comments andlor Drawin s:}
44
a) flerz� ce-cord jc7re�evx%arra) ram) l o►-t�Ya��
-F0 4' vh S r I A-ia a 1r` l {'q 1 k!
�,nsCID c+ua Y
" C� �� o� � a b� A✓�a'��51 s w ��pvl -�a (' fan_ O Sr
Ojero"Ak t -Caro-v t-3 iy\-* cyec,+
1212&04

Time -
© Permitted [3 Cerfifiied © Conditionally Certified 0 Registered Date Last Operated orjAAbo.ve
Threshold:Farm Name:..............A.Vta.........................................__ ...... County:...
OwnerName: --••••..... . ...................................... Phone No: ................. �.................._... _..__..__.
Mailing Address: __....._ ................................ _........ ..__._
Facility Contact: ............................................. .... Title:Phone No: ......... ............... ........... -
Onsite Representative:... 1 .... ,�s Integrator: -_------- --- --
Certified Operator.._ ................................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 64
Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow is gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........ .. l ........................................ ..-....._............................ ...... ...............
Freeboard (inches): Z 5'
.,1
gL
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ Yes
ElYesWo-
2
;FO�_,
Structure 6
12112103
Continued

FdcUity Number: 7 Date of Inspection 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancehmprovement?
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
f ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cis rV
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 2 rNo
ElYes No
❑ Yes
❑ Yes
ErNo
Co
❑ Yes
L,l 0
❑ Yes
❑ No
❑ Yes
❑ Yes E Noo
❑ Yes '_ o
❑ Yes
❑ Yes No
❑ Yes 0
❑ Yes o
❑ Yes 0-10
❑ Yes 31vo
❑ Yes Q,Al6
❑ Yes o
s = r- z x r a
Comments (refer W questran #) E _p.Whi any YE�a v and/or any recommendations or any other en _
�LFse draws �f facdi to`better szte�oas. use��dmonai es as � � ����' gs ty explarrt
{ m ne�sarY) �� ❑ Freld Copy ❑Final Notes
� ��.:mm � �-pag
2[,) G C A0 0 b
S�CaGCS 1�jV i �3As� oldlrt.S ,
�f�r1-� .�► G-oa1) 5 �{J PE .
v
Reviewerllnspectar Name "�- �-� `� '�•- �, � 'tr `�� � �"". �. =� � =`�` .-�`��,�� �� 1 �" t
Reviewerfinspector Signature: Date: Y
12112103 4 Continued

J
Facility Number: — 7
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
Yes No
❑ Yes
❑ Yes fdNo
❑ Yes 0<0
❑ Yes Ll<o
❑ Yes OV_o
❑ Yes 10
❑ Yes 8'lq'o
❑ Yes 0<0
❑ Yes [ (o
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? 1 ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

rf
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Q Routine O Complaint Q Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number E Date of visit: l 3! Time: 1:
Not O eradonal Below Threshold
® Permitted Mertified 0 C�o)nditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: - d►%T q /Vk✓5E'�L,/ County: Aalza
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:��
Certified Operator:
Location of Farm:
Phone No:
PhoneNo:
J,yJ
Integrator- _,1��/yrAZ4
Operator Certification Number:
❑ Swine ❑ Poultry [:]Cattle ❑ Horse Latitude ' « Longitude 0a 0 0
Design - Current Design Current bestgn - Cyrrent
-:.
Sisme. Capacity
. �r�., _
'Population .v. Pouiti� Ca acitv:_'Pd ulatton ._-Cattle -a acity -_=P©eiiaiton ,
Layer ❑ Dairy
#;
r
❑ Non -Laver F: ❑ Non -Dairy
p
,
z ❑ Other
Total Design Cagaciith74
w
TotaIeSSLW
Number of Lsgotios
�; :- ❑Subsurface Drains Present ❑ La oon Area
❑ 5 ray Field Area
Holding Ponds t 5ohd Traps .
�'. ❑ No Liquid Waste Management System
-
❑ Wean to Feeder
Feedero Finish
❑ Farrow to Wean '-
' ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts ;
Boars
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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: 1
Freeboard (inches): 39
05103101
❑ Yes L`K0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes Urf�o
❑ Yes [ate
❑ Yes � o
Structure 6
Continued
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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: 1
Freeboard (inches): 39
05103101
❑ Yes L`K0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes Urf�o
❑ Yes [ate
❑ Yes � o
Structure 6
Continued

Facility Number: j —% Date of Inspection 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0<0
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 2-I o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) �,,iv�
7_ Do any of the structures need maintenance/improvement? El Yes L`� o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 51K6
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [K l�o
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [9<o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type ( �A W&V-vT- _5KO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. floes the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
E1110—
la"
❑ No
❑ No
ENO
2�90_
❑ Yes ®'No
❑ Yes ❑440
❑ Yes O'N6
❑ Yes 1 wo
❑ Yes M-Ro
❑ Yes M19-0
❑ Yes ❑'l�o
❑ Yes 2�'�o
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'Cmmtnents (refer to_guest<on #) lvicplaut ally YES attsa�eis andJ©� �aay recnmmendatons or a;nv_`otb:tr c�irmmerits:
_ _
Use drawifies of f2e9 to better explain situations: (use addtttona[ pages as netessarv) ' ❑ Field Conv ❑ Final Notes _
J�ccor�ty �- �✓M �o,�s �a� .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 __<
Continued

i
Facility Number: 31 -74 Date of Inspcctinn l
Odor. Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
Q�i"o
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[' 17go-
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
�] Yes
ED-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
G-Nd
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
[-lo
31 _
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Additional'Cornments:and/or,Dr. Win�s
05103101

� e-
t� Drvrston of Water Qualrty
0 l]�vts�oan of Soil and' Water Conservation
r _---3itq.4_ Agency
Type of Visit O-Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for. Visit 'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Z Z7 Time: .j Printed on: 7/21/2000
� %
Q Not O erational Q Below Threshold
M Permitted IS Certified
�� © Conditionally Certified 13 Registered Date bast Operated
� or}Above Threshold: .......................
Farm Name: f�... ((!(�rS ... ... .?....................................................... County:....... eP.11.1n............
Owner Name:....... (!!�(.7 �.✓... lA,l�([f G Phone No: •.......
.............................................................................. ............................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:... ,rL!lti a`�. L .+��.................................•-_..._. .... Integra€or.......(%ll� ..... .........
Certified Operator:,.,..._--. Operator Certification Number:....,,..., _
Location 'of Farm:
l
7
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude • �� ���
t Design
Current Design Current Design Cnrreat
Srvtac t Capacity
.
Population . Poultry Ca aci Po elation Cattle . :.:. Ca `illation.
Wean to Feeder
I❑ Layer ❑ Dairy
Feeder to Finish
JE1 Non -Layer I Non -Dairy
x; Farrow to Wean
- Farrow to Feeder
❑Other
= Farrow to Finish
Total Design Capacity
Gilts
SSLW
r Boars
Total
_: ,7_'-tof Lagoons ,�
W-4dM
(
Subsurface Drains Present
Lagn Area Spray FieldPondsfSoLd
Traps
❑ No Liquid Waste Management System -
y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/rein?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier : .............. ....
................. ................ _...................
�./........................_..................._................................................
Freeboard (inches):
5100
❑ Yes V,No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes CM
❑ Yes �4 No
❑ Yes [9-No
Structure 6
Continued on back

Facility Number: 1 — 7/1
Date o1' Inspection L e!2zlhZ1 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
KNo
seepage, etc.)
6_ Are there structures on -site which are not properly addressed anct/or managed through a waste management or
closure plan?
El Yes
[)INo
(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 t1-,e structures need maintenancelimprovement?
❑ 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
B No
11. Is there evidence of over application?❑ Excessive Ponding [I PAN El Hydraulic Overload
❑ Yes
® No
//
12. Crop type (16M � G� - _....,.
_. .
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
$j No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15. Does the receiving crop need improvement?
❑ Yes
JU No
16. Is there a lack of adequate waste application equipment?
❑ Yes
10 No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
10 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
1A No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
JO No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KINo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
(R[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 reviewlinspection with on -site representative'?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
: 10 violafigris:or def cieticies were poted ditt`itig this:visit; tY:oil will-feeeiye fio fu>� ther
- •cories ori�ence:abatitthisvisit:.-.-.•.-. -....•.-.�.•....:.•.. .....----'- --•-•
Aw At d k, ep a 14py 44 wcc. kl` -ke c 4ot-W reai4r, 4vi ;q re eor o,%,
A.
I� �ao M 5'j'� e- , v � — A C 0 / 1 6 Ae; e / t 1411 , � % J � - A t,,; i g j,,/ rt
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility Number: 3 — Date of lospection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes JRNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes -M No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 09 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IN No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 91 No
Additional omments and/or ravings:
.&I
S/00

Water (�alJity
{
viSifln of
I�Ivision of Son a�ItIE W�tIY LL►li3@1'VaiIDII
�
�
vi"- ^• ,P,,.s .... -a^b' .R '".".S?-
y.
i ":_'e:.
�
et^FZ"' 'i rn
Y,
i
Y
`T +A
Y t
_
M
Type of visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number r Date of Visit: -3; 0 l Time: /25
0 Not Operational Q Below Threshold
,Permitted Q Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: �A�V 5 v r S r ......... ..............
.................—...
Owner Name:................c+rBh! t s Phone No:
................ ...................................................................-...............................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:
MailingAddress:........................................................••---•---•...____....._........................................_..........._.....____-__....._.------..... .................___ _-••-
Onsite Representative: �nl °1.. reav it Integrator: ...!......... .... m.�.-.
..__.
Certified Operator: ................................................... ............................................................. Operator Certification Number: ....... -..................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Design Current 'Design Current ---.
Swine C apacity. Population Poultry Ca aci . Po >,ulation -Cattle
Wean to Feeder
Z(p0Q
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
[] Farrow to Finish
❑ Gilts
[] Boars
❑ Layer ❑ Dairy
❑ Non -Layer I I❑Non-Dairy
❑ Other
Total Design Capacity
Total SSLW::
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If.discharge is observed, was the conveyance 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 gallmin?
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? ❑ SpiIlway
Stricture I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes '�No
❑ Yes 3'No
❑ Yes ONo
� In
El Yes No
El Yes No
El Yes J0 No
❑ Yes gNo
Structure 5 Structure 6
....................................................................................................................................................................................
F b •d (" h 2
ree 0— 1111, es).
5100 Continued on bank

Facility Number: 31 —rf j Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �] 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 YfNo
(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
Yes
elevation markings?
❑
EfNo
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
J No
12. Crop type a ✓'v1 1 Lj Zi eAh So !1 bey ns
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
. ❑ Yes
7No
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 f No
Re aired Records & Documents
IT 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 5?No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 11 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes JF91No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )EfNo
o yiolaticjns:or del ciencies rv�ere notca during this'visit' • Yoil will-i eceiye iiti #'ui•thgr : ;
rorres} 6eitce: abaut: this visit::::: .
Conuatents (refer to question #): Ekplain any YES answers and/or any recommendations.or.,any oiher c(imments. s ;
Use drawings of faLcility to better a plain situations (use additionai:pages as necessary) m
i G;) r T y 1-5 L ve 11 ke& - I,ee4 G or it we.11 C_�la b 11 SYJUA, AL
Reviewer/Inspector Named nG�✓cG.�'� j'yI �-f �� _ _
Reviewer/Inspector Signature: Date: if .3 3 6 0 / 5/00

Facility Number: '3 Date of Inspection 3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes'*J/No
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 ONo
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 0 No
31. Do the animals feed storage bins fail to have appropriate cover? [:]Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Shona omments_an or' racy ngs:.
AL

11
r.
D><nsion of Water Quality z
Division of Soil and Water Conservation- "
s. r
ui Other Agency
2
4
Type of Visit 9 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit l Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date. of Visit: i — 'afl Time: Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
0 Permitted Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold
Farm Name: �DtL.� I �........i,�IC.S.GY.i .1.
rounty:.........it.lint....n ................................................
Owner Name:..... I Y\e. Phone No:
FacilityContact:...............................................................................Title:...p........................................................... Phone No:...................................................
Mailing.Address: ..�..3�..3..- ..wt\XcL....I�iI�.Q. C._..�...................................................................................... ..........................
V ,I
Onsite Representative,!: -_-.. „._ Integrator: t4.0'!'ph
Certified Operator:..... �-1 ��.�. ... .a .1 t........... Operator Certification Number:.
Location of Farm:
Ix5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 46 Longitude a ° «
Design Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Cauacitv Population
Wean to Feeder
f,6(36
JE1 Layer
I
JE] Dairy
❑ Feeder to Finish
JEJ Non -Layer
I
I
I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
Z-4 © p
❑ Gilts
❑ Soars
Total SSLW
Number of Lagoons t ❑ Subsurface Drains Present 110 Lag -on Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System.
Discharges & Stream Tmpact5 �/
1. Is any discharge observed from any part of the operation? []Yes jy[J No
Discharge originated at: El Lagoon El Spray Field [I Other
(�
a. If discharge is observed -'was the conveyance than -made? ❑Yes No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes No
c. If discharve is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 0 No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes [WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 10 No
waste Collection & 'rreatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
r,u• ire I Structurc 2 Structurc 3 Structure 4 Structure 5 Structure 6
Identifier: ..........................
Freeboard (inches):
5100 Continued on back

s ��
Facility Number: S r — '7 Date of inspection L[! 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
CdNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan?
❑ Yes
OdNo
(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
14No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
19No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[�No
Wilste 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
qNo
12. Crop type cocn _.- Sbt [ �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
(XYes
/
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes -
❑ No
15. Does the receiving crop need improvement?
❑ Yes
*o r
16. Is there a lack of adequate waste application equipment?
❑ Yes VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design; maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
13: N6-yiglati6iis:oi-• deficiencies -were poled• during this'visiC - Y:oir will -receive rid fufthe' -' -
corres ondehCe: about: this visit. • : • :::.:..: ::::: ::::::::::: :
❑ Yes �ZNo
❑ Yes rN
o
X[Yeso
❑ Yes P No
❑ Yes 5KNo
❑ Yes IqNo
❑ Yes ZNo
❑ Yes 40 No
❑ Yes #No
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):
rq. IKcep eOrf- n� sod r7Cekk
rbs cin le, U(- c.<JasIL Ana.lysi's
A.
(Shaul. � cvt� cy ua.r� ly.) orJ f' uiezo( ►'n ,F,orsr►? ,'orr ter]
f
04
N N) UJ fib . tic x-We, acme, d d e,m�nol► dry . J15c ass w j , s <►- tie-L-r
IV
Reviewer/Inspector Name de, Ij
Reviewer/Inspector Signature: J Date: — —O d 5100

Facility Number: Date of Imspection 60 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 AYor hplow ❑ Yes fi(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32- Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes 4NO
AdditionaL - omments and/orDrawings:
J
5100

'G © Division of Soil andWater Conservation-Operatioin=Review-
D Division -of Soil and WaterConservatronCompiance Inspection = n
lDivisiou of Water Quality ;Compliance Inspection
y'
Q Other Agency Operation Review'-
%Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection`
Time of Inspection O 24 hr. (hh:mm)
0 Permitted Certified [j Conditionally Certified 0 Registered 10 Not O erational Date Last Operated:
Farm Name: ...`?!.!`....1 ]G ...........'Sy�r....a'...... County:. ............. 1��'............................. ..................
.....
Owner Name:... ................................................ (`. ..... .. Phone No: .._...1.�O-sf�3.-..49,o .,f........_....__.........
Facility Contact: ...... ........................................................................ Title:
MailingAddress:..........................................................................................
Onsite Representative:
Certified Operator-
Phone No:. .............
....................................................................................... ..........................
Integrator: ,,,-,,,-,,,,,,, ..
.
....... Operator Certification Number:
L ati n of rm:
01 Vs4A_w , o
'z
1.n az
�y
. ....t3. QG..-.................................................................. .................... ............................................... ....................... ......................................... .I ....... I............
Latitude ' ' i' Longitude • ° 66
Design Current Design: Current . Design Current
Swine -.. _Capacity Population:— Pault
:.: P Y Po P i3 Capacity Population Cattle Capacity Paph ulaon
Wean to Feeder
p(3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Nii nber 'of Lagoons a ❑Subsurface Drains Present ❑Lagoon Area
Holding_Ponds I Solid Traps ❑ No Liquid Waste Management System
❑Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a- if discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(inches): ........5D................................................................................................................. ...........................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[] Yes
gNo
seepage, etc.)
3/23/99
Continued on back

FacWty Number: - t ] Date of Inspection
0
.r
' 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
X 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
ONO
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
�'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
0 No
Waste A pplication
❑ Yes
10. Are there any buffers that need maintenance/improvement?
lk'No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
P No
12. Crop type `L-J U14
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
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
g No
c) This facility is pended for a wettable acre determination?
❑ Yes
V No
15. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONo
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 D�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes allo
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 ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [(No
:. o •violations :or deftciencies *,ere pQted� di mi' ihis;visit: - Yoit wiii •receive iiti fuki .. • :.:. `
cor'res oiidertce abauti this visit. :..:::: .. _ :: :
Comments,(refer to .question #) Explain any YES answers andlor any recoinmendattons or any other comments - "
m
Use,dravvings of facility to better explaiin.°situations {use s a additional pages necessary)
... ... _ e r
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
- k 9
3/23/99

Facility Number: 3 — Date of Inspection
I '
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONO
ona ommen an :or _-rawings
.&i
3/23/99

4 'N [:]Division of Soil and Water Conservation ❑ Other Agency
- W ® Division of Water Quality`'
t � A
m�
10 Routine 0 Com faint 0 Follow-u of 2w2 inspection O Follow-n or DSWC review O Other
LDateof InspectionFacility Number of Inspection 24 hr. (hh:mm)
© Registered 0 Certified © Applied for Permit j] Permitted 113 Not O erational Date Last Operated:
Farm Name y dw 1
OwnerName: .. ......... VA.. .............. ...D.aw..ti 3.............................................
Facility Contact:
Title:
Cauntr:
u.�.l .%.rl ........................................J.........
Phone No: ..�, E.3...................
Phone No:
Mailing Address:..1... `�.3..... I.:..........%.r....,`..rt ..P d.=.........(, .�.. t�l?..'.t...� �- ................I............. U_tlq.t
Ons�teRepreserftatwe:.Wc�..i. - .1?C*a.!.�.. Ld.:..�...n..�S.t.i:e !r........... Integrator:.. .Li..r p.k.......................................................
Certified Operator :......i ... Y....a!li........... .rr �.1..5................................... Operator Certification N ber....�.. B..Q...� °�..............
L...
Location of Farm:
tL....... saL6....... SIOU.......5............ .....:$..% ..........t 15. ...... ......
iL. S. 'Gh..).^.......1N.1�......_5�......�.3.0y.._............
Latitude Longitude
-M Desrgn: COF7 t� Desrgn Current Design Current
ea,,Swine >.� Capacity Papu3adoeti Poultry FCapacity Populaton Cattle ;�CapacityI'opulahvn
_ .
�.
®Wean to Feeder yfjr ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
�❑ Farrow to Feeder r Other
.❑ �: p
Farrow to Finish 3 T Z(a�Z7
Total Des><gn Capac>tty,
❑Gilts � '
❑Boars k�rTo3ta1 SSLT ­7 �-ODV m
Number of / Holdrtig'Ponds r` ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® 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 R No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes RNo
c. If discharge is observed, what is the estimated flow in gai/min? i -A
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes RNo
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 from a discharge? ❑ Yes &No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes RNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes allo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (RNo
7/25/97 Continued on back

Facility Number: -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La Dons tioldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes ® No
❑ Yes RNo
Structure 6
Freeboard(ft):...........................................................................
10. Is seepage observer{ from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? El Yes E9No
12. Do any of the structures need maintenance/improvement? ❑ Yes E� 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I5. Crop type ..W.lra.a,Ll........................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal, Waste Management Plan (AWMP)?
17. Does the facility have a tack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No violations -or deficiencies.werenoted ihiring' this -,visit.- You:wiq receiveRo• tirilier•:
corres06ndence A out this:visit'.-:
❑ Yes B No
ElYes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes RNo
❑ Yes RNo
O Yes ❑ No
❑ Yes RNo
Ed Yes ❑ No
❑ Yes 0 No
❑ Yes ® No
❑ Yes 9LNo
Cotnmentsreferyto questto�t #) E�cpLn any YES,answers and/or any recomtnen� datrtttns orany other cammentsW
lUse drawings of facihty to better explaut Setustians [use additional pitges as nece sary) �F � "'`�
T6✓4.0 d wa.sixVje t b10S"' -Q4 :.-, sp � 4�, ..5a-� k�°�
W 6- i 1-C W a S r-t S' enn. f a I d �qI �p �,-�.,.� 0. r-k, �I 1 d0 2-0 0 0 t tq ,.. $, e s
0y ?ira. 4-O r e 1n b 1 G e, KA_J - " r Y 8 a-.C� �' j� NJ V-� 00' - rn 1, V +n 4-V.
Vo-s ��S Ut,�t 4-o Q� t t� vJcL_Sp �0.G� i . #o ��00� Le•q. by:D'
Z. O s •e Phi ,,.,. c {-+ Q-d w a Si••e- �-o r a[ w L a -G 4-,•o Jc �.. b a (o�.ti., c e. t
r C 4 e rt'5 14 t t-- b" P �N) . 1'tn *_� & c
► -LZ.CL (-a b v- e a I w Lo. �o d C a 1�- ear ra --i W.e_y,c. t" . L
�'� . (bs • +� < I-"j +.— VV 2, 0 v-4..v CL p l , n M a Kz _ S .+ a e_.r-r r-t d-o V -o t0
4 t3 a %i t.¢r a i e.w wit 1 � �� { � r e .r-d i c w � i-2 • 7I25147 �
Reviewer/inspector Name t t
Reviewer/InspectorSignature: Date: L JD Lir
42Ir
C. C..a v

Routine O Complaint • Follow-up of
Facility Number 3l 711
E3 Registered E Certified ® Applied for Permit 13 Permitted
Follow-ue of DSWC review 0 Other
Date of Inspection 12/17/98
Time of Inspection 12:30 24 hr. (hh:mm)
Not Opera Date Last Operated:
Farm Name: DA'.%1 S N.UjrSex�:.:. �at�At�.D��:i.�. i i1�.2)................................................ County: I?uplin................................................ W..IRU.........
OwnerName: Wa?:rke.............................................................................................. . Da.�:is.Phone No: 9.10.-.293.48.01 ..........................................................
Facility Contact:
Title:.......
......... Phone No:
Mailing Address: 13.91W.....Wartl.Ilradge.Rd................................................................ W..a.rs w..NC.......................................................... 2.N3.98.............
Onsite Representative: Ms,.Davis...................................................................................... Integrator: MwTby..1F:aJWly.Xarxw......................................
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
Latitude F 35 • 00 26 �� Longitude 78 O1 30 66
General
1. Are there any buffers that need maintenance/iinprovenlent? ❑ Yes ❑ 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'?
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: 31-711
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, tc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Stricture 3 Structure 4
Identifier:
...........................................................................................................
Freeboard(ft):.....................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there plivsical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
D Yes ❑ No
❑ Yes ❑ No
Structure 5 Structure 6
15. Crop type .............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
ZI X0' V'iolatibtls: or:d'eficieifcie9-were: rioted 6, rin, t 1i9,Vi5iL, ' Y*4it-*,ill_reCet'e' "rtb tarbe, r, • - •
..cor:ri . .de. i . ihoutihis'N16 .... .... ...... .......... ........
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[j Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (l No
n Yes ❑ No
w up visit was made to see if ponded waste at edge of spray field had been pumped back to lagoon. It appears that this problem had r
corrected. Water at edge of field looked clear and had no odor.
7/25/97
Reviewer/Inspector Name
V.
Revicniver/Inspector Signature: (-- �J v e r �}(-1. Q 1. Date:

OwnerName: Waync.................................... Davis ........................................................... Phone No: 9.I0.-.29.J,48.Q7 ..........................................................
Facility Contact: Wa)3xc.DAv.1a.................................................. Title: .OAv w................................................. Phone No:...................................................
Mailing Address:1,321...W.WacdBridge.Rd................................................................ W..arsaw..N.0........... ............................................... Z839.8 .............
Onsite Representative:Ed..Lassitfi:.................................................................................. Integrator: Murpby..F.axWly..Farjw .....................................
Certified Operator: Walter . ...............................
Location of Farm:
Latitude F 35 • 00 26
Operator Certification Number:.18Q39 ..............................
Longitude F 78 ' F Ol 30 u
General
1. Are there any buffers that need maintenance/improvement? (] Yes ® No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field E] Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga.Umin?
zi
d. Does discharge bypass a lagoon system? (If yes, notifyDWQ)
3. Is there evidence of past discharge from any part of the operation? ,
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the'facility fail to have a certified operator in responsible charge? -
7/25/97
❑ Yes X No
❑ Yes © No
[] Yes © No
0 Yes © No
❑ Yes % No
❑ Yes H No
❑ Yes ® No
E] Yes Z No
❑ Yes ® No

Facility Number: 31-
8. Are there lagoons or storage ponds on site which need to be properly closed?. ❑ Yes ® No
Structures (LatroonsHolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ..............Z116............. __..............................................................................................................
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 0 No
12. Do any of the structures need maintenancelimprovement?
(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?
Waste A1stilication `
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DW,Q)
15. Crop type ..................... AO.Cm.5.................... .............................................................................. :..........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
I No. olations ci -d'erw-ielieies•wtte'Noted-duraingtll iS.visit.,_�•4U 411'reeeive-nofort-rier•-.-.
1...........................
:d&re's'' ' e' is ' ho' i this: visit f - . . . . .:.......:..:. .
■ Z-t .
■ Yes >:s
,19 Yes > f Nv
[] Yes 0 No
❑ Yes ® No
© Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
IM Yes [] No
❑ Yes 0 No
❑ Yes ® No
] Yes ® No
} Should get waste sample within 60 days of irrigation. Also need to follow WUP recommendations on records for N application rate.'
sure to keep records to show what is being wetted either by field or pull to show tru agrinomic and hydrualic loading on fields per Ir
eed to fill out emergency action plan.
eed to fill out odor, insect, and Mortality checklists. A T.S. at Duplin SWCD or Murphy can assist.
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

JQ Routine O Complaint O Follow-up of DW2 inspection O Follow-ue of DSWC review O Other
Date of Inspection
Facility Number 'j I 1
Time of Inspection 0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: [I Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
w Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: a. `' _ rt�.a1 k. ..�...J .... _........ County: _......... _.... .�
i
Land Owner Name:..Wtt�±4... _....._. s� 1t 1 �.............. ... Phone No:, ..._......
Facility Conetact:............_....... _ ......_..... ........... ..,..... Title: _.. _ .. ..... _. Phone No: ... ......... _ _-..................-......
Mailing, Address: ��.�.... �1 .. � .. � xwa.��. %x� �........... .. ��� �ui..t...�.�.... ........
Onsite Representative:... ......... _ ......!.?!.....�..... .... �...... ..... ..... Integrator:
Certified Operator: ll ._... .. Operator Certification Number: _.. .
Location of Farm:
�.....a .... .. ems.---...ce ..... 4
Latitude • QO `®" Longitude ®• `"
Type of Operation and Design Capacity
Design zCWrrent Design Cpent D,estgn Current
Swine �4 , �?' s r, Ca aci Po ulativn. Cattle.Ca aciP,o ulatiiiii
�: Ca aci Po ulation,41 .I'Qul
Wean to Feeder 00 f O Layer ❑ D
❑ Feeder to Finish ❑Non -Layer ❑ Non Da
Farrow to Wean
x
Farrow to Feeder cm otaUVes1gn Capac o°
u c= -A.
ir
10 Farrow to Finish I, q
T�taIkSSLWI MOW
El Other
Numberof LI❑Subsurface Drains Present
❑ Lagoon Area ❑Spray Field Area
y J
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
;. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
® Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes
®No
❑ Yes
® No
❑ Yes
R No
R1 Yes
❑ No
Continued
on back

Facility Number:.. &I...... —.. .�...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
21-19
10. Is seepage observed from any of the structures?
I I - Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ Yes
(9 No
❑ Yes
CK No
❑ Yes
CR No
Structure 5 Structure 6
❑ Yes
& No
❑ Yes
19 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Appli�atio_n
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ]n............. _ . ... _ _ .... —......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r Certified Eacilitiesn
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes J.No
❑ Yes RNo
❑ Yes &NO
❑ Yes 0 No
❑ Yes ® No
❑ Yes ES No
❑ Yes RNo
❑ Yes P9 No
❑ Yes to No
❑ Yes [a No
❑ Yes KNo
® Yes ❑ No
Comments: {refer to'queshon #) Exptarn any YES answersFand/or.any recommendar;ons nr any other catnments
Use drawrngs, of facility to better explain situatronsl,(use additional pages as necessary) ey Y
1. S. U.S VCL 1 a �rofo--Ut mat. -per VJ. a w
xA_ ,
to
�-enr t~ � w e�it� o c-i d,,.�
s>; P 4,1 tIL wovLJ,
1 S t" t- C e S S �-o Y C �M Y' U w0 of W J-4,W
at1q w w e~% p ti p i v --q is d 4 c a ,.'.•%_A_L
z.q . & e t
U Y r rive + c p C to
W U, S 4-k 6_ V_e' C tA4 GS e,
i 4i+"P L-"
v Lci_
10 e K-t..,. i^i k r.
L 0 a� S— y ego r e o f o-e.r --
o-
S � V_"
o_ � C-a.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc. "rvrarou r/j rrarer Vuarrry, rruter Lruaiuy aecnon, racurry Assessmenr unit 4/SU/Y /