310754_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

rl
r
Type of Visit: C iance Inspection U Operation Review U Structure Evaluation U 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: I 11-9 a I Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:(^
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: l
L�
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
W to Finish Layer
C*attle
Dairy Cow
Design Current
Capacity Pop.
can to Feeder
* (4 o
Non -La er
I
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Design M.Heit
Dr. P,oultr, C•_a aci
Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Boars
IPullets
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EJ- o ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes )E3156-7— ❑ NA ❑ NE
❑ Yes EFNo ❑ NA ❑ NE
Page I of 3
21412015 Continued..

Facility Number: 41- S Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): " �-
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 EKo
❑ 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 ONo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ON ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r3 'Co ❑ 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?
❑ YesTNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 VNo
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3'go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CD.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 E2-NT_r0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ XA—`❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [r]'1 0�� NA ❑ NE
❑ Yes Ej>tr~ ❑ NA ❑ NE
❑ Yes [J_Na__e NA ❑ NE
[:]Yes []'iqo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [g-NlQ ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes $hIo ❑ NA ❑ WE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to gaestion 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):
5!J 1 1 S 0 v �� r,e c i 3 �.
�. O r kt- i,--- l A 1
0
Reviewer/InspectorName: 00..-4 l S� W Phone: "Y
Reviewer/inspector Signature: Date: 't
Page 3 of 3 214, 20l S

Type of Visit: VCoTpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Pt rA
;LTt44 [S Uk
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
C+urgent
Design Current
Swine CIva
apacity -P,ap.
W.et Pou_]try
Capacity
Pop.
Cattle Capacity Pop.
�. �
.._
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry Ploult .
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence -of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑Yes V�NX
❑NA []NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
❑NA ONE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ONE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes J J 1V o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WN ❑ 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
�, ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectio;'Ngo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IVo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes Q 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 Zo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CfNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
7❑ NA ❑ NE
❑ NA ❑ NE
Zo NA ❑ NE
Comments,(refer to;question4) Explain.anyeYES answers. and/orany�additional recommendations or any other comments x
Use drawin s;of-facility to better ex lain:situattons:(use,additional.. a mas
P P g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone( ()6
Date: % &
l/4 OI S

Type of Visit: (D Co fiance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ®p Departure Time: ® County: S L) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _�" "- N4=04 E-, L. _
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
La er
Wean to Feeder
on
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P■i
La era
Gilts
Boars
Non-L.
Pullets
Poults
Other
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: IL '�;�;
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: j
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 ❑ No
Structure 1
Identifier: LA Cft-o
❑ NA ❑ NE
❑NA ❑NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes YNNo ❑ 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 Ef 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
Q 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
E '10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
o
❑ Yes EWNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: IS 1 - Date of Inspection: '1
24. DW,,the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
[] NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WN'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes EXINo
❑ 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 IL_I 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 CyNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes I__I 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 Elf;
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes L=1 o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refe, r Ito question" #) -.Ekplain any YES answers -and/or any additional recommendations or any other comments.
Use drawings of facility to better -explain situationi'{use additional pages as -necessary):
, �1G1.�5 r�+�C�J 1 I� 1�C � C,fl �T_LI�Cr YUK �110
IJ,�
Reviewer/Inspector Name:
v 6 0,) �A 1?,,d �z(.i. Phone( q Io)lG � —
Reviewer/Inspector Signature:
Page 3 of 3
Date:
(D
21412015

a.7 t" — � 1Jaa `! c.vuaYunua.c waksca.alvll v vYca naavu iccTa U -uuuuac sJ•-lu A-1 `,F A-1-9—MA LlJJIJLal1lG
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: S Z Arrival Time: I JO3o Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: ?o ( ��(14 a integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
IN.
Longitude:
Location of Farm:
Latitude:
Swine
01 Wean to Finish
Design C►urrent
Capacity Pop.
Design Current
Wet Poultry Capacity Pap.
La er
Design
Cattle Capacity
DairyCow
Curren#
Pop.
}C
Wean to Feeder
3Z�D
�o
Non -La er
DairyCalf
El
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
i. P,oul Ca aci Pao ,
DairyHeifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
7Non-La ers
Beef Feeder
Boars
ullets
Beef Brood Cow
Other
Other
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ICJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ o
❑ NA
❑ NE
[:]Yes
Wo
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of inspection: S Z7
Waste Collection & Treatment
— -_ _4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
r a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Identifier: LA lid
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
C3 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff 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 environmR�oNo
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
dyes
D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
['J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O 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
To
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E2 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
d�To
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -'] Date of Inspection: $ 2,7 I 11Y
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes
25., Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNo
11 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 E3 o ❑ NA ❑ NE
0 Yes EkN/o ❑ NA ❑ NE
❑ Yes [21No ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
[:]Yes To ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Rio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 1<T�70
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [DNA ❑ 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 naves as necessarvl. 7
Reviewer/Inspector Name: N N hi A A*.Lk, Phone: �91b) ?16 :21g0
Reviewer/Inspector Signature: Date:
Page 3 of 3 214120111

Type of Visit: C) Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
j.
Date of Visit: $ Arrival Time: ❑ Departure Time: County: Dtay Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: tLEr-�-{' wi�,sw aA�
Certified Operator:
Phone:
Integrator:
Certification Number: 16 56
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dair y Cow
Design Current
C*apacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , P,oult . Ca aci P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No O NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
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 ❑ o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -7N Ds ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&c60
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No7 ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes /No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes '6"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?
s No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VYes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[—]Yes YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesVo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA D. NE
Page 2 of 3 21412011 CondAmed

Facility Number: - Date of Inspection;Al7
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes LI go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2 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 0 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes o<
❑ Yes `C No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
�No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
1) S (10 )Lk(:.V S 1�Cc/,PI/ft__
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
I

L'
Type of Visit: (Z) Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: QRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Zb Departure Time: / Zo County: _TVfLr� Region:
1 r
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: MxrC" El'_
Title:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: I � S f
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop. Cattie
Layer I Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder 2.66
'37,66 1 INon-Layer I Dairy Calf
Dairy Heifer
Design Current Dry Cow
D , P.©ulti. Ca aci_ P.o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[J/No
❑ NA
❑ NE
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ld o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 11 - Date of Inspection: I 13 t,_
Waste Collection & Treatment
4. I$V storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Ey_es_i� No ❑ NA ❑ NE
❑ Yes [2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes[?
(]o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes ❑ 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 [/JNo ❑ 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
[f/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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
cl o
❑ 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
E/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
[,—JlNo
❑ 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
FZINo
❑ 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
6No
❑ 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
21412011 Continued

[Facility Number: 31 -
Date of Inspection: 13 r 7,
E
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. 1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: ,
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
F(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
B/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
dNo
❑ 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
[3/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
(2/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 pages.as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.Jetil�✓ ; �/��i1�Ct
Phone:( 96) 51 -732P
Date:
r
21412011

Division of Water Quality. :
Fae�hty Number, _ r]5 Q Division of Soil andF Water Conservation
0 Other Agency
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency O Other�❑ Denied Access
�t
Date of Visit: 3 if Arrival Time: Departure Time: 1 ZS County: 4-1X%Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o =' = If Longitude: = o = d = 1[
Desi n Current Des ng CurrentDes� n Current
Swtae,` Ca accity Po ulation, _ - Wet Poult Ca ace 1?o ulatton y Cattle '
y P P p. ty P. r Capacity�P.opul on..
�° ❑ Wean to Finish - ❑ Layer
® Wean to Feeder I °31AZ ! U,06 [10 Non -Layer
❑ Feeder to Finish17
❑ Farrow to Wean
Pry:Poultry,
❑ Farrow to Feeder
r, — _. .. n i avercm
r
❑ Gilts
LJ Non -Layers
a'
❑Boars
❑ Pullets
❑ Turkeys
:Other
❑ Turkey Poults
❑ Other
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EII)ry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:'v 1 — Date of Inspection t
Waste Collection & Treatment
-4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure,I Structure 2 Structure 3 Structure 4
Identifier: CA %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VNo
El NA El NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 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 E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect'application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
VNo
ElNA ElNE
❑ NA ❑ NE
�Z<o ❑ NA ❑ NE
L'TN ❑ NA ❑ NE
No ❑ NA ❑ NE
, , . , . , E � � • ..; ., ;� � ,� �..�
Comments {refer to question #) Explain any YES answers and/or anv recommendshons or any other coFnments $r
Use,drawmgs of facility, to better.. explain situations (use additional pages as necessary) x
IReviewerlInspector Name,3 cs}-� s` yf Phone���t7 "�3 a p
ReviewerlInspector Signature: , Date: S 1
Page 2 of 3 1 12128104

s , Facility Number: 3 Date of Inspection S
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes a<01' tEl NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
uZo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�/N a
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes❑
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
��N�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q4 o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff 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?
J
30. At the time of the inspection did the facility pose an odor or air quality concem?
❑ Yes
j,,,y_,'
NNo ❑ 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
t KNo ❑ 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
N i ❑ NA
❑ NE
Does facility require a follow-up visit by same agency?
❑ Yes
6JZ33. ❑ NA
❑ NE
Additional Comments and/or Drawings: M.
Page 3 of 3 12128104

Y
?� FactLty Number. D
y
-Division of Water Quality
O Division of Soil and Water COnsen'ation
Other -Agency,
Type of Visit 3 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 2y1 la Arrival Time: Z3f7 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �2�->�tLs<�L integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = ` [—] Longitude: = ° "
.:ar a•- .,.; � r s ,�,�;.� -;, � .. �� ; ,: �g .:,„.�.;� � r mow'- � �',:�°,�„" .
x: Design� Current - Designs Current - ," ,, Design Current
S ine, Capacity ;Population Wet Poultry „Capacity; Population-- 1Cattle p ty P
..,
yam. Ca act 1?o ulation
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
R'Wean to Feeder 1 1 Non -Layer ❑ Dairy Calf
El Feeder to Finish `� ,; ❑Dai Heifer
„❑ ❑
Farrow to Wean � �' *' `" � `'� Dry Cow
❑ Farrow to Feeder
❑ Layers " ❑Non -Dairy
❑ Farrow to Finish ❑ Beef Stocker
❑Gilts -
❑Non -La ers El Beef Feeder
El Boars El Pullets
❑1 ❑ Beef Brood Cowl
Turkeys
�Other� ❑Turkey Poults"
❑Other ❑Other N u m� tof Struct ,
a
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 1 of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
No
El Yes
�❑
L�J No
❑ NA
❑ NE
❑ Yes [j No ❑ NA ❑ NE
12128104 Continued

r
Facility Number: IEW Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4o ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E4No ❑ 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 2No ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JQ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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
❑ ❑ NA
`No
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ll ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No ❑ NA
❑ NE
'
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Wo❑ NA
❑ NE
Comments.(refer to question #)." Explain'nnyYES answers andlor any recommendations or -any other comments
Use drawings of facility to.better explain situ ations._(use additional pages as necessary): =A :. Rf ' <
Reviewer/inspector Name 11 -1 : , " `- Phone: <0
Reviewer/Inspector Signature: Date: 12,9 d
Page 2 of 3
T 2/2R/nd Cattlinned

Facility Number: 31— Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 6'Na ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ 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?
El
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ET'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P<
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNA
❑ NE
Other Issues
:7
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑ IN`
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
o
❑ 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
J 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
o
❑ NA
[INE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
A Additional Comments'and/or Drawings: : ,
Page 3 of 3 12128104

is
Type of Visit f) C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: `� o Arrival Time: u Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: E LSjE 14COL CM46N _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: = o
Phone No:
Operator Certification Number:
Back-up Certification Number:
Longitude:
0
Design
Swine Capacity
Current
Population
esign
Wet Pougi
Capacity
CurrentCurrent
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
3 7—
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
DrJ Poultry
❑ La erg
Non -Layers
❑ Pullets
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Qther
❑ Turke s
❑Turke Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d o
❑ NA
ElNE
ElYes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 — 121 Date of Inspection ��81oi I
,Waste Collection & Treatment �� l
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UAC-a-od
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.) allo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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 &o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] 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 6No ❑ 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
0 0 ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Wo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
l_I No ❑ NA
[:1 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6 o El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Reviewer/inspector Name I J,.14kj jEjdWIL&L Phone: cflo r
Reviewer/]nspector Signature: Date: 6
Page 2 of 3 12128104 Continued

,I Facility Number: 31 — ]j Date of Inspection
AReguired Records & Documents `
� f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check' ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ P ❑ Ch
s
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
dNo
❑ 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
dNo
❑ 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
VNo
❑ 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
�
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
rJ No
❑ NA
❑ NE
Additional Comments and/or Drawipgs:
Page 3 of 3 12128104

V Division of Water Quality
=acifityumber i ���( 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Zoutine
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �6 6$ Arrival Time: a Q Departure Time: County:-QU0?L`UJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:+��
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = c =1 0 Longitude: 0 o = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer dG ❑ Non -La et
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
[ILayers
❑ Non -Layers
❑ Pullets
LiTurkeys
❑ Turke Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
,.i
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stockei
El Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
El Yes7No
ElNA
❑ NE
ElYes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection a
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: _L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): tit
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes LI 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 ,D No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes LJ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes n No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DrifE ❑ 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 L%
El NA
El 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
❑ NA
❑NE
17. Does the facility lack adequate acreage for land application?
�N�o
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �rNo
❑ 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):
i
Reviewer/Inspector Name va o wE(,(r Phone: t'I 0 r Q (, . 3
Reviewer/Inspector Signature: Date:
12128104 tontinued

Facility Number: 3 — Date of Inspection
Required Records & Documents �,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes To ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B<
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
��OEl
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
13 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�
[3'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
El 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
Ll No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comme°- nts and/ar. Drawings
Page 3 of 3 12128104
Page 3 of 3 12128104

[Facility Number
0 Division of Water Quality
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: f i Arrival Time: Departure Time: County: l) 1/pL-1P Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: ft f XE 14CR,2ZJ*- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swin e
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c =' 0 « Longitude: = ° =' = "
3$66
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I
3 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
ElPullets
ElTurkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
El Dairy Cow
❑ Dairy Calf
El Dairy Heifei
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LdNo ❑ NA ❑ NE
❑ Yes
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 LdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑.<o
❑ NA
❑ NE
❑ Yes hlo ❑ NA ❑ NE
12128104 Continued

•Facility Number: 3 — 7 T Date of Inspection S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA rr, ca AJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 717
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thfeat, 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 Gl 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 E3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ON. ❑ 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?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
LJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L'J No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/inspector Name VU A Phone: 7A0 79�'
Reviewer/Inspector Signature: Date: Utz
12128104 Continued

Wility Number: 3 --'] Date of Inspection ij 1 -7
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
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
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
ONo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ N
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Now
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E
NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
,❑,
QNA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O-lo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
F-1 Yes
2 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
ETNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ 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
CJ No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Cl Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: � 49R:5eparture Time: �County: Region:
Farm Name: �J x/z,:& rV�(/l✓r' Owner Email:
Owner Name: �i -see G F�lLZrIIG _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0& 0 u Longitude: = o= 4= 46
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[]Layer
,32.60 15 ❑ Non -La et
Other
❑ Other I-
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EFDry 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
44 No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo ❑ 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?: AIP
Designed Freeboard (in): 5,
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.)
jo
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
ZNo ❑ 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 _E1 Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
i
14, Do the receiving crops differ from those designated in the CAWMP?
El Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
VNo
Cl NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
1 1005 ZG S7
Reviewer/Inspector Name Phone: l(�- �lv`�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f�No El NA [I NE
the appropirate box. El �p El Checklists [I Design El Maps El Other
r
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ONo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )ZNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )zNo ❑ 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
El NE.
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
,❑l
❑ Yes ❑ 1� No , NA
❑ NE
Other Issues
28. Were anv 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 �No
El 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 VNo
❑ 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/Inspeetor 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
Addttional�CoM, —M," Dr -and/or awin s }C 33 �[
Ft 11 w ., ......... ', �2.. A _

►a'= � � ... a Divz Swon o waiir.
0. Dii ision of SOII and "Water Consei'Vation
O Qther Ageacy
Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit feKoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
i)ate of Visit: PO—NotOperational
Tune: Q�
Facility Number
O Below Threshold
U Permiitted ©Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: lS.le... � x•�G ill. 'rC� County: ._............ ..._--- ------- -- .----
Owner Name: ......................... .. ....._...... ............... Phone No: ,.......... . .
Mailing Address:7p..��l��tz..a rlf'I........ ............. - ..... - . ...---•--.................
Facility Contact: F�f1 f '0itle:.. +.... .. Phone No: _. .. —�-
Onsite Representative: , �,51 ,� �/rliz�c �. l !? L.yfl .��1 Integzator: S.?f 7/ e .r ----
Certified Operator: ................... . .............. .............. .. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 0" Longitude • 4 «
Design"Ciirrenf = "Design
CurreiitM = = Design Current
$wine _C
_P© illation ci
:alatib>i. - ap ulatton.
4,
;_'_Pouitil'_.. _�Ca`
_.Cattl77
rPo �._s _ ,-'Po
Wean to Feeder
Q. ❑Layer
Dairy
Feeder to Finish
_ ❑ Non -Layer
= ❑ Non -Dairy
Farrow to Wean
_ ._: A! F
Farrow to Feeder
Other
-- ---_
Farrow to Finish
-°
Total Deslgn Capaaty d
Gilts
❑ Boars
{ �-. •r',� psi?
-
;NumberafLagoons
Discharges - Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
W to C Aectii &Treatment
❑ Yes dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZrNo
❑ Yes �No
as o on _
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Stryc7e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ...... .....(------- - _ .. _._............ _.......
..._................*------- ll'll!
Freeboard (inches):
12112103 Continued

Facility Number.3 •-- 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
❑ Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement?
❑ Yes
WrNo
8. Does any part of the waste management system other than waste structures require maintenancerirnprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
[:]Yes
No
elevation markings?
Waste_Amlication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overlo ❑ Frozen Ground ❑ Cop and/or Zinc
12. Crop type In D t �,e7, L19soQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
FfNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes /No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [(No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONO
Air Quality representative immediately.
C. nts er to get o E plain any)YESa and/or recomm ndatto or'A _'Any at6er conunr eats ,
77
p p y
Useiiravrtngs of facilityta better expi�n srtnateons. (arse addrhonsl pages#as necessary) � ❑Feld COPY ❑ Ftnal Nates �
.s"Wiz_ /45
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: /Z Ap
12112103 Continued

Facility Number: 3_ 7S Date of Inspection /� G
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes W(No
❑ Yes ¢( No
❑ Yes ;dNo
❑ Yes O.No
❑ Yes pfNo
❑ Yes jZf No
❑ Yes L2fNo
❑ Yes ['No
❑ Yes ;Z No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

f I `�
Type of Visit JO Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: T
Facility Number ime: [ %�
Not O erational 0 Below Threshold
Permitted Q Certified � ndii 'onally Certi ed Q Register Date Last Operat or Above Threshold:
Farm Name: TC'k i 2 �' ' - `.�je County:G��G�N
y
Owner Name: �G�zF LRMf-9 �'.� Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: l�/1% TCffF.0 /�SZ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
T
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Desige Current
wine Ca acity P,o ulation P1aultry Ca acity P,o ulation Cattle Ca aci P,o ulation
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish
❑ Non -La er
❑ Non-Dai
Farrow to Wean
Farrow to Feeder
❑ Other
Total Desig
Farrow to Finish
Gilts
If
Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
— -- — .......... _-
❑ Spray Field Area
Holding Pands / Solid Traps � ❑ No Liquid Waste Mana ement S stem
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ��jj
Freeboard (inches): 21
05103101
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
Cl Yes; / l� No
Structure 6 /
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 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
0 Yes No,
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement?
❑ 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 IN o
Waste Application
10. Are there any buffers that need maintenance/improvement?
�
❑ZE
❑PAN Hydraulic er�to;71
11. Is there -evidence of over applicati ? ❑ 3� 've Po�"x/
Crop type ,��1C�1�fi LlftSl }. K. � �Sf1f%�I
❑12.
OW1J
13. Do the receiving crops differ with those `deiignated in the Certified Animal Waste Management Plan (CAVIN&)?
N6
10 Yes4No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
1
17. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all•components of the Certified Animal Waste Management Plan readily available?
(((
(ie/ WUP, checklists, design, maps, etc.)
[I 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
2.2. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
X No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[J Yes
No
.24. Does facility require a follow-up visit by same agency?
❑ Yes
o
XI/I
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? . ❑ Yes M No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

A . .a
Facility Number: Date of Inspection OOEF
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.)
3l. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes tu�No
❑ Yes No
❑ Yes o
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings:. ->, , W
/J�
O5103101

&, + "� �ISIon of Wateir Qnali �'£" � s�
�r
t"";i, nOsion of Soil and water Gv�h anserott Y
2x. W
r r
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit4
utine O Complaint O Follow up O Emergency Notification O Other [IDenied Access
Date of Visit: 6 t Time: % ;6
Facility Number I I I
t�7 Q Not O erational Q Below Threshold
0,fermitted © Certified 0 Conditionally Certified [3Registered Date Last Operated or bove Threshold: ............. .........
ff �
Farm Name: ......... ,r ......f.1.....�`-----•..✓..t........................... County:.........�......................
OwnerName: --••....................................................................... Phone No:..............................................................._.......................
Facility Contact: ...�'L. ..........rk.+ .i...............Title:.............. Phone No: ...................................................
Mailing Address:
Onsite Representative : ............................ ........... .................... g 0 .+.-U:S1, L'r ......1."..4 f..?.. .....
Certified Operator: ............. Operator Certification Number:
Location of Farm:
Swine
[IPoultry ❑ Cattle ❑ Horse Latitude r_�• �� �« Longitude �• ����
Design Current
CaD2dtV POnulation
Wean to Feeder
a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design. Current Design Current
Poultry Capacity .°Po ulation Cattle Ca ci ..:_ I'o olation ,
❑ Layer ❑ Dairy -
❑ Non -Layer 10 Non-DairyI I -
❑ Other
Total DesigwCapacity_
Total 99L W
Number of Lagoons' ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldingPondsa Solid.Traps ❑ No Liquid Waste Management System -
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ElSpray Field [3Other
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 pan 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
SLrucWt I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..................: .........................................................
Freeboard (inches):
5/00
❑ Yes 1�0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X
o
❑ Yes , o
❑ Yes
Structure 6
Continued on back

Facili y Number: -ij Date of Inspection ! )( Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed. {ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste 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 �6 '
J a , � i 0/W
13. Do the receiving crops differ with'those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment`?
Reguired Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does -facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NoMbFatid.rs'otft,&.W..ndt.*.M- ngfed- during this.v. s. C • Y:oi) WHI reb0i* iio further - :
correspondence: about this visit+ .
. ' ............. .
❑ Yes t 0
❑ Yes kfNo
❑ Yes �(No
❑ Yes ro
❑ Yes I�No
❑ Yes ONo
❑ Yes krNo
❑ Yes 1No
❑ Yes S?'Vo
❑ Yes 8 No
❑ Yes 0
❑ Yes )IN\ o
❑ Yes�No
❑ Yes AN
❑ Yes kNo
❑ Yes o
❑ Yes ,'qNo
❑ Yes o
❑ Yes jP-No
r
❑ Yes �No
❑ Yes No
❑ Yes -E�No
Comments {refer to questionirzplain'any YES answers and/or any recomrtiendations'or any otheir comments
Use drawings;nf facility to better explain situations: (use addition pages as necessary) -
U AL
1 J
Reviewer/Inspector Name kto r LAI);
Reviewer/Inspector Signature: Date:
�.�!?
Ic-
5100

_Flity Number: 1 — Date of Inspection Z / % Printed on: 1/9/2001
Odor*lssues ,
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Q�] 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 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property) [V
29. Is the land application spray system intake not Iocated near the liquid surface of the lagoon? ❑ Yes M 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 JVNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional ommients an or- rawengs• - _-
5100

t
r Division of Water Quality ,
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or visit: 'i1ne: �� � Printed on: 7/21/2000
Facility Number s
0 Not Operational 0 Below Threshold
E3 Permitted 0(Certified© Conditionally Certified © Registered Date Last Operated or Above Threshold: .•............
Farm Name: ........... .I SI..:......... :....... rrl r ,ilsF'1. Count :............ Ltf................... ..&-' .......
Owner Name:.. 1.5�..1 ..........f ! Il ,1� ........ Phone No: .......................................................................................
FacilityContact: ....... �.....J.................. .................'ifitle:................................ Phone Nb:...................................................
MailingAddress: ............................................... . ............................... .......... I-- .......... I ........
j f
Onsite Representative: G.-�s$%� I7'CQ..... - tl { /Integrator:..........�(%L!/. ..........
.. `..
Certified Operator: %�/(�.. J L/
P .�...... ...........................�.7..f�,l,,,�,,•�1�................... Operator Certification Number: ......
/..[i�.�.[� .... .
Location of Farm:
157r-5'-
XSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 14 Longitude " 4 &1
Design Current
Swine Capacity Ponulation
Wean to Feeder
32-60
❑ Feeder to Finish
arrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I El wiry
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischars & Stream Im acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. II' dischar-e is observed. what is the estimated flow, in galhnin"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure , Structure 4 Structure 5
f ri
Identifier: .......................• ---........ ....................................
Freeboard (inches):
5/00
❑ Yes K No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �tNo
o
Yes
❑ Yes jtg�qo
Structure 6
Continued on back

Faciliy Number: — Date of Inspection Printed on: 7/21/2000
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Cl 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 4No
(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 §kNo
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 pplication`? ❑ Excessive Po ing ❑ PAN ❑ Hydraulic Overload ❑ Yes D(No
12. Crop tyre )
13. Do the receiving crops differ with dose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
13: Kd'j btl fioris'or• deficiencies -were noted diWkiii �this'visit: • Y:o.' Will -receive iW further: :
ories�ondeRce: a�otit 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):
❑ Yes KNo
❑ Yes JKNo
❑ Yes ( 'NO
❑ Yes �o
❑ Yes IR-fNo
❑ YesNo
❑ Yes kNo
❑ Yes KNo
❑ Yes KNo
❑ Yes [KNo
❑ Yes 7No
❑ Yes 0 No
❑ Yes $ No
❑ Yes CdNo
❑ Yes % No
kAwl-I I A.
&Pot.
Reviewer/Inspector Name C
Reviewer/Inspector Signatu , z2o o Date: / - d % Sloo

Facility Number: — Date of Lsspection
a "
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 5(No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes ��No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 5(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 P(No
Additional -"Comments an or rawtn1 : - - s
f

�h\
�� [y,Drvision of Soil and'Water.:Conservation -'Operation Review , '" -
z Division of Soil and Water -Conservation -Compliance Inspection
Division of Water Quality ,Compliance` Inspection
0 Other-Agei►cy - Operation'Review
Routine 0 Com taint Q Follow-u of IDWQ ins ection Q Follow-u of DS«'C review Q Other
Facility Number Date of Inspection
Time of Inspection 1 103624 hr. (hh:mm)
0 Permitted 4Certified © Conditionally Certified © Registered 13 Not Operational Date Last Operated:
FarmName:". � .... '.................................................... .J..._. .
Owner Name:.....— } ,.... !w{-q Phone No:
Facility Contact: .........................ritle:.................................... ............... Phone No:......................
MailingAddress: ............................................................................................................................................................................
Onsite Representative: Integrator
:... ................
....................................................................................... ..:.............
Certified Operator:...... .....'--f............................ ......... Operator Certification Number..............
Location of Farm:
Latitude 0 �&� Longitude • C 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder I❑ Layer ❑ Dairy
❑ Feeder to Finish JEI Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
EE
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-inadc?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischar-is observed. what is the estimated flow in Eml/tnin'?
d. Does discharge bypass a lagoon systen)?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 2
Freeboard (inches) ...........J.................................
1 /6/99
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes
Q(No
❑ Yes
N(No
❑ Yes
Cd No
❑ Yes
9No
Structure 5 Structure 6
."...............................................................
Continued on back

=Facility Number:. —�sl.� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes XNo
(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 pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings'? y ❑ Yes *0
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes [YNo
12. Crop type .. b,.l.1. Ct... C> ... .............................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes %No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes MNo
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ief discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspcction with on -site representative?
24. Does facility require a follow-up visit by same agency?
0. M)'violadons or. deficiencies .were noted. du'ring .ttiis:r�Wi.. You'wili.receive nar ft rider .:.
c-oer&b(Hideitee: about: this visit. _ _ _ ; _ ;
..................................................
❑ Yes ONo
D(Yes ❑ No
❑ Yes bNo
❑ Yes NNo
❑ Yes 9No
❑ Yes M No
❑ Yes 9fNo
❑ Yes W No
[:]Yes EN(No
❑ Yes )4 No
Cominents:(refer to question #): Explain any YES answers and/or any. recommendations or any other_ comments.—.—x _
Use -drawings of facility to better explairi'situations. (use additionalpages as-necessary):j
m.
l J p
Reviewer/Inspector Name ;
Reviewer/Inspector Signature: Date: \ c� l 1
1/6/99

❑ Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
laRoutine O Complaint O Fallow -up of DWO inspection O Fallow -up of DSWC review O Other
Facility Number r7
Date of Inspection `I f� lCTg !
Time of Inspection : {0 24 hr. (hh:mm)
13 Registered P Certified 13 Applied for Permit © Permitted JE3 Not Operational Date Last Operated:...
Farm Name: �e- �}• vl� County:......1...........................................................
Owner Name: �►�\,.,..``t'l l- 5�-- 3as
...............1...........................................................-----........... Phone No..
....................... ....................................................
FacilityContact:.............................................................................. Title:............................. ........ Phone No:........................ ........................... ...........................
}
� 1 r` v r
Mailing Address: .� ..-.... !Q r�` 5..?. `............ . V� � 2L... .......�`$,365
................
...........
Onsite Representative:. C Jv-... �...... Yam' .................... .. Integrator:....�dct................"
vY . ..........
Certified Operator:............................................................................................................... Operator Certification Number:..................................
L_Katkon o Farm: 41V%� x ..... '
.. 13.... ....... ....------...-----.. ..............._.........
Latitude • ' 66 Longitude 6 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes CO No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 19 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes E9No
c. If discharge is observed, what is the estimated flow in aaUmin? N IL
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1gNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes EfNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ONo
S. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
ih_�A 7/25197

t*
Facility Number: —�
r
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
i No
Structures (Lagoons.Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1
Freeboard(ft): ..........I..................................................................................... ....................................
.................................... ....................................
10. Is seepage observed from any of the structures?
❑ Yes
M No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
IgNo
12. Do any of the structures need maintenancelimprovement?
$ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health ortcnvironmental 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
No
(If in excessof WMP, or runoff entering waters of the State, notify DWQ)
15.
Crap type3.{.��j...............s!'!'�``'`.................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
56 No
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
V No
18.
Does the receiving crop need improvement?
Yes
❑'No
19.
Is there a lack of available waste application equipment?
❑ Yes
1ANo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
t5No
22.
Does record keeping need improvement?
W 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
allo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
)ni Yes
(j No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
tZ No
0-No.violatians-or. deiicieilcies:were,iloted-dl iing this:visit.-You:v1 receive no ftirttier
0&60Ondeike about
l� Ne,,.� �,os�.t ��. L��s 9.e� ._ �.�„� ���e�� �{ tti �F►-e c!;►-ctl��� r�{.i �,.c.ti ,
�11 eep�� s�-G-f �. �.�, rt N1 -tc
�.► \ ct—p
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: _,��/�_ Date: C__[(O-

t❑ DSWC Animal Feedlot Operation Review.
.� DWQ Animal Feedlot Operation Site Inspection
Routine 0 complaint 0 Follow-up of DIVQ inspection 0 Follow-up of DMVC review 0 Other
Date of Inspection
Facility lumber
Time of Inspection �24 hr. (hh:mm)
13 Registered 0 Certified ©AApplied for Permit [] Permitted [3 NotOperational erational }, Date Last Operated:
Farm Name: 1!5ie...-. '�!t&........ [kf.rAt� County:. .tl.V..�f iA.............................................................
Owner Natne:....... . 5.1.e...........F.tcyr,\Y 5......................................... :............ .... Phone No: .......................................
Facility Contact: .6jk4(n." ...... Title........ }!!{ ........................................ Phone No:.jCi1 .. ?. :... ar-Z....
TMailittg Address: ... -`%0..... Mom ..... SLI�1�5.......'................trl�ll(�,...... t ........ M /�fi+t.. ........................
Onsite Representative :.....�J. SIC...... rl^ .......................................................... Integrator: ..... Gpldsbt?r'C.......
Certified Operator........ Amf......�- ............. �........................................-.-..-... Operator Certification Nutnber.....EM ..-.-.....................
Location of Farm:
Latitude 3S ` b3 ` ©" Longitude �C :4 Side Lrl�1.t3.
Swine Capacity Population
M Wean to Feeder
3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population. Cattle Capacity Population
❑ Layer FEH
Dairy❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity 3 goo
Total SSLW 9U coo
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area '.
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes tK No
2. is any discharge observed from any part of the operation'? ❑ Yes 54 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1� No
b. If discharge is observed, did it reach Surface; Water" (If yes. notify DWQ) ❑ Yes �j No
c. If discharge is observed, what is the estimated flow in Wal/min? ^j
d. Does discharge bypass a lagoon system? (I17 yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 9FNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes V§No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [jNo
7/25/97
Continued on back

FaFU;jy Number: 3 S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes P[No
Structures (Laeoons.Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes � No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ,................... .................................... ................................... .................................... ......................... ........... ................................ ....
10, Is seepage observed from any of the structures? ❑ Yes JO No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 14No
12. Do any of the structures need maintenance/improvement? RYcs ❑ 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 Ej No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 94 No
(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)) Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes allo
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?
[KYes
❑ No
21.
Did Reviewerhnspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
j$ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
OLNo
0 No.violations or deftciencies.werenoted-ditritig this:visit.-.Yoil4ill receive-ho' ftirttier,
e6frespondence about this:visit'.-,
st on #) ;:Explain any,YES ;answers andloir.ai
tibetter;explain`sttuations {useadditionalp
u.
IZ. gQYC, Srts on tG900n t.��1�5 5 rJl}y { YICSCQ�C�, y 1 )
Imo• Uc:;h S , 1 in S F p�O J be,(�C �5 UFSi� i7�e� +h WRS�[ 1i7�tei
IA
zz. ►vo S mcol� s �r I��� -5 rec&,4% ShouP ice- Kc,p, to trw� numb -
`c r Num�r, U �� � 50� avt� w avla si % skcd� Le � ex Cerf � -Ft'r� p Ian- 'k `�,1,'
Ppr�l p f -- i be. i h etr-� ,A e� law.
pum+ ,flJ GOv11T�c`�' [mill 1 Mf�A`!►�r � 5M0 � G � y�,��
z�}. (t�aS c. UyyaS appf � 4b wm+s error. Oelly mps 14� in cerji-pA) p[ar C'A01 J irn5/97
Reviewer/Inspector Name b
a
Reviewer/Inspector Signature: !.._1 �- ��,u,�,,_` Date:

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
April 3, 1997
Elsie Herring
Elsie and Nick Herring Nursery
270 Alum Springs Rd
Mt. Olive NC 28365
SUBJECT:
Dear Mr. Herring:
e��
�EHNR
Notice of Violation
Designation of Operator in Charge
Elsie and. Nick Herring Nursery
Facility Number 31--754
Dup" County
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997-
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
-#.ptt)o'
for Steve W. Tedder, Chief
Water Quality Section
bb/awdesletl
cc: Wilmington Regional Office
Facility File
Enclosure
P.O. Box 29535, 1W- 4 FAX [phone]
Raleigh, North Carolina 27826 0.535 WfC An Equal Opportunity/Affirmative Action Employer
Telephone [phone] VERM74 50°.6 recycles/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Elsie Herring
Elsie and Nick Herring Nursery
270 Alum Springs Rd
Mt. Olive NC 28365
SUBJECT: Operator In Charge Designation
Facility: Elsie and Nick Herring Nursery
Facility ID#: 31-754
Duplin County
Dear Ms. Herring:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service - agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Irejston Howard, Jr., P.E., Director
Division -of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687, �y�C FAX [phone]
Raleigh, North Carolina 27611-7687 An Equal Opportunity/Affirmative Action Employer
Voice 919-715-41 - 50% recycled/ I Tk post -consumer paper

JUL-14-15 S5 15' 22 FROM DEN WATER QUALITY E=,-T I ON TO
WIRO F.02/e2
49
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT ,r
ANIMAL FEEDLOT OPERATIONS SfM VISITATION RECORD iV
DATE: 7 '_a , 1995 /���
Time: i Y3 v3 `
Farm Name/Owner: CtS; c fly /Viplc 1 r,_tiy
Mailing Address: :2 2.u�11�
County:
Integrator: T'sA/ 0 6:„ ��Y►- S.. - - Phone: 7
On Site Representative: Phone:
Physical Address/Location: S 2 _ s 3
Type of Operation: Swine `� Poultry Cattle
Design Capacity: �i_`o0 �"`�►� Number of Animals on Site:
DEM Certification Number: ACE — DEM Certification Number: ACNEW__
Latitude: '�)" " b -1) ' '� _" Longitude: -2a" '� 'I)' _ ? Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ufficient freeboard of I Foot + 25 year 24 hoar storm event
(approximately I Foot + 7 inches) or No Actual Freeboard: Ft. � Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings
100 Feet from Wells? CeArNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by roan -made ditch, flushing system,. or other
similar man-made devices? Yes a N If Yes, PIease Explain.
Does the facility maintain adequate was a management records (volumes of ruanure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No "-r
Additional Comments:
- 71 5�ft crwe-'. - -
Inspector Name
Si_ -nature
cc: Facility Assessment Uiu't Use Attachments if Needed.