310727_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: 1rCom ce 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 0 Denied Access
e3-
Date of Visit: Arrival Time: Departure Timer County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: pnu �� �I Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
JLayer Dairy Cow
W to Feeder
I
lNon-Layer I
Dairy Calf
ceder to Finish
o
Z j DD
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design► Current Dry Cow
D , P,onl_ Ca aci PopNon-Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
HTuu—rk-ey
Trke s
Poults
I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 FNo
❑ NA ❑ NE
❑ Yes [] NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Z7
Facili Number: -:Z2-7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[j_Ne---❑ 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
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
[2-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
9<0 ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes rNo
.
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �>/ ❑ NA ❑ NE
YesNo ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

z7
Facility Number: -Z 2- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ 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 I_J lqo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L3 `Vo
❑ 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
LQ lqo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[fNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FI-No
❑ NA
❑ NE
Comments (refer to question`#): Explain any YES answers and/or any additional recommendations or any either comments:.
:Use drawings of:facility to,6etter explain,situations (use_ additional pages as necessary), -" �,
z,t -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone:
Date: ( /* 7
21412015

Type of Visit: (0 Co pliance Inspection U Operation Review (� Structure Evaluation () 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: O Departure Time:© County: QR&_-5( - � Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: W& 01LI
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►apacity Pop.
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D, P,ouItrF C•_a a_cit Pao
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Boars
Non -Layer
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Ldg_
I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Page I 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 C_-I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZN
, ❑ 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 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNN ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VN
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
N❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number. !'' - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA 0 NE
25. 1� the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ZNo
[]Yes ❑�No
❑ Yes ZNo
❑ Yes V(No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: a L Phone: 10 _73 0�
Reviewer/lnspector Signature: PDate:
Page 3 of 3 21412015

Type of Visit: QrCo 71liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q, Arrival Time: Departure Time: �, (" County: D)Q,,—r_Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
r
Onsite Representative: �_kL6 :f Ago I V !ZU SA, Integrator:
Certification Number: 1 -1I Gq
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
INon-Layer
Design
C►apacity
I
Current
Pap.
Design Current
Caitle Capacity Pop.
Dairy Cow
Dairy Calf
Da'y Heifer
Wean to Feeder I
Feeder to Finish 3 a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , $oul
Layers
Design
Ga aci
Current
Pao
Cow
Non -Da'
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars I
Pullets
Beef Brood Cow
Other
Other I I
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 MR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes dN
o❑ 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 YNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Daoinspection: {
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? D Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment"threat, notify DWR
nvironm2Nj
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes�Zo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, andlor wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P/No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNoo
❑ 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
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: -I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes o ❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
rL_l ' - NA, ❑ NE
I_J 1" ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10l
Date:
214120 S

Type of Visit: a =0utine
Hance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O 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:
Onsite Representative: �- 1Q 6-tA Ao ft�-A'1_ L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1-716`-f1
Design C►urrent
Wean to Finish
n C►urrentWet Poultry Catt[e
znaciffv=��Q
Layer Da' Cow
Capacity
P.
Wean to Feeder
[Non -Layer DairyCalf
Feeder to Finish
Farrow to Wean
DairyHeifer
Design Current D Cow
Dr. P,oultr,. Ca aci P,o Non -Dairy
ILayers I Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
D NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZN�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. 4s' storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: t�
Spillway?:
Structure 4
❑ Yes
Structure 5
02 /No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ffNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental -threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FZ/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 [3 Yes C]r'N'o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes n No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0o
20
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
l o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
ElYesVNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis - ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
l No/
I6/No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
CD Yes
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection: 1K
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
257 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P4410 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ffNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes DO ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [2<o , ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yesbo�61_❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinus of facility to better explain situations (use additional panes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I
Date:
214 014

0
Type of Visit: 4Z) 7Routine
pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: O Departure Time:® County: � Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
� Onsite Representative: 'Jpa�'n n
�tJ V V talki5-- ft. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Poults
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?
Phone:
Certification Number: n I b {
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
. ❑Yes En No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑ o ❑ 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
No ❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: - Date of inspection: 3
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1, Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? if yes, check the appropriate box below, ❑ Yes n No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C3'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
d
g
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
k10
❑ 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? ❑ YesrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: Z
,24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RN o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ 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 EJ< ❑ NA ❑ NE
❑ Yes • io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [fj�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ 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/InspectorName: dpN Phone:( 1
1 _ D
Reviewer/Inspector Signature: Date:
Page 3 of 3 /4 OII

Type of Visit: OCon)� fiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance v
Reason for Visit: Q'Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: p Arrival Time: Departure Time: County:` Region:.
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: J0A/Ajq6LJ OIW L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: _ _ % 7 10
I
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
nish
Layer
DairyCow
eder
Non -La er
Da Calf
r-anF
inish
O
Dairy Heifer
D Cow
Won -Dairy
Beef Stocker
ean
eeder
inish
Design Current
D . P■Dolt , Ga aci_ P,o
Lavers
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other I
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: a
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 j Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: NJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3d
5. Are there any immediate threats to the integrity of any of the structures observed? EYes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
/No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 21
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes d No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dN��VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Ls.J' 0 Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑Yes �o ❑ NA ❑ NE
25As 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
o
gNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�To
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
Wo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
2
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
rNo
❑ 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):ig
Reviewer/Inspector Name:
0
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

► 1117;�
Type of Visit: (D Co�fipliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: V( Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: Departure Time: County: DUR/D-U1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
I
Onsite Representative: JdNj tj4A#f MILIldt—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Wurrent
Swine Capacity Pop.Ft7itry
Design C«urrent
Capacity Pop.
oil U
Design Current
Cattle Capacity Po
Wean toFinish
Dai Cow
Wean to Feeder
r
Dai Calf
Feeder to Finish
o Wean
o Feeder
o Finish
O
?r'a
Design Current
De, P,oul. . Ca aci- P,o ,
Layers
Dairy Heifer
D Cow
Non -Da'
Beef Stocker
Non -Layers
Beef Feeder
tBoars
Pullets.
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
rVN
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Nutnber: � 1 - I Date of Inspection: KIWit
Was;W Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iAGwo-J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I'_I "'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
' No
❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3"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
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of inspection: 8111
24.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
TNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
U 1V� ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No C] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ff No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L 1Zqq
NA ❑ NE
Yes U ❑ NA ❑ NE
[—]Yes Io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or any other comments F ""-"
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ad N .. b 0
Date: /
21412011

t
Division of Water Quality :` a r��
Facility Number -7
.,
Oa D�v�ston of Soil ands Water Copservatton
Other Agency
Type of Visit
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical AssistancReason
2Routine ccess
for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [IDenied A
I k
Date of Visit: r, /� Arrival Time: ©
V
Departure Time: County: ' I/t Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
OnsiteRepresentative: w0JRt lAd t`
h U-kk_ Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: o =' 0" Longitude: =°
A.
•
Design CurrentDesign Current,y;�-y Des,�gn Curren
Swore. Ga acr Po ulatton Wet Poultr Ca aci Po ulahon
p h P k,.;«.�y..�. P
Cattle >Ca acio ulatioq ,
_. :�t? .ap.
.wee _�°.� .�p
` ❑ Wean to Finish
_ ❑ Layer
; ❑ Dairy Cow
❑ Wean to Feeder 40 Non -Layer I I ❑ Dairy Calf
Feeder to Finish
y "~
El Dairy Heifer
Farrow to Wean
Praultry -e
❑ Dry Cow
Farrow to Feeder
ElEl
�Da
Non -Dairy
El Farrow to Finish
fi
IL
El Beef Stocker
El Gilts
Non -Layers
El Beef Feeder
LEI
❑ Pullets
❑ Beef Brood CoyA
Other,
ur e s
❑ Turkev Poults
ElOther
El Other
"' MumberAoStructures,
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?.
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 [INo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
[I NE
❑ Yes
El Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12/2"4 Continued

Fa*ity Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
ff No ElNA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
AAStructure
Identifier: to &5z-d
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 4-6 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
u1 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
n 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)
l3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? 0 s
15. Does the receiving crop and/or land application site need improvement? Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
11
No ❑ NA ❑ NE
El No El NA ❑NE
ff No ❑ NA ❑ NE
d-No ❑ NA ❑ NE
0 No ❑ NA ❑ NE
Comments (refer r , to.question #). Explain any YES. answers and/or any. recommenda#ions or -,Any other cflmfents
Use.drawings of facility to better -explain situations. (use additional pages as.necessary),:
D61 `b ILCk I �T
Reviewer/Inspector Name o �, �. Phone 1?)
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 ' Continued

Facility Number: 7j —�� Date of Inspection
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. ❑ Wl1P ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L"I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1--4 NNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes E; N/o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 53 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [;�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes LEI No ❑ NA ❑ NE
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
El Yes
ElNA
❑ NE
El yes
,�o
L'J No
❑ NA
❑INE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes
lz No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2128104

Type of Visit U7Routine
pliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: g f Arrival Time: F/i" Departure Time: County: P Zr_ - Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: I Title: Phone No:
Onsite Representative: �JdN __ Pura Z Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ ❑ Longitude: [� o ❑ . = Ai
Design
Current
Design
Current Design Current
Swine Capacity
Popularion
Wet Poultry Capacity
Population C*attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish I1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other,
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

1F&cility Number: — Date of Inspection d
�W� Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S_LAtructure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate tbreats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltreat, 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? ElYes L21/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 it No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ ❑ NA ❑ NE
7CJN NA ❑NE
NNo ❑ NA ❑ NE
VoVN
ElNA ElNE
o El NA ❑NE
Comments (refer to question"#). Expla�_n a.ny YE.S answers and/or any�recommen_dations or anther comment_s_.
Use drawings of facility to better explain situations. (use additional pages as necessan);+ -�.-•`
�.) ,�yT.:o4 L A FT69, �A i✓t APO 1 zoM.�✓ �NSPE 1J7-,X QJ. `
Reviewer/Inspector Name a. ;:� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

'Facility Number: 31 Date of Inspection 0
Required Records & Documents
i _ .-
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
dyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly FreeboardWaste Analysis ❑ Soil Analysis
[IWaste Transfers
❑ Annual Certification
//❑
❑ Rainfall ❑ Stocking ❑ Crop Yield [2 120 Minute Inspections Ymonthly and I ° Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
,CJ"No
U�No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
CJ No
[INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
9'No
ElNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El'No
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the hermit or CAWMP? ❑ Yes O N ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Rio
❑ 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?
El Yes
[ J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�
D 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
;Wog
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

1 H q2
Type of Visit 0
7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical AssistancReason for Visit 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: i J@NAr Pali . n k Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o = d =«
DesigAiPopnulafloi
rrent
Design Current
ine Capac
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑ La er
❑Dai Cow
Feeder
❑Non-1 a er
❑Dai Calf
to Finish
❑ Dai Heifer
to Wean
NFarrow
ltr❑
D Cow
to Feeder
❑ Non -Dairy
to Finish
❑ Beef Stocker
Non -La ers
Beef Feeder
Pullets
El Beef Brood Co
❑ TurKe s
Other
❑ Turkey Poults
❑ Other
❑Other
t3umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ldNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
} N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 31 Date of Inspection/GS
1Naste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t_ i Cr"N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6I 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 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes l' No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
.._.
0<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
01go
❑ NA
❑ NE
Is-,) W S 6 rlC14
/A6 P 4 r <✓6 E,D C4n1traL
Reviewer/Inspector Name L Phone: f/o 7
Reviewer/Inspector Signature: Date: / 'o
Pane 2 of ? 12128104 Continued

'Facility Number: — Date of Inspection a
dR d V. t
eaure ecor s ocumen s �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El,.,
Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Designs ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes fx(
El ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes �J No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
�No
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
.
E, o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
No ❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings.-'': ,
Page 3 of 3 12128104

[Facility Number ']a�
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit d C pliance 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: Arrival Time: ® Departure Time: County: D!? Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: M- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ 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?
❑ Yes WNo ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
do
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

F�acility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): a!Q •�
Observed Freeboard (in): Y
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?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentZNo
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA
❑ NE
N'
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
,�
L.d'No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,.,%
Id No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CfNo ❑ NA ❑ NE
maintenance/improvement? ,.,/
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
, ,
0"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
NNoo
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,E
C?Ko
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�70
❑ NA
❑ NE
j 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):
(,SASE LAJD &16W NFG/ AG2EEM-E1+/rl
ti,) lek c-P m-m-osr RECe4VT (,d C il PAX-A-VIF 411A 1�twr'
24,) lq 6 P c«P'' OF AM11 f9 L C-115n477 f s-W <rj,/4�- G,, a_ECoxPf.
Reviewer/Inspector Name 04"W pl<_ Phone: 8 9b — 13W
Reviewer/Inspector Signature: QZ66e, Date: U
12128104 Continued

Facility Number: 3 1 -72Date of Inspection !
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes M4o ElNA ❑E N
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 12 /No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Er/Yes ❑ No ❑ NA ❑ NE
❑ Waste Applicat� n ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 016nual Certification
❑ Rainfall ErStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E1 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 o ❑ NA ❑ NE
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?
Comments and/or Drawings:
❑ Yes ON"oo ❑ NA ❑ NE
❑ Yes O'No ❑ NA ❑ NE
❑ Yes ["No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA dNE
❑ Yes Leo ❑ NA ❑ NE
❑ Yes 9-Ko ❑ NA ❑ NE
❑ Yes 9-116 ❑ NA ❑ NE
❑ Yes ❑-ice ❑ NA ❑ NE
❑ Yes 9-110 ❑ NA ❑ NE
❑ Yes Q'<o ❑ NA ❑ NE
12128104

�f
Facility Number 31 D--E=
Q Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: lODD Departure Time: d U S County: DuPLZr#3 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: CE^'a Integrator:
Certified Operator: D AVM . t3Ayt5 Operator Certification Number:
Back-up Operator:
Location of Farm:
S-Aine
Back-up Certification Number:
Latitude: = c 0 d = {[ Longitude: ❑ ° 0 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
2880
00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co"
Number of Structures: F
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
❑ Yes
o
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes E(No ❑ NA ❑ NE
12/2"4 Continued

Facility Number: 3 -- Date of Inspection
+' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Cl Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAG 00/f I
Spillway?:
Designed Freeboard (in): 1 q
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
Dlf sio ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
O No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
'No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
,�(
LJ No ❑ NA ❑ NE
maintenance/improvement?
'No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Ef ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) 13 f-2 Myf3A (G + u) 560
13. Soil type(s) A u e Vo Fl
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffj 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
se drawings afrfactlity to better°eaplam s�tuattons {use addtt,onal�pagesiasinecessary)
1 .) %44 * r co PY c t c.-ERT s E r 6wrt w r) eC r,- 1` tT L.im ti GAS b.S
zl. na c of� Ys��vS. 1c.ECr cart uE Ar+NvAicER-T -t- StDc-k:tNG
IL�rcP �P `� 6� SLUp6E pND l�.Al,.�ft_�iTfJi,J W.1`A� /ZEGU2�s wsas De�+< ,
Reviewer/Inspector Name '.Jo N r> (A R,n1 fc t'L Phone: !a r S DO x za 3
ReviewertInspector Signature: t"- Date: 31 r a to r
12128104 Continued

Facility Number: 3t — 72 Date of Inspection 3 t 6 aS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [I Soil Analysis ❑ Waste Transfers [I Annual Certification
_ca
❑ Rainfall � Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
29. Did the facility fail to properly dispose 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?
[�Yes ❑ No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes
fr No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
[ ?No
❑ NA
❑ NE
El Yes
[�No
❑NA
El NE
NA
❑ Yes
❑ No
Q
❑ NE
[I Yes[]
No
❑ NA
❑ NE
❑ Yes
E'1 No
❑ NA
❑ NE
❑ Yes
�f o
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
ElYes
0 No
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes VNo ❑ NA ❑ NE
additional Comments and/or Drawings: : <'
12128104

Type of Visit ([Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit &Routine Q Complaint O Follow up O Emergency notification O Other ❑Denied Access
Facility Number
Date or visit.. �l Time:
'' Z
Q Not Operational Q Below Threshold
Permitted MCertfflfed 13 Conditionally Certified © Registered Date Last OperatedorAbove Threshold: .. �. ..
FarmName: ..... L(! _Wd Q6�( ...... '�h'1_.._...._............I........---•- County:.....Neff'7.... ..................... ........ ........ _.............
OwnerName:... _ ........................ ......... ....... .............. _.............................. .............. Phone No: _........�__...... - .............� .. ..... .
Mailing Address:
Facility Contact: ......_ ./_..... _.... �.../ ..... ..,..... ... Title:.-......__.. Phone No•
Onsite Representative:.. .�(lll....�` [ - ..................... ...,_�...Integrator:... A-lfrH/ i K' r- ........ ......
Certified Operator:.-.. . .................. .... Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 64 Longitude • 4 49
Discbaraes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
i
a. f discharge is observed, was the conveyance man-made? ❑ Yes El 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 ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ .............................. .................. . .......................... ......
Freeboard (inches):
12112103 Continued

Facility Number: % — 7Z% Date of Inspection j
5. Are there any immediate threats to the integrity of any of the structures observed? (i��e/ trees, severe erosion, ❑ Yes [-]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenanceJimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel ❑ Yes ❑ No
elevation markings?
Waste A heation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding [IPAN [IHydraulic Overload ❑ Frozen Ground (3 Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16, is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
eCommeat (r fer to quesbana#) Expiate any YFS-answers andJor any rrecammendatzoru grapy othef,00mme_n#s.
las ❑ Field Copy ❑ F' - Noew—tesUse drvsvtugs offcil*4tise" tiompgneespusar3���
.�."
fl f 4 vt G oa f l✓ i` he `�ee
HW
Reviewer/Inspector Name ....'._= �`
Reviewer/Inspector Signature: Date:
12112103 Continued

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

Date of Visit: Time:
Facility Number
10 Not Operational 0 Below Threshold
0 Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: — ��w �u7 -- - - -- County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: /Title: Phone No:
Onsite Representative: !✓� aP 64 '14W1. r/ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude a <
Design
ine Ca achy
Wean to Feeder
Current Design Current
P,o elation Poultry Ga aci P,o elation Cattle
❑ Layer ❑ Da'
11L]
Design Current
Ga aci P.o elation
Dd Feeder to Finish
$6
Non -Layer
❑ Non -Dal
El Farrow to Wean
[[E:lFarrow to Feeder
❑ Other
Farrow to Finish
Total Design OpaciGilts
Total SSLW
Boars
Number of Lagoons
Holding Ponds 1 Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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? ❑ Spillwav
Struc e l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes Jallo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes [RNo
❑ Yes & No
Structure 6
Confinued

Facility Number: 1 — Date of Inspection / Q�
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 IM No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [2,No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crop type A"'6 x S_&? _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®,No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
P No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ZgNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22,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
P,No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
E,No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Lallo
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
RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,Yt:A7c-1 .:i...... . i<_'^ala'n':"-
Cowmen �(iefer to puesbon.#1.._ mlam,adWYES answers•and/or anv recommendation ,oraanv other comments . _ 4t
�r� V - 4® z /' "
Reviewer/Inspector Name I
Reviewer/Inspector Signature.
Field Copy ❑ Final Notes
Date:
05103101 1— Continued

s sa
Facility Number: 7Z7 Date of Inspection
Odor Issnes
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes CgNo
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 W No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [&No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes n No
Additional Comments:andlor Drawings:,- :
05103101

i
(Type of Visit )C) Compliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: ' C' Tim,
Facility Number a-
Q Not O erational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated orAboveThreshold:
Farm Name:..............�4.................................... County:DL—fl%_�--...._.._-.................................... . .
Owner Name:
PhoneNo: ................................................ . ............
.....................
FacilityContact: .............................................................................. Title: ........................................ 11-........ ............. Phone No:............................... _.......»
MailingAddress:..................................................................................................................... ...
Onsite Representative: `�............................................. Integrator:.. !' ti y�^" :1 ..................................
............................... !
Certified Operator:...... .............................................. ........................... Operator Certification Number:.....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 4 64
- Design . Current • ,
_.
Design Current Design ` Current
Somme =_ ..- - Gs nci ` -Po ulation
Poaltry Ca ae Po` ulation., Cattle Ca aci .: '>Po `alation.
❑ Wean to Feeder
❑ Layer ❑Dairy
22 Feeder to Finish $ b
10 Non-Layer1 10Non-Dairy
Farrow to Wean
❑ Farrow to Feeder
❑Other
❑Farrow to Finish
Total Design Capdpity,
._ ❑ Gilts
❑ Boars
Total SSLW
._Number of Lagoons
❑ Subsurface Drains Present IF0 Lagoon Area I0Spray Field Area mm
_ Holding Ponds I;Solid TFW
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )?(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ONTO
Structure I Structure 2 Structure 3- Structure 4 Structure 5
Structure 6
Identifier: ...................................................................................................................................................................................
....................................
Freeboard (inches):
5100
Continued on back

Facile Number:--2,t —TP7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site -which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARylication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
•yiola(iQris;or- derc}endes ►ire ni�ted dirr;irig thjs;vis�t� Yo>�► wild �eceiye , . d further;
corxesporidence a�auti this ISIL
❑ Yes ) No
❑ Yes �fNo
❑ Yes ONo
❑ Yes t9 No
❑ Yes IA No
❑ Yes gNo
❑ Yes A No
❑ Yes 4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 6No
❑ Yes M(No
❑ Yes )d No
❑ Yes XNo
Ayes ❑ No
❑ Yes No
❑ Yes XNo
❑ Yes ,E�No
❑ Yes ,l No
❑ Yes 1� No
❑ Yes M No
Com ents.(refer to question #) W.Explain any -YES answers and/or any.recommendati6M or<;any other comments. �-= -.
_ _ _
Use`drawings of faclhty tii;better'expla n situstions.;(use adciitio�ual-pages as,pp5ess rp)
.m:
<j) WC-1 U_C_� Am ALI
Lk
t,, A it Cu..
Reviewer/Inspector Name
Reviewer/Inspector Signature: «- l—, - Date: ' f — UI -C-j 1 5/00

Facility Number:3 Date of Inspection
Odor Issues"'''"'
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes WNO
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 permanent/temporary cover? ❑ Yes KNo
AdditioR21 Comments an orDrawings:
� v�ca�-pis i `-� e. ` h.Ce S
5/00

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency -
Type of Visit Acompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: �-riine: G6 Printed on: 7/21/2000
EFacility Number 1 'a-r?
0 Not Operational Q Below Threshold
*Permitted © Certified ❑ Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: ...... Countv:.............................:......................................................
...lo��,..A...'�-.....................................................................
OwnerName: .................................. ........................................................................ Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ..........................................................................................................................................................................................................
Onsite Representative:. :�--- ....� ..... `-- .��... Integrator:.... ,GC1 V. `...............................................
..............
Certified Operator : ................................................... .............................................................. Operator Certification Number:........................ ..................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' �'= Longitude �• �' �"
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag•+nn Area 10 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?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge Us 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?
ci. 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
2(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
['W/No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
[�(No
Structure I Suructure 2 Structure ; Structure 4 Structure 5
Structuro 6
Identifier:.......................................................................................................................................................................................................................
Frechoarcl (inches): 33
5100
Continued on back

Facili6x-Number: --3 1—D77 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 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
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
[]Yes
jgNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
4&0
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑Yes
E(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
X No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
El Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
)<No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
34No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
'WNo
19. Does record keeping need improvement? (ic/ 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
;qNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[�fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes P�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
Nd -vii h ioris;oi- &flcienc{es -mere hated. during tbis:visit; - Y44 will receive iiq fucther.;
co_ . riesporidence: about this visit :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. -
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
70 Oil
Date: f G _3 , OQ sloo

r
F'aciljAy Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes -/No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 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? El 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 gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes j�No
AdditionalComments and/orDrawings:
5/00
5/00

" 13Division of Soil and Water Conservation -.Operation Review
D Division of Soil and Water Conservation - Compliance Inspection -
- - ED Division of Water Quality=_Cotripliance,Inspection
(].Other Agency Operation Review- -
Routine 0 Complaint 0 Follow -tie of DW ins ection 0 Follow-up of DSWC review 0 Other
Facility Number l ' L1 Date. of Inspection L 9
'Time of lnspectiori 0, 33 24 hr. (hh:mm)
�j Permitted 10 Certified © Conditionally Certified [3 Registered [] Not O erational Date Last Operated:
Farm Name: c1G[hAS.-......-. '� OA .. t�'L'tfc�.. County:... tSf4...............................................................
kl .................. ......... ` r
Owner Name:...... .....r� p ki►lt�.....(�, .&J ..........1�A.............. .... Phone No:...�r%l��.Zq.�.'.��i��..-.
FacilityContact: ................................ ............................. I ........ ..-.. Title: ...................... .......................................... Phone No:...................................................
[17ailingAddress: i. � ../.. tL�' n....... CRttt...I`!i-.......... I11Z3{......C.......,....................................... ..U...�..........
Onsite Representative: ........... [..!►.tJCh .......... .......111101 ........................... Integrator .aiL...................... .......... ...........................
Certified Operator: ....................Aa&f5t.......%oA ............................................. Operator Certification Number:..........................................
Location of Farm:
,I ko............se......�.s ............................................................ --
�:
Latitude Longitude
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
Mo
LYio
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEI
❑ Boars
Design Current - Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity Z4$a
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. [f dischargc is observed. what is the estimated slow in galhnin'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l
Identifier: II
Freeboard (inches): ...............44.
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes [� No
❑ Yes
No
❑ Yes
[p No
N��
❑ Yes
No
❑ Yes
d No
❑ Yes
$ No
❑ Yes [P No
Structure h
1/6/99 Continued on back

t acilitv�,Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
L q
❑ Yes M No
❑ Yes (j No
❑ Yes 1P No
❑ Yes ()0 No
❑ Yes ® No
❑ Yes FLAW No
11. Is there evidence of over application?
❑
Ponding ❑
Nitrogen
❑ Yes CO No
] 2. Crap type :'�m+..........,,.......m`�c-
................Ss1xt>`!
r.. ofrnx►u................W...�.1(Gar.....�,
r..tw........................... ............
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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 certified operator in responsible 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?
0. No.vio]ations .or. deficiencies .were noted. during O' is.visit . You w' 01'reeeive no' Nrttie'r .: .
.. .. ...... ... .
eorrespandence: t botit.this visit.: :::: ............... ..... ........ .
❑ Yes J�j No
❑ Yes CA No
❑ Yes ?!] No
❑ Yes 'El No
❑ Yes ® No
❑ Yes ® No
❑ Yes 50 No
❑ Yes ® No
❑ Yes ® No
❑ Yes DO No
❑ Yes [J No
❑ Yes 4 No
Comments (refer to question.#): Explain any YES answers and/or any_recommendations or any other comments.__u
Use, drawings of facility to better explain. situations. (use additioiial pages as necessary):
l
Ir, 6k l t)41L, y�V r
Reviewer/Inspector Name, y�„YtCth L
Reviewer/Inspector Signature- Date- 94
1 /6/99

Q Division of Soil and Water Conservation 0 Other Agency
0 Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection Facility Number%a.
Time of Inspection �24 hr. (hh:mm)
13Registered © Certified 0Applied for Permit Mermitted JE3 Not Operational Date Last Operated:..-
_
Farm Name. . >r 1. `. ..��rr.tr, County:....... L.I.\ a ................................................ .....
................................... ............. I.. .... .........---.....-----....... .........-----
Owner Name: ......................... Phone No:................lA..�................................................
�~ .. _5�...-
FacilityContact: .................................... ....................... ............. Title: ..------..--•-•-.--.......... Phone No: ...........................
3�1, rS l
)Viailing Address: ��.........................�Q......�......... �.. ...."�.��......�.5...8.............................. ..
Onsite Representative:-G�+-.......�-f�.�..................... Integrator: ...... .4�G!......'.........
Certified Operator;
Lo ration of Farm:
Operator Certification Number:,.,-•
...............................�.�........Nrac.... a;�.....
51...........................................................................
---------------------- .............................................................. ................
Latitude �• �' ="
Destgtt Cui
❑ Wean to Feeder
eeder to Finish
�XP
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes Cd No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes dNo
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in gal/min? *1l
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes IXNo
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 1xNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes XNo
7/25/97

I _,r
•. r
Facility Number:
8. Are there lagoons or storage ponds on site which need to he properly closed? ❑ Yes NNo
Structures La oons Holding Ponds Flush Pits etc.-
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi Fier: "
.............................................................................................................................................................. :.....:......
Freeboard(ft): ...... f ;..................................................................................
..... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes No'
I I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 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 Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type. �_�
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 reviewlinspection 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.vitilations•or d6f ciencies.were-noted-during this'visit.' You.vvill �ecei�e,no-furitier- : -
:. cpfrespi)bdence about this' visit:. ' , .. .
IqYes ❑ No
❑ Yes VNo
❑ Yes 04 No
.......................................
❑ Yes
&No
❑ Yes
J�fNo
❑ Yes
[�<No
❑ Yes
J.No
❑ Yes
CgNo
❑ Yes
R No
❑ Yes
C(No
❑ Yes 54 No
❑ Yes R) No
❑ Yes [S(No
In ACC � L5 ems. 00� Ace dl� dike &�41, C.'SAV-�
4 -e a-L, � _'N W.A. F,
7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:

EaC111, < 'Number 3i Z
Date -'of Inspection Time .of Inspectron
;
.o . .� ti ims'
Farm Status: 2�� ... Routine ❑ Complaint O Follow-u
Farm Name:���c,7�5.. �....�_, _ County:l
Owner Name:.. 1�? :� _._!�1.� ! S _. ._. _ Phone No: c??9
Mailing Address: /e�laC L`Se�✓1 S�Q'q,j]jQr,s�kilfZ'ylS�__
Onsite representative: �, +-�- -Zia Integrator:
Certified Operator Name: ._
Location of Farm:
Latitude �'s®�� Longitude ®' ®
0 Not OperationalOperatlonalj Date Last Operated:
Tvae of Oneration and Desian CaDacity
wi_rt,e s . W �.- Numlaer
Wean to Feeder
® Feeder to Finish
Poultry � :.NiainGer .� Cattfe _ .. NirrnbeIf �
La er Dair w
Nan -La er Beef
tEarroze
[3 Other Type of Livestock a 3 F
lo Feeder
Farrow to Finish
N7tmberof�agoonsF >iolcli gFos / x 0 Subsurface Drains Present
LagoonArea ❑Spray Fteld Area
General
1. Are there any buffers that need maintenance/improvement? Q Yes ,❑ No
2. Is any discharge observed from any part of the operation? [:]Yes ® No
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1' No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes J'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. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes El No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ER Yes ❑ w
maintenance/improvement?
Continued on back

-
6.
Is facility not in compliance with any applicable setback criteria?
❑ Yes
RNa
7.
Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
❑ YesNo
=i
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Ea No
Structures (Lagoons and/or Moldin I?ands
9.
Is structural freeboard less than adequate?
❑ Yes
No
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
2
10.
Is seepage observed from any of the structures?
❑Yes
OR No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
I
12.
Do any of the structures need maintenance/improvement?
❑ Yes
[Z 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 adquate markers to identify start and stop pumping levels?
F1 Yes
❑ No
n
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No -
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
i
IS.
Crop type
_
16.
Do the active crops differ with those designated in the Animal Waste Management Plan?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
®No
'?
18.
Does the cover crop need improvement?
❑ Yes
IN No .
19.
Is there a lack of available irrigation equipment?
❑ Yes
No
For Certified Facilities Only
20.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
] No
21.
Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
No
=
22.
Does record keeping need improvement?
Yes
❑ No
23.
Does facility require a follow-up visit by same agency?
❑Yes
No
24.
Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
Yes
El No
�e�+_'urr
Re fi er� Name
evrewcto
�+�� ag
�,K
Revewer/inspector Signature- r .Date, u
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

r
•
U
Site Requires Immediate Attentio
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIOW
ITE VISITATION RECORD 3 J — Z
DATE: , 1995
i . Time: L0,N9
Farm Name/Owner: ZIA (//1� 4:5A%''/ ZIS /t'
Mailing Address: / 4A ei 64 Vj�
County: % ' V
Integrator: ke Phone: �PD
On Site Representative: W L rrZ_if= _ Phon
Physical Address/Location:_ %
Type of Operation: �Swine
�V_ Poultry Cattle
Design .Capacity: Number of Animals on Site:
DEM Certification Number: DACE DEM,C�errtification Number: ACNEW
Latitude: 3� J Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year.24 hour storm, event
(approximately 1 Foot +`7 inches es r No Actual Freeboard: - _ Ft. - Inches
Was any seepage observed from the agoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available fo;,spray? Yes or No IsAe cover crop adequate? Yes or No
Crop(s) being utilized: ,�-a[.� il/�/ /d�� /i/� �)Fje 4Y_12
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wells�'Ye�Ybr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? ��Yeess or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters ofthestate by man-made ditch, flushing system, or other
similar man-made devices? Yes pf Nod If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
��'Loil!!►�ff�i�/l�l
a//G�/�� _
Inspector Name S
cc: Facility Assessment Unit
ture
Use Attachments if Needed_
'S/s