310750_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qual

F Division of Water Resources
Facility Number l� [J - ® Division of Soil and Water Conservation
O ©ther Agency
Type of Visit: *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 02,E0190jA County: k00PC;:0 Regionw. !""
Farm Name: �lrf (! wine Email:
Owner Name: ell % Phone:
Mailing Address:
Physical Address:
Facility Contact: TQ Yw S t Title: Phone:
Onsite Representative: Integrator: 7rn 1 1 + 4tlw
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
WItpoulIYEapacity
Design
Current
Pop.
C►attle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
11136
D r P,oult r
Design
Ca aci.
Current
P,o �.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
El
Qther
Other
T'urke s
Turkey Poults
I 10ther
Discharp,es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ Yes [—]No
[:]Yes [:]No
❑ Yes No
❑ Yes No
�NA ❑NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1Facili Number: - Date of Ins ection:
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
—a<--•— Structure 5
Identifier: f
Spillway?:
Ep No ❑ NA ❑ NE
[—]No r%;JNA ❑NE
Structure 6
Designed Freeboard (in):
3 30 U
Observed Freeboard (in): �i � `Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 [P 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 ❑ ence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C WS-l�.[ .r7yt,t t �q Evi P6"),so, ."waws'w f
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1f No
❑ NA
❑ NE
Rewired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FO No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [0 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes y No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: 'fo 1 %
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes,
No ❑ NA 0 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
M No ❑ NA 0 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
fp 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
[p 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
[9 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EP No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency.9
[] Yes
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations..or: any other comments --
Use drawings of facility to better explain situations (use additional. pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
' Wl
Phone: l -3? '9D
Date:
21412015

\ - ivi"sion of Water Resources
FacilityI EiEDivision of Soil and Water Conservation
• � Other Age,�cy
Type of Visit: ()-Eemplianc6 Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �QRoudne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:/h Region: "k
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
0
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine C+apacity
Wean to Finish
C►urrent
Pap.
I
Wet Poultry
I Layer
Design Current Design
Capacity Pop. Cattle Capacity
I Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P.oul
Layers
Design Current Dry Cow
Ca aci P,o Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
I 113eef Feeder
Beef Brood Cow
Boars
Qther
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes effNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes )2�No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes �No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Ea'&
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes TD-eo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility N amber: - Date of Inspection:
Waste Collection & Treatment
J.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo
[DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ZNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: T� 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pr-V
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes M 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 j� No
❑ NA
❑ NE
waste management or closure plan?
T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 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
❑ Yes ZNo
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;a No
❑ NA
❑ NE
maintenance or improvement?
t I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes P 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 J' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
gNo
❑ 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 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
jo
❑ Yes 2 No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [�No
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the fLility fail to calibrate waste application equipment as required by the permit? ❑ Yes PkNo ❑ 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 J;J-No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Effrlo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L2-No ❑ NA ❑ NE
❑ Yes ,E�fNo ❑ NA ❑ NE
❑ Yes _4�!t No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes 1�No
❑ Yes No
❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
A//V
r �'qr"' �QJ�� src"'7L Ut°/ (.J �� Ing In line"/
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
7_71-
Date: Z
1412015

Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: p Routine Q Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: i I Arrival Time: Departure Time: County:
Farm Name: Klcp �-f`� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: O �Q Integrator: r1't ��
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
I Layer I
Design Curreut
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,onl Ca aN P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
0 Yes [A No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
14 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
0 NA
ONE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge? ,
Page 1 of 3 21412014 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 PTNo 0 NA ❑ NE
r' a. If yes, is waste level into the structural Freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of anyofthe structures observed? ❑ Yes J�!rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2rNo ❑ 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,ZNo ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑Yes O'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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P�rNo ❑ 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 J2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,Ej*No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�"No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[fNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Des ign ❑ 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 aste Analysis ❑ Soil Analysis
0Waste Transfers ,,E5weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [ ] 20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a ram gauge?
❑ Yes
o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo ❑ NA
❑ NE
Page 1 of 3 21412015 Continued
T�

Facili Number: 71 - Xw= I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J2'No
❑ NA ❑ NE
•�� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ZfNo
❑ 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
ED'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
I:jNo
❑ 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
)ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�'No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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?
❑ Yes
ZNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ed No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�No
❑ NA
❑ NE
Comments (refer to question #rJ Explain any,YESranswers and/or -any additional_recommendations or.any other)eominents ;;� Z,
Use drawings of facility tombetter exc am situationsg(use -additional pales as=necessary).::
_
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
z'y
,_ 2-y
1 r-*--
APO
U
r P (,C}� �c1Q�5 (r-\
1
tQ e!C_V_\
yea/ e
Phone: �cy'
Date:
214 014

Type of Visit: 8-Compliance Inspection Z5 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: .Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I b Arrival Time: Q eparture Time: unty:21 RegioFZS f
Farm Name: { (' �-- _ t' ^ %�) Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:G (1 Ge__
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Desigu Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish 600 Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder 1) . P.oul. , Ca aci Pao Non-Dairy
Farrow to Finish__L Layers Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Uther _Turkey Poults
Other I Other
Discharees and Stream Imnacts
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[:]No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

[Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4.6Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? p 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 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1, r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes
❑ No
❑ NA ❑ NE
the appropriate box.
❑VP P ❑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
[]No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
❑ No
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - DoInspection:
24. Did the'facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? []Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [:]No ❑ NA i , ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
V
SC 7
Reviewer/Inspector Name:
Reviewer/Inspector Signature: fC
Page 3 of 3
Phone:
Date: 3
4/l 4

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: J21outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q 2 Arrival Time: Departure Time: County Region:
Farm Name: �►+ Z, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Q —I &_454:;�PD
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ill
Certification Nu ber:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity . Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current Dry Cow
Dt. P,oul C_a acity P,o , Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
f7ther
Other
keys
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?
❑ Yes 4ZI No ❑ NA ❑ NE
❑ YeAffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes )2!] No
0 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 '
❑ 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:
24 :Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes/n No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jj No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ Yes JZNo ❑ NA ❑ NE
[] Yes jo No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
[]Yes VfNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes tNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP? ❑ Yes Zj No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional rages as necessary).
Jr
�r il 3
<< <<cC'
l V -7
r � 1
l . `f 7—
< <'G ci
2� a v
1. 3 q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/a�`c� do 2
Phone:
Date:
2/4/201

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ,n/ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L i� .30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'Z 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 D 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes P'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 ff No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Y6No
❑ 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 0No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes T��o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f No
❑ NA
❑ NE
Required Records & Documents
r
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
4] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste T ansfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

umb Lcil�iy Ner,
-�
-O Division of�Water Quality
Division ofSoil andWater Conservation
�'°Other Agency
Type of Visit compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit P<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L Arrival Time: eparture Time: County: Region: [�
'i
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (� Title: Phone No:
Onsite Representative:( NU i�! L� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
S,M'*- Capacity.: Population
❑ Wean to Finish
li-1- ❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean I
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
~, ❑ Boars
Other
Back-up Certification Number:
Latitude: = 0 0 i = " Longitude: = ° = S a "
_ ",Design -- Current
Wet Poultry ,Capacity Population` Cattle
U Non -Layer
dry in
❑ Layers
-O Division of�Water Quality
Division ofSoil andWater Conservation
�'°Other Agency
Type of Visit compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit P<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L Arrival Time: eparture Time: County: Region: [�
'i
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (� Title: Phone No:
Onsite Representative:( NU i�! L� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
S,M'*- Capacity.: Population
❑ Wean to Finish
li-1- ❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean I
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
~, ❑ Boars
Other
Back-up Certification Number:
Latitude: = 0 0 i = " Longitude: = ° = S a "
_ ",Design -- Current
Wet Poultry ,Capacity Population` Cattle
U Non -Layer
dry in
❑ Layers
❑ Non -Layers
❑ Pullets
0.Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
N u m b e r of'Strut u re
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 Po ❑ NA ❑ NE
❑ Yes �No
❑ NA
❑ NE
❑ Yes )�TNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 01No
❑ Yes ETNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: -7 Date of inspection:
Waste Collection & Treatment
4. Is storagexapacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes &No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Stru e 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j "No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �fo ❑ NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 5;kNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes j ;Wo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes,,0 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 CAWMF?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
_0
❑ Yes �No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes oNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J�oNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes,,4�!J'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes &No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yesjo No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t 20 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 12'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �ZNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

[FacUity Number: -7 5r2 ifiate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P111
0
25. ili the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12'No
the appropriate box(es) below.
0 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P1110
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
jC2'&o
29. At the time of the inspection did the facility pose an odor oP air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
'FeTNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes L21f4o
❑ 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
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW T?
❑ Yes C3'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ N
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
El Yes 4�0�_
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
7
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: fd/ /L/ /Z—

Type of Visit .('Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit,.4D-Routine O Complaint Q Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: j1(12Z11&j Arrival Time: � Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: G Title:
Onsite Representative: C �c
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No.
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =' ❑ ' ❑ « Longitude: = n =,
=
Design ° Current Current
' " Design Cetrrent.
r Swene
Capiictt} "Population
Wet Po'*Design
._ ultry,Capacity P©pulation.
CattleC } ctty ° P�apulaiio
T. El Wean to Finish
JEI Layer
7; ❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er I
❑ Dairy Calf
El Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElFarrow to Feeder
: Non -Dairy
El Farrow to Finish
❑ Layers
+; El Beef Stocker
r El Gilts
-„ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Co
❑ Turkeys
` ❑ Turkey Poults
P El Other �; ❑Other
mre b er off St cu
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 O'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes PNo
❑ Yes /r No
❑ NA
❑ NE
[]Yes 6No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection l
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,2 No ❑ NA ElNE
a. If yes, is waste level into the structural freeboard? ElYes ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): -2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P-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 ,,O'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �allo ❑ 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 INo El NA El NE
maintenance or improvement? r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%.or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/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
ZfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
WNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or'any recommendations or, any other comments j
Use draWings of facility to'better explain situ ations.juse additional pg es as necessary) :
- low s fo f t ri S)a—aY 0:�'Ie V ve f late�t-
Reviewer/]nspector Name 7,7Phone:
Reviewer/Inspector Signature: Date: l
Page 2 of 3 12128.44 Continued

FacilitytNumber: — Date of Inspection
Required Records & Documents 91�4
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,E�No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XdYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Ga"W aste 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 j'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes );TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ZrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes [2rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 2fNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes PrNo
❑ 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 ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 0No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes PTNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ZNo ❑ NA ❑ NE
Additional Comments_ and/or Drawings:Ald
*Iyllo e-7
r
1,7
s h 3 1m of- % S'
Page 3 of 3 12128104

(Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit outine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Vh
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Arrival Time:
re Time: County:
Owner Email:
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Region: 10&
Bach -up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = . = fl Longitude: 0 ° "
Design Current Design Current Design Current
Swine Capacity Population �IetPoultry Capacity Population C**able Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ DairyCalf
❑ Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
El Pullets El Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turkeys
Other91010njElTurke
Points
❑ Other
10 Other I Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ?TNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ;rNo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
/
❑ Yes Ko
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

FaciliVNumber: — Date of Inspection
Waste Collection & Treatment ��,//'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes Id No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Struc e 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a2Y o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )2rqo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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? -enmYes VkKo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [io ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) `
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q` No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ElNE
maintenance/improvement? `
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
j2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
rComments (refer gaestton ##) E pl`am any�Y,ES answers and/or any',, ecoimmendations or any other comments.
Y.ay £ .4°'� MH ir.lYY'Sv r+caiM� 'K, +�,C,s. R- �-
-Use drawings of,facmty to better explam situations (use additional p � ag s•as neceTs�sary)
.� k�''ir_n0.-.ay `-'•.-i'C�"'^
.r-- .,�. w.:� .:;:�,
V411 0'5 k? Tt Ae>hl^Ao'r
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: Q
Page 2 of 3 12128164 Continued

Facility Number:.' Date of Inspection
Re uired Records & Documents ,_,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes .'L! No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes hfo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [:1 Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. /Yes Po ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield P/1"20 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24 Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes AVo
❑ NA
❑ NE
El Yes El No
El NA
[__1 NE
❑ Yes 2rNo
❑ NA
❑ NE
❑ Yes FzKo
❑ NA
❑ NE
❑ Yes 21'No
❑ NA
❑ NE
❑ Yes �3No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Addittonai, Com m ents�and/or_Dxawm
-7/ 31" 6- 3' ' a �c L� r. r�G� ';:N11'l
_
3- re-,
3. 0 1 m56KC—e
q Need ac4c&L
�~ I, had i J 1Cbj_aj
P
Jr),e, 90 (V OYV-�
Page 3 of 3 I.M8/04

IN U
f Facility Number
(Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ecompliance
Inspection
0 ration Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
7Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: j [ 3v Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C3orL- samcx__
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
Boars
Latitude: EJ o
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T.❑ La er
❑ Non -La et
Other
❑ Other —
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Longitude: [= ° =, ❑
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ DEX Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

7$6
Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 2/yes ❑ o El NA [I NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes L No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 86-oo- o 1 CA Gco rs Z 1-1rma,13 LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �tp q a\ Iq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #): 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):
µ ,) gj µ So Ar D
,A1 LA G-"N t� rrC 0 -4- Psi 076 . pJOV w 04
CrJ F, PtA eo-c NT
16 Q 06NE 4A)t YC1,A To c t)oTC-- QtLt-G& As AP. 0EEo to
FxLL_ PoA ,
PAPS a,�-�cr rt—
�'�R- - rrdr �s s�MT ws�� AvD akss .�
N ov "f SENr�
ReviewerlInspector Name
`j6 IQ (��� Phone:
1b
Reviewer/Inspector Signature:
Date:
�;L a
' 12123104 Continued

-7 Se
Facility Number: 3 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design '❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or
d
6U�es W u (e_ua6�C j inSer e' �A A A,qA�-
anq uU�,'' 3�`�!° ar. La11• al sw�r
1 C" 4 �
12128104

T�
0 Division of Water Quality
Facility Number ! p 0 Division of Soil and Water Conservation
0 Other Agency
.; ;
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ✓0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: jo 3 o Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: C-c-) wmc CATck Integrator:
Certified Operator:
Back-up Operator:
�f
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: = 0 =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
93 Feeder to Finish '? 13 I i G
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .',",
Capacity Population'-''
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 L/J No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El El NA
❑ NE
❑ Yes
El Yes
0 ❑ NA
❑NE
❑ Yes
7N,0❑ NA
❑ NE
12128104 Continued

j Facility Number: Date of Inspection o 3
Waste 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jA�� L_ CA Z LA j„ 3 (A Grw J L)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3, `3 a(Q 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LdNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E 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 tl�teat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UNo ❑ 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 C No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
��No
No
[;�No
0
No
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑NA El NE
El NA ❑NE
o) AU_XPF� AVA"lsLk RuY or✓ *N t WI - '0 V
kmc- ?2ANSf7E2 10 FrLvfo.. roKwt s w b Amb Cs.P `y `Co QWQ -Forte
YEAe-tbDfi,
NE aJ E 1, j W up 16 Coj 6n_ Pry &T W i-1 EtJ rJo G3 a Tl7'.
S�.UrJG E: SurU/�`►' �� (�`�' ENS 8 � JE42 .
Reviewer/Inspector Name Phone: !6 --� 3gS
ReviewerlInspector Signature: Date: 0 3 0
IL/17Y104 Lonunuea

'J Facility Number: Date of Inspection 3
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. L7 Yes (To ❑ NA ❑ NE
❑ Waste Applic tion El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
❑ Rainfall Mocking ❑ 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 2o El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes 20 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Zo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes WVNo
[I NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes ❑ NA ❑ NE
❑ Yes D'No ❑ NA ❑ NE
❑ Yes Ld No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UIo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;""
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CVICFo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
f
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�I No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
'
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M o
❑ NA
❑ NE
33, Does facility require a follow-up visit by same agency?
❑ Yes
JQ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

'Division of Water Quality
F20l1ty Number. Q�Drvision of Soil and. Water Conservation
— --
�: _Other_9Agency •:
IType of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: C� County:
Farm Name: C on_ t 4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
/
Onsite Representative: a��� I7I�11r f /u 6't Lf�li1P/
Certified Operator: (((
Back-up Operator:
Location of Farm:
e Swine Capacity PopulationAl
❑ Wean to Finish
IA
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
7. Other.
❑ Other.
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c = f 0 « Longitude: = ° = , =
Design Current Design -.Current
Wet;Poultry--.Capacity =Population Cattle Capacity Population
LJ Non -Layer I I_
Dr'3'Poultry",..":, __
❑ La ers
Non -Layers
❑ Pullets
1❑
E] Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:. , a
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[--]No
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
12128104 Continued

Facility Number: f3 1 77 S@ Date 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 I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
l 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question # ): 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):.. _
5j-,er-4ecA,t v--,- {e S fo)N &,R— Ao
fP Sc -� 10wk- ON r- � s 1-k
6,rr�� 1PCi�n�\
►-,
P s
ecu ft'= -
tlI
VhQtr,1y\Z'5, ��t 1S
r�o�i` 5�ve r"� 511o,til
�i1rl� Ly�, -A3 k 4AN k- -1 V\fS\kT./S 1
Reviewer/Inspector Name Le
Phone -
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1&28/04 Continued

-
Division of Water Quality
Facility Number / '� Q 0 Division of Soil and Water Conservation
- — — 0 Other Agency
Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Accesss� J
Date of Visit: // Arrival Time: =� Departure Time: o nty: «J'� Region: fill • f_
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �Lf'S7D�11 [�5,F� Integrator: /S/=7
Certified Operator:
Back-up Operator:
Location of Farm:
" Design Cu
in Capacity Pope
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: 0 ° = 1
ut` Design Current Design Current .
ion Wet Poultry Capacity Population Cattle Capacity Population
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other-.
❑ Other - - - -
--IU Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑Other`
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
ODry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 10 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ONo
❑ NA ❑ NE
❑ Yes )KNo
❑ NA ❑ NE
12128104 Continued

jj:�. . 4
Facility Number: — Date of Inspection !/ O
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? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: e W � A�- S
At el —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
V(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? V(Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
0
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/11
❑ 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 ❑ Applicatio Outside of Area
12. Crop type(s) Ul"L$ '
13. Soil type(s) tf-
f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
X13
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
. Yes Ef No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes A No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other:comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,Sol /fs� ���/.zTJ•�'
Cf�s �p� ��'4s
EsP�z� y 8�nuoq ��oWP) Af 69 .
Reviewer/Inspector Name Lr j 1 Phone:(q/v)
Reviewer/Inspector Signature: Date:
Page 2 of 3
12128104 {;onttnuea

ti
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 196
Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Zf No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
kNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
&Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
toYes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Zfyes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] yes
J% I No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
0
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
2, 615,x �°RvvFlJlri,
"}
No CeR VF y ��CF z�d.X�.n P7Zo,� �-fy�
25?
,ye-C'�a ���zf� 9)1 e,-_70�
65Z0n1 A 7--r-on�
00
,J
25 2(P
Page 3 of 3 12128104

M
L
f Visit A Compliance Inspection Operation Review Structure Evaluation Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: Arrival Time: Mr Departure Time: County: Region:
Farm Name: 2> Owner Email:
�f^
Owner Name: Zf L ��' 1� Phone:
Mailing Address:
Physical Address:
Facility Contact: D Title: Phone No:
Onsite Representative: D/J i �r _ Integrator: _ A6,91, �<a �'�-
Certified Operator: ��yQN Gf5_t;6��L _ _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c ='
=" Longitude: = ° =' = «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Boars
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 11 ❑ Dairy Cow
E.
�; ❑ Non -Layer ❑Dai Calf
Other
❑ Other - - ------ — 1 .
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Heifej
f
❑ Dry Cow
3
❑ Non-Dairyj
❑ Beef Stocker
❑ Beef Feeder
JU Beef Brood Covj
Number of Structures: IK J
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 PfNo ❑ NA ❑ NE
El Yes [I No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Cl NA ❑ NE
❑NA El NE
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 9 f�!i` ad �p
Designed Freeboard (in): e� f
Observed Freeboard (in): �1 Jr ,3� _ 2 3
❑ Yes V(No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J0 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 El NA [I 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 VrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) to
9. Does any part of the waste management system other than the waste structures require ❑ Yes V1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) �C 6_9,,. i?40 - i` i l .S. a-
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
9No
❑ NA
❑ NE
VNo
❑ NA
❑ NE
O No
❑ NA
❑ NE
No
El NA
El NE
21No
❑ NA
❑ NE
('�e� ss C d�2�. �.✓ oo� �i4�G5 �i'C,�PT `ojL Ale
aW 1"14C'VoAl A13
2p5
Reviewer/inspector Name I jT I Phone: 91f%'K�
Reviewer/Inspector Signature: Date: !? S a
12128104 Continued

Facility Number: — Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
VYes
❑ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W(No
❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PdNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONO
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�fNo
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
A No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA NE
Other Issues
((
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PfNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VrNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
A No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LNo
❑ NA ❑ NE
Additiional Comments'°and/or Drawiings:
L 0
0a.Va
�aavfAl-,"7,4 7;;�,'
� 51
12128104

* 0
sD1VlSIEIn Ol•;�Oi�l and Watet~COnservetiOn g x
^Other
�.� Jk
l
3
Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason tot Visit /Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
EFacility Number Date of visit: Time ' 3 d
I _' Q Not O erational Q Below Threshold
GrIp"ermitted g(Cer#ifiied © Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: .,�'%P.� X�L�1 �Cf7..c.... d . #..> -- - -- �w_..._ County: w ....� .... ...
Owner Name:..._ _ .._ ......
Mailing Address:
Phone No: ............................
Facility Contact:.............................................................................. Title: —............ — ,....._. Phone No: ...........
_.....
/ f _
Onsite Representative: Integrator:�li _
Certified Operator:._ .� __. _. __...._ .� __.. ....� _ ....__ ........ Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ' 4 Is Longitude • 4 «
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in 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 2rl Fo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JO NO
Stru-tune I Structure 2 Structure 3 Structure Structure 5 Structure b
Identifier: ............................. ............... .............................. ....... ........ _...
Freeboard (inches): r 30 2
12112103 Continued

Facility Number: — % Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes P 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? XYes [INo
8. Does any part of the waste management system other than waste structures require maintenancelmprovement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes VNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes Elqqo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes .ZNo
❑ Excessive Ponding [IPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with tho a designated in the Certified Animal Waste Management Plan (CAWIVIP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
— - — ; -
7 �e C�Se �o vtd 6&bhc
a ('eas o --F lagoon 3.
lonaUnn?ry) . ❑ Field Copy ❑
� ro LA 6c)Ver o e) e�L foSe
lk7aal au 1-61 U& o-fic 61i4 &,,tz // 0-� layco.? 3
��> �ar�I �t/7Gli ���i' 7�',j 7`t? �/�Y!?/s't�i`� G✓ 2��5
❑ Yes Cwo
❑ Yes P"No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes [3No
❑ Yes P<0
❑ Yes 12r<0
❑ Yes ❑'CTo
❑ Yes .fNo
Final Notes
T-�a� f�2rinuc�
Ol
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Conunuea

Facility Number: Date of Inspection / r
Required Records & Documents;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard jVaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
XYes ❑ No
❑ Yes O No
Yes ❑ No
❑ Yes eNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 014o
❑ Yes ja No
❑ Yes PRIo
w'es ❑ No
❑ Yes ❑'No
❑ Yes 2 No
❑ Yes ONO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 2No
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..,,.. ..,,... �. .......... - _ r _
/ Pleas'
S� Ale q1e 4 x ?�M7G�r�i�Li��
12112103

0
Type of Visit pf Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit: o O Time:
Not O erational 0 Below Threshold
0 Permitted ©C
ertified [3Conditionally Certified� ©Registered Date Last Operated or Above Threshold:
�4
Farm Name: rJ[ 1 C Q i
Z ` � County: 1/1P1%%l/
Owner Name:
Mailing Address:
Phone No:
Facility Contact: -� Title: Phone No:
Onsite Representative: integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
to Feeder I I I JLJ Layet I I 1.21LJ Dai
to Finish I I 1E1 Non -Laver I I 101r] Non -
Farrow to Feeder U Other
Farrow to Finish
Boars
Subsurface Drains Present
No Liouid Waste Mannaen
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?
Area ILJ Spray Field Area
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 5t eture 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number:'3 —7f Date of Inspection
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 ❑ No
8_ Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste .Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
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 facilim, 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
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WI_iP, checklists, design. maps, etc.)
❑Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DIVQ of emergency situations as required by General Permit?
❑Yes
❑ No
(ic/ discharge. freeboard problems. over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_.:�3auy4»:.k'4
Criitmeitts;(refer to gnes6on.-Ezglam:any YFS ansvperssttd/ar,ny recoiumendatsams.or�y.other.camatenta~r
Lse drawings of facslsty to better zplam situations.(nse additional pages as necessary)❑Field Copy El Final Notes `
,--Final Notes
41iOG��rr�
61 A -le)
r`C G Lo4n127 1eihip
e, i e !0
Reviewer/Inspector Name
Reviewer/Inspector Signature: Dste: 3O D
OSIV3101 V - Continued

Facility Number: — Date of Inspection
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphali-
roads, building structure.. and/or public property)
39. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. N ere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�l��PfL'7ZOi✓ '✓�N� -5"
n I.JGIJ( i�L y4 L/Z5'e- 601V %7749/ 10 /
-SniY1,E �'45�� P����� e Selz OF ��✓ --
�oDK
05103101

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason #or Visit 9fRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
d: CFacility Number ate of Visit
© Permitted ❑ rtified 0 Conditionally Certified Q❑ Registered
Farm Name:
Owner Name:
Mailing Address:
Z d Time:
Not O erational 0 Below Threshold
Date Last Operated Above Threshold:
County: 1�;z _
Phone No:
G
Facility Contact: Title: g�����y� Phone No:
y DD
Onsite Representative: e.PSrt�n� f�[ j 514 ER _ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0a 0" Longitude • 0
ean to Feeder
eeder to Finish
W
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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? ❑ Spillway
Sture 1 Structure
cture 2 Structure
cture 3 Structure 4 Structure 5
�c
Identifier: 2
Freeboard (inches): �Il� 2
05103101
❑ Yes � No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
P�No
Structure 6
Continued

PEaumber: — Q
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
to
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
El Yes
/No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jzfNo
Waste Application
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
No
essivePonding ❑ PAN ❑ Hy Overload
11. Is there evidence of over application�0_0e4Z
❑ Yes
No
renlic
12_ Crop type Z DV �J '
13. Do the receiving crops differ with those designate in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ YesKNIO
c) This facility is pended for a wettable acre determination?
❑Yes
o
15. Does the receiving crop need improvement?
❑Yes
1
16. is there a lack of adequate waste application equipment?
El Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
ElYes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
!!!! No
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
I
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
X No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
Y]o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.C6mmenti'(refet-to gtiestiiii #():, Explain any YESrvattswers aiid/or,any reco_mme'ndattous ar anv other comments.
y P
Use drawings of facHity to better eiplatn sttnstrons.:(ose add:teonal;pages as neeessarr)' Field Copy l Final Notes
w _
� OM F� � Q/✓7i2DL /VFf_Q.��O /10cc/✓D �%I-C�t�rJS �j 3 /q�t7,p
Reviewer/Inspector Name -— -
Reviewer/Inspector Signature: Date: 2
05163101
Continued
V�

Facility \umbe�r.Date of Inspection � OZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additional;Comrnents-and/or Drzwin s.'
O5103101
❑ Yes ❑ No
❑ Yes No
❑ Yes XNo
❑ Yes XNo
❑ Yes VNo
❑ Yes Yo
❑ Yes ❑ No

y '"wisian of Water Quality '
Q Division orCe f Soil and Wateonsrvation
= w:
_Other,'Agen -y = w
_
Type of Visit 45"Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit�Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 3j SQ Date of Visit: I t, I ITirne". /O'v6 Printed on: 7/21/2000
Not Operational O Below Threshold
[] Permitted © Certified (] Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: i Cieca! wL �y !� f . i f County: f t ► r1...................................................
OwnerName: ................................................... ...................................... .................................. Phone No:....................... ............................................................
._..
Facility Contact: .............................................................................. Title: ....... Phone No:
Mailing Address:
Onsite Representative:. JLrs 4' � US e r Integrator: M v f
.��.....'................... r....... .. ..............
r13 4W1 0
Certified Operator:.._...... .. Operator Certification Number: .........................................
Location of Farm:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current
Design Current Design Current
: Capacity Population
Poultry
CattleCa
. Ca ci Po tztation
Wean to Feeder
I[] Layer ❑Dairy
r Feeder to Finish
10 Non -Layer I I I[] Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
_ Boars
Total SSLW-
of Lag'--olk =
Subsurface Drains Present
Lagn<►n Area ❑ Spray Field Area
EirNeiiinber
�Hol�ing Poads/;solid Traps ,
No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... ..................................�.L..................... -3..... 'T........................... .............................
Freeboard (inches): ?Q 2 [a 33 34
5100
❑ Yes XNo
❑ Yes ZNo
❑ YesxgNo
� I 1
❑ Yes J214o
❑ Yes )?fNo
❑ Yes Zfo
❑ Yes ETNo
Structure b
Continued on back

Facility Number: ',y ]— Date of Inspection 1i t?I 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 1 No
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ff No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes E�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application_
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'J�fNo
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes j� No
�_
12. Crop type Ge r rvd-, C. An4 rol1 f,/r, z e, C -" i 11 /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 7fNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes /0 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
I5. Does the receiving crop need improvement? ❑ Yes /P No
16. Is there a lack of adequate waste application equipment? ❑ Yes /11No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes PrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONo
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes gNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`! ❑ YesNo
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,-6 No
0: No-violations:oi- ilefieienc.es were pQterl dix`ing this:visit; You witl receive Ino fui-the� -:
corres�o de"e: about; this visit:
`7 . - W Ser10i [, o f 4 ` e ,.1e. q PC,- wt, -
*eeol 4v G11-iotoe 4 h e OL&ec',5e 4 - 4 ojran. 6 v t 4ke -Tey?' _1Is4p
-ewe-[c4cj( cle-ree�)e err- t R 6g. 8e s o re 4c Use a wAsle_
q ►'LQ 5 ; S a�a}ed Wi :�, �Q 1�� `j iscA4 to,-r o r-\ 41,e -Tze - �rr�
Alt 0
roes v�d ,'cc G d-t ct r'P J'2 r P i y kL0 `
Reviewer/Inspector Name 11 4 S L1`t tY ,p j`t
ReviewertInspector Signature: Date: 5100

FaOlity4Number: 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 ❑ 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 J1rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑T10
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 PNo
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.) ❑ YesZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;J'lVo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additiona1 Comments and/or rawin -

,6Divrsion of Water Quality
Q tvtston of Soil and Wafer Conservation
O.Other Agency: t
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit fi(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: %-4 -firne: �Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted 0 Certified E3 Conditionally Certified Registered Date Last Operat d or Above Threshold
1�
Farm Name: ............ �.. _.............
�} /1
iS.l.r�•Cr ..............�lefl!..,f'6�..fr County: ltLn�,�,..
OwnerName: .......... .f!tl.l...........................4%.................................. Phone No:.......................................................................................
Facility Contact: ......... .......Title �lfltotn.. ........... Phone No:.. .................................................
MailingAddress: ..................................................................................................... __........ ............
Onsite Representative:... f �.� f-i Yi,...... 5 • Integrator: �. f. ........................................
Certified Operator:..,__ „• Operator Certification Numb
Location of Farm:
A,
a. Z ti ; eas-1- o-s- S R t101
(Swine []Poultry []Cattle ❑ Horse Latitude ' C�1 is Longitude ' 4 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer Fr-
Dairy
ceder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Nlanagement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [krNo
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 Ilow 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 qNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes JNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
L► 6 Z L 3 4- A!
Identi fie r:.................................. ..........._._.
Freeboard (inches): 3 8 ' 3 i 3b "
5100 Continued on back

acility�'Number: — 0 Date of Inspection Printed on: 7/21/2000
5. Are there any im ediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes qNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does'any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes uk l0
9Yes ❑``No
❑ Yes J(No
❑ Yes KNo
❑ Yes NNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 19�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes T<No
b) Does the facility need a wettable acre determination? ❑ Yes TNo
c) This facility is pended for a wettable acre determination? El Yes \�io
15. Does the receiving crop need improvement? ❑ Yes 1�No
16. Is there a lack of adequate waste application equipment? ❑ Yes Ekio
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
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
2I.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El YesTN
o
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yeso
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?
ElYes
No
0: -Ablaii6 is:oi- dMc 6ni-_ e9 mere h6ted• diWkW 4bis:visit: - Yoi} will 4-60HVci ti6 t'ui'ther _
corres�otideifce: 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):
We,& ►, 0 -t fi e-� 4 hr�-�i'%V'V ry --A 1n ie .,ti
1 S
a L c w. r.� . S� W C-- - % : i-cr � [,�.,n,,., ,I` L �i w 1/..1 s .,,. ►,� d�O
hM1.(0Y �.�� Cv✓ dYth } �O ► •tY OWE_ .r { - PC 4&ar1
Reviewer/Inspector Name Yo'�"
Reviewer/Inspector Signature: v
Date:
5100

Facility' Number: Date of Inspection—`i7—rr 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 tiJor below j� 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 INo
28. Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �`'N0
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 PNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes krNo
itiona ' omments and/orDrawings:
J
5/00

13 Division of Soil and Water Conservation - Operation Review
© Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection
Other Agency - Operation Review -
LURoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Z 'j
I - Time of Inspection 24 hr. (hh:mm)
Permitted ❑ Certified [3 Conditionally Certified El Registered [J Not Operational `Date Last Operated:
Farm Name: I d ..%1(s-Gf.........rp.................................................... County-:.... 1TY�................. .......................
OwnerName: ....................:.L :............. ........... Ina ............................................. Phone No:..........................................................................,..i...........
Facility Contact: I' klW............................- Title:................................................................ Phone No: ( �� :.. �"[.........
MailingAddress: ......1 ...-.....``fV1?ll+-....1.17....:.................................................. ...............W—t�......... �........ ...................... ... .....
Onsite Representative:......,,,,�,�S ja.5�,€y. . Integrator: �k
Certified Operator: ................................................... ............................................................. Operator Certification I umber:........-.................................
Location of Farm:
............... ...... .�Q....................5..-..1.1�. ..�.....)....ln)i�.t ....ia��S.....Q....... 5.9... UI.2,.......................... ................ ............................ I ....... .. A.1
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- T
Latitude Longitude �• �Ort
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish - ' Total Design Capacity 1 { 36
❑ Gilts.
❑ Boars Total SS, LW
hYuruber dLagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area -
Holding Ponds / SoEid Traps r ❑ No Liquid Waste Management System
Discharges & Stream Impac
t. 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
h. 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. Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes MNo
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 1�3 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier-, Z 3
Freeboard(inches): 2�............................ZJ............ ..........12............... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ict trees, severe erosion, ❑ Yes AyNo "
seepage, etc.)
3/23199 Continued on back

f`r
Fa *- y Number: 2+ —']G j Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public stealth 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 maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste L% lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? L] Excessive Ponding SPAN
12. Crop type
❑ Yes to No
❑ Yes [9 No
"N Yes ❑ No
❑ Yes W No
❑ Yes 10 No
Yes XtNo
13. Do the receiving crops differ with tl ose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? Ea Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
ReQuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ 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?
0: ivo-violations,ot. de#iciencies -mere noted- diwing this:visit; - Y:ou will -receive lid further
ctirresoricieizce ahoutithis visit
❑ Yes 10 No
[]Yes M No
❑ Yes N No
Yes ❑ No
Yes ❑ No
❑ Yes C9 No
❑ Yes M No
❑ Yes RNo
❑ Yes 1�kNo
❑ Yes No
❑ Yes No
Cotntments (refer to .question #) Explatn any YES answers and/or any recommendations or any other comments
Use drawingsof farili}� tii-better exµ lat situahotis /`ustt
e addibo'aal a es as necessa µ _ -
p p g ry�� =J--
$- 6 or-, low O*trf- �. SQL -e[ �e C Sul 0-MV4
SQ+ Owroc� �41� o_a rvna•
11. d.reko�v��cc;or� OVAc�raw�3 3z `ti" 3 ar, �exmvae- 1 IZS. lice `F �Ql, Iiasf��.
SeYalt r� aue- A �Au.4,4_ naY a • v 3z c z� k^t
ti. LO To . a cs ll5 �w Om kx [#-rns4+� 11 � � [�- ti t \ ` yV,�c urr .n
�rc Do t S Shoup 6. acov,^11 � Wf e Ir� r i�l i r
Reviewer/Inspector Name
ry=-�
�n -.
Revieiver/Inspector Signature:
Date: 1 ZI —, /qq
3/23/99

4 FiNiity Number: 3 —=50 Date of Inspection
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below P 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 �PNo
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PNo
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 10 No
Additional omments'an or. rawtn
.�
i
3/33/99

Facility Number: 31 — 120
8.
'Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
1�1 No
Structures (LagoonsMoldine Ponds Plush .Pits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: �.................:..............Z.............................. ............................ ..........................................................
...................................
Freeboard(ft): ...........1:................................ .:.?:................... .............
..................... �:.4 ................
10.
Is seepage observed from any of the structures?
❑ Yes
KI No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
'M Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
91 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
13 No
(If in excess of WMP, or�trunoff entering waters of the State, notify DWQ)
15.
Crop6�S A. ...! me 1..... � g ice------------------------ ---
type ....... ..........................................-----......----............................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
91 No
18.
Does the receiving crop need improvement?
99 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ig No
22.
Does record keeping need improvement?
91 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
ER Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
011 Yes
❑ No
0- No.violations-or. def"iciencies.were-noted-during this.visit.- You'4ill recei've-na-ftirttie_i~ : -
. • ctirresp�ndence about this: visit: � : : ..:. _ .: � , .: ...:::... � .: . : . . ..:.:.: :...::. . .: :.:.. .
's.'BrL6' k r� us `� �b+i SOU[0 tcMpve %01�- 4,,L Sp�dw i1fIU� . AvoO s�va I1�
�d1�1 _ ► LO.X- N% r�pllsBs c.-� gg � • ` 1 1 i r I
�l 112.C1er a rts5ia►� o�t,�S Grp `�{.•,- `ac``�fCr of Ili tix.�(S o� �ar�aorS f�f 3'F tom}. ir�tse
artas t�n�Id � l �J � M-werrcl�e11Cl FS Sao:. 5 osSi bt.Y.. wcc,s a.. l oor. J%P4s
o{- r l #b 3 i- its sho✓� �e NJ1Cg2 {tttrtl- I(t oaali s a gw all 1. yo. 5 5 �d e '-0
Do'yY ' tow• G�c�i:+� `�iet.S ��` ("JO),'+L} d►v.; w�-l1 S�clt� be rVW-Vvtj.
&e"KAa. lr� all F�cic�5 •sko-U J can�;,tve {v be t,ni,,rovPd- I
Gev E o fc;cA�-ior �a�ma o� ,� � g i* l 4- JNQ#7_ �r is skocJl) Vkc Ap+ S4_ 4, 7/25/97 �
Reviewer/Inspector; Name
Reviewer/Inspector Signature: �/� f,� /' /„ J� _ _ Date:

I Facility Number: 3 t — T p Date of Inspection
Addifi na n&r DrawEngs: w "liLl A
yy LC)jrr�&. b,2
P--Y,w- Kwrds, —tL (Pfk-2-.
-4% Z"kojd k�-- (Atbj Jiuv
-C Cot -CL
Pw- tatoor, -�-, C)&wc aW<CWV\ &Ati JD4LV-MA 0'- asA 43 ��r\ LA) Ulp-
17-T. hiF \nevyKLO&ir, NO No
"In
OK 1"ory 4j
7/25/97

0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
14) Routine O Complaint O Follow-up of DWQ instimtion O Follow-up of DSWC review O Other I
Date of Inspection Q $
Facility Number ' I .{--
' Time of InspiK:tion 24 hr. (hh:mm)
Registered 10 Certified [3 Applied for Permit 13 Permitted 0 Not Operational Date Last Operated:
Farm Name l�.... g County
:......--.- --... t ..�.tc.�...........xr ............................. . • ....... a.i
OwnerName ............ J..L.............................. ....................................................... Phone No:.......�? :.��
Facility Contact: ...........AvaIQ W-kr. Title: . Phone No: .............
BW 'v 7_V4 I
Mailing Address:...... - ............. a►�..... .............Ewa...nl�...�"�.IJ....................... ........... c....tn r..l........
r.......................
Onsite Representative : .............. L.11 0 ....utll� ..................................................... integrator:.....................................................................
Certified Operator;.............................................................................................................. Operator Certification Number:.....................
Location of Farm:
?h ......... .. ...SC�4...A ..............l�is..j.A ��..Skt'�.tS.. S�.....Q.....sz.i111!.......................................................................................................
qW........................................ ..... ..I.................................................................................................................................................. . .
Latitude �'_�� Oar Longitude • ��"
Swine,
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
5 ❑ Boars
Current Design Current :•: Design Current
Population Poultry Capacity Population Cattle . Capacity.Poptlatioa
9Number df Lagoons /.Holding Ponds '�� Subsurface Drains Present JrEl Lagoon Area 10 Spray Field Area '
No Liquid Waste Management System
General '
1. Are there any buffers that need maintenance/improvement? ❑ Yes P9 No
2. Is any discharge observed from any part of the operation? ❑ Yes [A No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes No
c. If discharge is observed, what"is the estimated flow in gal/min? N
d. Does discharge b}pass a lagoon system'? (If yes, notify DWQ) El Yes M No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [61 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes P§ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement7
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97 Continued on back

4& Routine O Complaint Q Follow-uR of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection a
Z
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: JR Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:....._ ........ ...... ..... _ .... _ ..................... __... _ . p
Farm Name:.�.Ld.:.. ..... ._ �.... _...... County:.�.4.1i.�w..............L.I�Q
Land Owner Name _ i. _ Phone No:...... . _....� ..............._ ...... .. ... _ .
Facility Conctact:.....__... .......... .. Title: _. Phone No: 9.1 a ?-•.
Mailing Address: .�r�..� l�ta.h..�..... .....__..... _...... ...�?.. 2.. ,�. _.... Z..�..
Onsite Representative: .�!l s.5,;.. �.n..� �n �.^�.._ Integrator::,...
C mil' T L r � _ .._. .2p3 0 ..... _..
Certified Operator:..... ...�... _....3DQ...... . 5 ..........., Operator Certification Number: _ _..
Location of Farm:
�GLr►. Yxfl %_...5 t d .._. !. oL.,.....a. .ram arm r ^�.. �7.. Z,�...x �.E,c �... �, a..s..x�.. d. _...1 .._. .V �. C
.. Lst.t.�:.`......3.G+....�.!.�.i.s....�9�.r..�_...:�t... �_'_S�t._..........5t�._t. .............'1"a�.`..'�.....�c�A�._........_..---..,----..........._........----..................-- �
Latitude Longitude ®•® K
Type of Operation and Design Capacity
Design Curreat� Design Current} uilesign Current
Swine Ca aci Po ulation N Poultry: ' Ca aci Pa i3lation.. Cattle T
Ca "aci Po elation
nL
Wean to Feeder La er '- ❑DaiTy
;® Feeder to Finish 10 Non -Layer ❑Non -Da'
El Farrow to Weana.
Farrow to Feeder � Total 0esig i Capacity
Farrow to Finish z
S
otal sSLW Zo
❑ Other "' ,
Number ot'I,agooas"/ Holding Ponds ❑Subsurface Drains Present
c ❑ Lagoon Area❑Spray Field Area
'if'•: „"" .Y.ca v ,3 �,.. kit ,a. Wit t
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes &No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [,No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 91No
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 Eg No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
S. Does any part of the waste management system (other than lagoons/holding ponds) require R Yes ❑ No
maintenance/improvement?
4/30/97 Continued on back

Facility Number: .3-A...... _ -
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes EffNo
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ([,agoons and/or Holding PoncW
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft)- Structure I Structure 2 Structure 3
.......,fir...: �.......... .......—..r............. _..._...—.........._...— ..
10. Is seepage observed from any of the structures?
❑ Yes ® No
❑ Yes E9 No
❑ Yes [R No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there 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 review/inspection with on -site representative?
For Certified Facilifies Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes JR No
91 Yes ❑ No
❑ Yes ® No
❑ Yes ®.No
❑ Yes ER No
❑ Yes ®.No
0.Yes ❑ No
❑ Yes JRNo
❑ Yes ®.No
❑ Yes RNo
❑ Yes Jallo
❑ Yes ®.No
N,Yes ❑ No
Comments (refer to'queshon #)f Explain any YES, answers and/or.: any recommendattonsor any other comments
Use drawings of facility to better ezpiatn situarions (use adciihanal pages as(necessary)# x y
tl �a �qJ0 0 v. W+�-cL Y q J- Q
U C v� } s P G w0 S i {-4, , s } kA - V It f-t' 4 h V^o
+4-p. ►""-�-u�t I off '0� l I s f
'A0 V% , t ^- cX—d— d- tt-� 0 v% j k_ L t 5 k-o V
a
' 4 0-•4-S V f
ZN t M"'C • f 'S v � �. a �-a (. c,v to
�} tI
Reviewer/Inspector Name �
Reviewer/InspectorSignature: ]Aa� Date: ZZ
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

10 Routine O Complaint Q Follow-up of DWQ ins ection O Follow-up of DSNVC review O Other
Date of Inspection A7 9
Facility Number
Time of Inspection I D 1 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: E[Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: County: -111. Li ,r,.. _. ...........
Land Owner Name: aTa ...Zx_�
........... ..�...., -..t...Q....__....__..............................._ Phone No: .........._..............:........................---
.....---
Facility Conctact:.... ...... .............. Title: . Phone No: .... .......
MailingAddress: .......... ._........ _.— .... .......... �.... �..... _ ...............
OnsiteRepresentative:..I .x.1 �..�1 _ _!��! l.1 ...� .i.�a..rw Integrator: �1 .�.t,. ---
_.----_.....................
�....._.
Certified Operator:.... , ....__ ...__....__..... .......... _....W ......._..... _.....�..... .., Operator Certification Number:
Location of Farm:
!r4^ ----...._F
.............,.....................I-----...._..............._,...._..........----..-_.........
Latitude �• �� 0 u Longitude
Type of Operation and Design Capacity
vDesl Current
Svnae �.P It Design C went Catiie "-'Diiign XA%irrent
ulation r'Y >�ea acitv�Po ulateon Ca ael Po - nlanon .
n ❑ Wean to Feeder ' ❑ La ❑ Da
®,Feeder to Finish A ❑ Non -Layer ❑ Non Da
'E
Farrow to WeanW-dL'otal.Vesig!!
� g
171 Farrow to Feeder Capacity
flrl Farrow to Finish j
0 Other
� 3. _ ToKLQ
talsSSLW
Numbe of.agoons/Holdtng Po ds ❑ Subsurface Drains Present
0 Lagoon Area , ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 18 No
❑ Yes &No
❑ Yes ® No
❑ Yes No
❑ Yes
W No
❑ Yes
(. No
❑ Yes
R No
❑ Yes
RNo
Continued
on back

Facility Number:. 31...... —...,,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures goons and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
❑ Yes
19 No
❑ Yes
19 No
❑ Yes
jallo
❑ Yes
O_No
Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
Z[ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
[KYes
❑ No
12.
Do any of the structures need maintenance/improvement?
1K Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid Ievel markers?
❑ Yes
IR No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type J.� a-- ..........�isl!.�.� .. h......_ .... ...... -.. _ .. ...._
16.
7
Do the receiving crops differ with those designated to Animal Waste Management Plan (AWMP).
❑ Yes
9[No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
UNa
18. Does the receiving crop need improvement? ❑ Yes ® No
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a follow-up visit by same agency? ❑ Yes JKNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes R No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes KNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
24. Does record keeping need improvement? 19 Yes ❑ No
.. .c 1.s , 1 1 3
Corift '(refer to Neshon #) Explain any YES answers andlor any recommendations ar any,;other comments:
llse diawtn s of facilt to better ez lain situations use additional pages necess,
g ty A { P g ary)
:n "A, .
nv wall ,.e.� f-.!1 7-T-
4
v e E �, �-t o �-, 0- -^1 -�-3 a,.t o ti t e-�— t a e •-t w 0,11.
'
0 o vL ct, l 1-
.
t w . � a .r n � e.Jl � r e �.o v-� 'L�t. l b �-a, � r e +•t w kz-v...L a �`ja��, .i � � , ''`'j
AA S o , v. {-w �.,.-. C a i v La. t o— v► a '44 � la-.R. d aIin.(r o ... o` r e-y V CCL
is w� �� S , � �.J
w--a a { Q_j
Reviewer/Inspector Name
Reviewer/Inspector Signature: �_. Date: 24
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

C
C7
Site Requires Immediate Attention:
DIVISION OF ENVIRONMENTAL MANAGEMENT Facility No. L— i a O
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. _ ��1 `/ 1995
Time -
Farm Name/Owner: 4cC_LR Lk4,.4 t -F", , CKA_111._ j�_ L` ,
Mailing Address: _ fi-+ X `� o ssz I~l C ay r
County:
Integrator: _ Phone:
On Site Representative: Phonek 6 0 3) .a
Physical Address/Location:
r 1 a 1. Go a 3�; r ; Q c, , Za_ 10 f . S e 4cau L
Scam. Esc 1 1 {T 6o►1.
p.. Rrnr'. p r ri!7[o tr r
Type of Operation: Swine Poultry Cattle
Design. Capacity: '3 �-4 '�- --
DEM Certification Number: ACE
Latitude:
Number of Animals on Site: 7 U-4
DEM Certification Number: ACNEW
Longitude:
Circle Yes or No
Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Ye or No Actual Freeboard'. �L Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or� Was any erosion observed? - es r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? es r No
­- C) fv-
Crop(s) being utilized: C
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
t�U ySa—
Is the animal waste stockpiled within
100 Feet from Wells? Yes or No
100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes orb 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
Additional Comments:
Inspector Name Signa e
cc: Facility Assessment Unit
Use Attachments if Needed.