310756_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff
II

.31
r
ype of Visit: Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance j
Reason for Visit: O Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access I
Date of Visit: 7 Arrival Time: Departure Time: J,3� County: Region:
Farm Name: '--��-� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -,a V 4,q-, (X,-" �( -C,—
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 a 'l �j
Certification Number:
Longitude:
Design Curren
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
We Feeder
Nan -La er
I
Dairy Calf
4�1eeder to Finish q is
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Mwign Current Dry Cow
D , P,oul Ca aci PoP. Non -Dairy
I n ers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[i]'No U NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[] No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faciii umber: r3 I- f6 Date of Inspection:
Z
Waste Collection & Treatment
--
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑_1QO ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(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
I - o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E31No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
2-1 0__❑ 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 Drifi. ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]-K-b__[] 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?
❑ YesF]No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes - No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: Date of Inspection: z`f
246 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ-MT_❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No 0 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 C3-t6— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0<0 ❑ 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
Iq1"o L7 NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q- 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
C3'��❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3-No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LJ "o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q-Nb ❑ NA
❑ NE
.
C©mmenls {r..... to question #): Explain any: YI✓S answers;andlor any addit�oasl� ommendations or any other eotiinnents71
g -
wins:t©f facliw io �,
ty , better explain situations (uwaddq! nal pales as necessa Use dra, ry):, .:.
—52
Reviewer/Inspector Name:
c ems=, j- ✓" 4
7 ' 91"t<
G� M 4) vr-
Phone: I (.., 7-r6 ? _� "�'
Reviewer/Inspector Signature: ���� Date:
Page 3 of 3 21412015

Type of Visit: i3 Coliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: =0utine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:% ! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: �plJ -Aij
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 6 4 -3
Certification Number:
Longitude:
rLTF
Design Current
Pop.
to Finish
Design C►urrent
WPoean
La er
Design Current
Dai Cow
ean to Feeder
Non -La er
Dai Calf
eeder to Finish
DairyHeifer
Farrow to Wean
Design C►►urrent
D Cow
Farrow to Feeder
lte, C•apaci P,o
Layers
Non -Da'
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
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 ❑ No [DNA ❑ NE
❑ Yes [✓f4
❑ NA ❑ NE
Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAj61Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 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 f 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 EYN10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes JZ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
o
ElYeswl�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes WN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes La o
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes gNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Nilmber: jDate of Ins ection:
24. D:d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ElYes 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 ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes r/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?
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 D/No ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
❑ Yes [/No ❑ NA 0 NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
[%(No ❑ NA ❑ NE
YNNn ❑NA ONE
WNo ❑ NA ❑ NE
Comments (refer to questton #) Explain any -YES answers=and/or any`additeona[ "recommendations or`any other comments.':
�.._
Usedrawmgs"of facility to,better.:esplain situahons'([rse:addihorial"pages as,necessary): .
Reviewerllnspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 7 19
Date:
214J2015

Type of Visit: (D C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I Arrival Time: L ! �lL� Departure Time: ® County: DALM� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: a ^023
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Eat#le Capacity Pop.
DairyCow
Wean to Feeder
Z
Non -La er
D . $oultr.
Layers
Design
C_a aCi.
Current
Pao
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otther,
Other JML10ther
Turkeys
Turkey Poults
_M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesoNA
zl�
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes Q o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: � - 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
Identifier:;j)--per✓)
Spillway?:
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in): �`y —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No 0 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 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�J/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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Y 6No DNA
Yes ❑ o
❑ Yes 4 No
❑ Yes [/]�
❑ Yes [ No
❑ Yes Z40
❑ Yes Co
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NA
❑ NE
[DNA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page 2 of 3 214,0014 Continued

Facili Number: - Date of Inspection: e-?Iatj IS
24.,Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 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 EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
f yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes io ❑ NA ❑ NE
[:]Yes NNo ❑ NA ONE
❑ Yes [ZNo ❑ NA [] NE
[—]Yes �No
❑ Yes
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to.guestion #) ,Explain any, YES answers and/or any; additional recommendations:oFany other comments;r°
Use drawings of facility to Better explain situations (use additional pages as necessary). -
Nt_ay (> rft
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon42�
Date:
15

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

Facili limber: IDate of Inspection: 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure,I } Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - ZA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat,
notify
DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/No
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
❑ 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
V ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
[3NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Nuimber: - Date of Inspection: I
24. DV the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
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 to provide documentation of an actively certified operator in charge? ❑ Yes VN
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E KNO
❑ 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
To
❑ 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
1; l o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
To
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additionaLrecommendations or any other,comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: C 1a 71 — 3�
Reviewer/Inspector Signature: cli4aljed
Date:
17"Itt
Page 3 of 3
214120
h

Type of Visit: ®Co Fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: GAIoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j Arrival Time: � Departure Time: j 3�7 _ — County Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� _Um 1 a Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
IS A3
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Da Cow
Non -La er Da' Calf
Wean to Feeder
Feeder to Finish
!2,60
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to finish
Design Current Dry Cow
INT19 P.oul_ Ca aci $o , Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] ❑ NA ❑ NE
❑ Yes [ N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I&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
2�No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
reat, notify DWQ
or environm;ro
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
21 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 0 Yes ❑Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F:Ko ❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes [3] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E;'<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[-]Yes [� o
❑ Yes
❑ Yes C], o
❑ Yes to
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
[DNA
❑NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L2-No ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;No
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 FaTo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

ft Number: <z I- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
It
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
No ❑ NA ❑ NE
E-eo❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F2/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �o
❑ Yes I__I No
❑ Yes ZNo
[:]Yes U 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
0
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Ose.drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone_ f6
)��_
Date:
2141 01

9
(Type of Visit: (?Co pliance Inspection O Operation Review Q Structure Evaluation U Technical Assistance ,
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: '! cUkjmw fy)'T 1'(Q4 Integrator:
Certified Operator:
Phone:
Certification Number: l g8 l3
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
Layer I Da'x Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I Dairy Calf
Feeder to Finish
(
Dairy Heifer
Design Current Dry Cow
D , P■o_ult . Ca aci_ P,o , Non -Dairy
La ers I I Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
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 fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑N
❑ Yes L_J Nqo
[:]Yes <o
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

[Facility Number: S t IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 r Structure 2 Structure 3
Identifier: CA %I'yf
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
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 ZNo ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments reat, 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? C] YesVNo ❑ 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 21/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes PNI10
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�J�Np
❑ 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
❑ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2NNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EJ'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
^
o
❑ NA
❑ NE
the appropriate box.
TTT
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
eNo
❑ 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
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of inspection: lb LaL, jiZ�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Isthe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
L_14 ❑ NA ❑ NE
❑NA ❑ME
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ I oo ❑ NA [3NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0_310❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ! ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes 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
Reviewer/inspector Signature:
❑ NA ❑ NE
Cl No ❑ NA ❑ NE
No. ❑NA ❑NE
Fgll�/o ❑NA ❑NE
Date: r) d� L
21412011
Page 3 of 3

Type of Visit: aC0pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: p Arrival Time: / / s Departure Time: 2 County: `aW&_jjQ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: doo>✓r>tW4 ki. a, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: / 6 0 1 3
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Wean to Feeder Nan -La er Ell
Feeder to Finish
Farrow to Wean Design Current
Farrow to Feeder Dr, P.oulti, C*_a aci Pia ,
Farrow to Finish ILayers
Gilts Non -Layer
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
11111
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Namber: 31 jDate of Inspection: /6 t
_Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [] N ❑ 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 Gogo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EdNo [] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [:(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes L rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [Z/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ) 0% 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?
go
❑ Yeso
[3NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E0 No
❑ 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 rN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes fNo
❑ 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 EyNo ❑ 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 NMnber: - Date —of Inspection: /Q
t
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
go
❑ 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
N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ffNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes CJNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [!]Yes 1 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes F2/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations .or any other comments A�
Use drawings of facility to better explain situations (use additional pales as necessary).
Reviewer/Inspector Name: Phone: p C —? b D
Reviewer/Inspector Signature: d [ dw Date: to J
Page 3 of 3 21412011

Eac>11�tyeNumber 37 JI
,�Drv�sron of Water Quality
D Drvksion of Soii and=Water:Conservatton
0 Other Agency s
Type of Visit CComm Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit S 0utine 0 Complaint 0 Follow up O.Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: UO*2
Arrival Time: ' b Departure Time: County: Dafit<Al Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
�/�
Onsite Representative: �� N�?71`il � w I/TLCJ 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = {[ Longitude: = o = 6
Design Current Design Current Design C�r1ent
ZSwi�ie �-< - Ca aci Population Wet Poultry Ca acity,-,,Po Mahon Cattle * �Ca actt Po Mahon'
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1 t4 q
'j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
IN
FM—Other
❑ Layer
❑ Non -Layer
Dry Poultry �- •-
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dair
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
Zo
❑ NE
❑ Yes
El Yes
❑ NA
❑ NE
El Yes
o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection I I�
+ Waste Collection & Treatment
4. 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:(r"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2KNo ❑ 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 thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �Zo
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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
ClNNoo ❑ NA ❑ NE
❑'IVO ❑ NA ❑ NE
El NA ❑ NE
;IN
WV- NA El NE
Zxo ❑ NA ❑ NE
w h�.. _
.Comments (refer to question:#) Explaiwany YES;answers.andlo'r,,any recommendations or any�other comments
r e e .�
"Use drawings of facility to better. explain situations. (nse addrtronal page"s as necessary)
AL
Reviewer/Inspector Name
J.G 4 �[..c�f Phone. 91u
Reviewer/Inspector Signature:
Date: 16 /D
Page 2 of 3 12128104 Continued

facility Number: 31 --7zil Date of Inspection o /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No[03NA
NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 /NoO 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 Inspectio��No
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [IYes ,,,VNo,
[I NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ( iNp El NA El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 1 N [I NA El NE
'27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C1 No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ef No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�❑ 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
i o ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
17No ❑ NA
❑ NE
Additional Comments,and/or Drawings:
Page 3 of 3 12128104

Type of Visit Qf C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
isit V Reason for VRoutlne O Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 13 O Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: `joO AIMAO M at-1-_ r
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Iutegrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 I =Ig Longitude: 0 ° = 4 0
As
Design Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
-Layer
❑Dai Calf
❑ Feeder to Finish
kA
3
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
O#her
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
NJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
En No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dZo
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
El Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i A&5V-'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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 L�J 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? El Yes El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes rJ 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 [J"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_.,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[I NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
El Yes
IJ CoN❑ NA
❑ NE
Coriiinents(refer to uestton.`#) "Exp:atn-any YES,ansrers and/or any re comat mendionsor«anyrother comments.
Use drawings of facility to'b tier"explain situations. (use additional pages as necessary):
Reviewer/inspector Name v - Phone: 4la o0
Reviewer/Inspector Signature: _ _ _ Date: Yfi a

Facility Number: I — Date of Inspection
Required Records & Documents
9'19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes
E:fNo
❑ NA
❑ NE
❑ Yes
eNo
❑ 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
EfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ YesWNo
,[✓(No
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues ,,__,,//
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes D
IN [:I NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Id 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
IJ 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?
El Yes
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
12128104

Type of Visit 6 ZRoutine
pliance 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: d Arrival Time: JDJv Departure Time: County: DIRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ) ■� ) , ` /�J� Title:
Onsite Representative: V oNA-mvi + 'c�.i_�r_
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = ° = g
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
❑ Layer
10 Non -Layer
C*attle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
54 Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
[I Non -Lay ers
❑ Beef Feeder
❑ Boars
El Pullets
El Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑N
El Yes
VNo
❑ NA
❑ NE
❑ Yes
94
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 31 Date of Inspection
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 24 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S�tructurr% 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U 16 — "
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eo [I NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ [INA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
WNo ❑ NA
❑ NE
Reviewer/Inspector Name I Phone: Y!Q 176 - 71T W
Reviewer/Inspector Signature: ZZ_Date: `1'A D
_ .-5..... J ..

Facility Number: 3 —1 Date of Inspection 9 i
'dtenuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropiiate box. ❑ ❑ ❑ ❑ ❑
WUP Checklists Design Maps Other
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
[—�V/o
❑ 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
[2(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Lrf No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Cl/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ef/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
LI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E 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
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
AdditionaliComments-and/orDrawmgs
.a »,..�.y r. sr.., tip:: »•r29:i... .w-... r. .�,". '�il3isw �M. ^;•- r
7
Page 3 of 3 12128104

=Facifity
;Division of Water Quality
umber 0 Division of Soil and Water Conservation
✓' _ 0 Other Agency
Type of Visit 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 ❑ Denied Access
r� Date of Visit: Arrival Time: © Departure Time: County: J/Yr L Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �,ylg 1 r1�v EA,
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
Other
DO ther
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = = Longitude: ❑ ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et I EE
Dry Poultry
Non-L
Pullets
Poults
Cattle
Design Current '
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
j
❑ Yes LdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
No
❑ Yes
,❑l
, J No
❑ NA
❑ NE
❑ Yes PIK1 ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 _ Date of Nspectiion l d !
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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
_
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environ ental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Zo
L� ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
-,//
B o ❑ NA ❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
0 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Q N
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
L26No
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Y
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1) W-Ove Pike lvol<l<
1qIA60 kC-0 C0G V'
21) AJt(-P We ,&1,0 30
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: ►1 d
12128104 1 Continued

Facility Number: 31— Date of Inspection d
`F Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes �o El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ �klpFroeboard y ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ElAnnual Certification
ElRainfall ElStockingCroYield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �YyNo
o El NA El NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes 20 ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes L Zo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I NA
[I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes Yes
Zo
❑ 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
O 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
El Yes
�1
Lt•f 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
U No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

- �
vision of Water Quality
Fastltty:Numberf 3 �� OD
ivision of Soil and Water Conservation
— O Other Agency
Type of Visit om Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (p Arrival Time: 0 Departure Time: County: 2 � Region: `C7
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Bach -up Operator:
Location of Farm:
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ ' ❑ Longitude: ❑ ° = s
-t
Design Current Design' Current Design `Curren#'
Swine :: r k�,. Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ,
10 Wean to Finish -
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
—
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes El No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number: 3 -7
"1r
Re uired Records & Documents
i 9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stockin Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No [I NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
y171G6 3,
7121106
_
IPAd tA 5 I
a1
Page 3 of 3 12,128104

Facility Number
0 Division of Water Quality /
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit CO pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: `A�rrivaal�Time' 1Z3 `�� CDeparture'rime: i b County: �p Region:
Farm Name: _y�� IG1 _ 1� Y�i-� Gp t Tl�� _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L E_� "�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede.
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ 1 Longitude: = n = , = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys '
❑ Turkey 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
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: E
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 LJ'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNN
❑ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number:31 — S
Date of Inspection •� @S
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA '❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 7
Observed Freeboard (in): SS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ 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?
El Yes
NJ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RfNo
❑ 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
3<10
❑ 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
U'Zo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Gs 1 j
13. Soil type(s) Gro +-j:>S go"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L9 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes9j'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination , ❑ Yes
dNNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CJ"�No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
ETNo
❑ NA ❑ NE
1 �� Co C cAct<oS.
F(L,>D ram- :v. t✓�t � U- �N 7,aa �} pa.c�-czar. C-rE � � b- `' �' � �SEt.dJ N a v � t3 � � r`-j
Li
Reviewer/Inspector Name ZCs�{�,j Phone: �'� 3�� ~ 3y'o
ReviewerlInspectorSignature: Date:
12/28/04 Continued

Facility Number: �j -��6 Date of Inspection
Reguired 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 en, ❑Maps ❑Other
E Yes ❑ No ❑ NA ❑ NE
Oes LRNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee ly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
Vo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Zo
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
2NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LdNo
❑ 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
2 No
❑ NA
❑ NI,
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
E2 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
o
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
'�a�ar- EiL FALL— Pis p vAG-0-a rj u(SU k_-L.S t7s IJ-_S..1az'yl1-S.,
12128104

I
I3esigp Gurreat __ = _ iiesagn Curti
Pouitry� _Capacity rPopulation.,� .Cattle ' CapacxtyAnPopiila
10 Other I'
µ,
=p r T©tai Des>IgCapaci n
x._. e. - ... - .... -
of Visit j0 Compliance Inspection O Operation Review O Lagoon Evaluation
]Reason for Visit O Routine jecomplaint Q Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: ime:
Q of O erational O Below Threshold
Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated o bove Th�refshold• ........ _... _. ..
Farm Name: .........._.-----f
�County:
Owner Name: .. oneNo:_. �.. .+....!......"--.-_---_---_--._...............�.•-•-.........�........�.....
Mailing Address: ...._................... . ..........
Facility Contact: .._...... ... ..... ..._..._....... ..... Ti • ...... .. .. ... Phone No: !-ir .. ..
Onsite Representative: r.- '�/ �ly�� -_ ` In tor: �,
__..... f _. ............ ......_.. ._...
Certified Operator:
Location of Farm:
Operator Certification Number: • ,•,• .............. ......
jgSwine ❑ Poultry ❑ Cattle ❑ horse Latitude • ` '° Longitude • ' «
Wean to Feeder
eeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
Boats
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes lErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes /No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes ,KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................--....... __ ..... . __ ..__...- --
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [I Yes ❑ No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancermprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
WasteApplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Pgnding ❑ PAN, ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
=Csoemdmraeintsi aarany rrnmons o* r.any oh=er—c—ommefi_U__� _ a e
_wirexsatwue a ;
1tField Copy ❑ Final
m, WF
Aavci ' 14cleE Ae,6A AAe7avo Aao?,6vv-r
ups bozo DF �.�,
w
Reviewer/Inspector Name
Reviewer/Inspector Signatur : Date:
12112103 v. Continued

Facility Number:31_ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
XYes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
RKes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34- Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. )ZYes ❑ No
❑ Stocking Form .Crop Yield Form gRainfall 0Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
LqNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Add' i nal Comments Ed/&Drawtngs
zGC Iv, 49D 4 / LGO 4
lWA7-
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tiE /� GirlPL14ZI✓ i/[J�-2 �iQ't�
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I2/I2/03 . _itl 177, C�!

A
Type of Visit xCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for VISit O Routine O Complaint RfFollow up O Emergency Notification O Other ❑ Denied Access
Facility Nzmiber Date of Visit:
Permitted © Certified 0 Conditionally Certified Registered
Farm Name:
Owner Name: .. .
10 Time: 1 //J//1 -,
O Not Operational O Below Threshold
Date- Last Operat*r Above Threshold:
County:
Phone No: — _ Z_ _Q03
Mailing Address:
Facility Contact: _ _ . _ . _ . tle:._ ----- �.,1 . _ . Phone No: _ • N_
Onsite Representative: _ L �G f rim In //tegrator.
Certified Operator -
Location of Farm:
__.. Operator Certification Number:_.
❑ Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 4 �u
_ Desk
Cat =-Desagn z Current Debi uriit
C
Svviaiie - =Po` 'x toa SMalt
P9 ci" `,-Po an' Caitle� tion -
Wean to Feeder
_ ❑Layer
Dairy
- er to Finish
Non -Layer
Non -Dairy -
Farrow to Wean
R�
Farrow to Feeder
Farrow to Finish
Gilts
Boars
s _
}C
Ti?Zt8�'_a�+�'
Numbero#'Lagoon5 } .
Y
:SCharueS &, StreamImpa
1. Is any discharge observed from any part of the operation? ❑ Yes 2!'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaumin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RfNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): �f
12112103 Continued

I
.
Fa ' ity Number: / — �6 Date of Inspection / O M
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1-11
To
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 DWt)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive P ding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type D T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Feld Com+ ❑ Final Notes
(/� v` L � �/'� `� �/O�� �Cr/`�n1 z�/�,L �5 5G 5'�iF}�✓C/' �f1- 5 !�i✓--�
Jr'
�, 14 4eOL� 7-
ReviewerAnspector Name >/
ReviewerffimVector Signature:
Dane:
12112103
Continued

' Fa'' ty Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iet WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Ej'No
27_ Did Reviewer/Inspector fail to discuss reviewftspection with on -site representative?
❑ Yes zNo
28. Does facility require a follow-up visit by same agency?
❑ Yes ZNo
29. Were any adeat oral problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit.
:L�:-�r=r-:7e].�-at •_�--,`^-a.,s=.S T _::�.c--_'{`A,.= ,.s��`•'y...h.. r»_�.��...... _„�..",r-r.�,.-..�v..:r:.'s�= �r:x�_-�c�.m:.T>e.-:��.i�,..:-��.�....-,. :s
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r _Division of Water Qualtty = _
W
µ - OD�vts�on ofSotl;and Water Conserve#ion
WO
O: ` Cher Agency - - - s
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
.`~Facility Number 31 756 Date of Visit: 2/4/2004 Time: 12:30
O Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: ..............
Farm -Name: Ricky.1�.ttru:egay..k:umt.............................................................................. County: Dxtptliut................................................ WJRQ.........
OwnerName: Ricky ......................................!?tltcy.......................•••-•••••.................. Phone No: 91.9-§58.:!G.41...........................................................
MailingAddress:7.56.[YG.4.4j..%'51................................................................................ Kt,..0Ry.e... INC ....................................................... 25.3.65 .............
Facility Contact: ...Title: ................................................................. Phone No: ...................................................
Onsite Representative: Ce]ust.Kcilikedy........................................................................... Integrator: PrcSXagc.f.ArMS.....................................................
Certified Operator:Rielcy..1. ............................... Koirinkgay........................................ Operator Certification Number:18.0,93 .............................
Location of Farm:
East of Calypso. On West side of SR 1306 approx. 0.2 mile South of SR 1371.
® Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 35 • 09 19 " Longitude 7$ • 03 44 "
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
® Feeder to Finish
4410
❑ Farrow to Wean
0-Farrow to Feeder
[].Farrow to Finish
❑"Gilts
❑ Boars
Number of Lagoons I
Discharges & Stream Impacts
Design Current Design Current.
Poultry Cavacitv Po elation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,410
Total SSLW 595,350
I Subsurface Drains Present II 1 Sorav Field Area I
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentifierI ................. .................. ..............................•..............................................•.........................................................
Freeboard (inches): 39
12112103 Continued

1
e
Facility Number: 31-756
Date of Inspection . 2/4/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require 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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Corn, Soybeans, Wheat
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Field Copy ❑ Final Notes
Need to show fertilizer used on PAN calculations if used. Lots of land growing com.
and farm looks good.
Reviewer/Inspector Name Cale:Stenberg
Reviewer/Inspector Signature: Date:
12112103 Continued

V
Facility Number: 31-756 Date of Inspection 2/4/2004
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is'facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

0.6 0 '0.6 1.2 Miles
VIA,
�i
Facility # 31-756

(Type of Visit I&Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine o Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �� Time:10 Z�3
3/ 7� l
Not Q erational 0 Below Threshold
Permitted ® Certified 0 Conditionally Certified O Registered Date Last Operated or Above Threshold:
Farm Name: I A A r'4 County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: / ®® Title: Phone No:
Onsite Representative: GG�QL/lp/A../ Integrator: �� _ ,
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine ❑ Poultry ❑ cattie ❑Horse Latitude 0 ` " Longitude 0 4
Design Current Design Current Design Current
Swine Ca acity Population oultry Capacity Population Cattle Ca acity Population
❑ Wean to Feeder I 1 10 Layer I 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer I I ILI Non -Dal
Farrow to Wean - - - -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons.0, ❑ Subsurface Drains Present ❑ La Don Area ❑ Spray Field Area
Holdiug;Ponds 1 Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Cl Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Freeboard (inches):
05103101 Continued

facility Number: 3/ —
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. .Axe 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
S. 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
Wasle Application
10_ Are there any buffers that need maiatenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CANVMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22_ Fail to notify- regional D«'Q of emergency situations as required by General Permit?
(ier discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reiiewer(Inspector fail to discuss review-linspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about "visit.
f
Coitnmeots (refer t6 gae�sdiii #):=Eo]ain,any:,YESlnsnrersy ndforrany r_ ommendatians organ other,
Use drawings of facility to better explain sttuahoas 46se addttiorial pages is necessary) Fieldopy ' ❑ Final Notes
At»_aS'9+Clk.Y__.-2-o-L •w — S'�
6lti4e or A / /! /V e4 /C tt ZC he F1 i A&5e /!, ��`1 Or
4,az 14
Reviewer/Inspector Dame �; -. •. w y �� �` � ,� ._ " ' :
Reviewer/Inspector Signature: Date: 2
05/03101 61 " Continued

FacilityNumber: Date of Inspection
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge arlor 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 anv 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 anv major maintenance problems with the ventilation fan(s) noted? (s_e_ broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
71. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Comments and/or
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Type of Visit 95 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ElDenied Access
Facility Number Date of Visit: Time:
Not O erational 0 Below Threshold
APermitted © Ce'ied 0 Conditionally Certified Registered Date Last Operated �A�bboove Threshold:
Farm Name: County: LfT��/l7f
Owner Name: r, O Phone No:
Y J_
Mailing Address:
Facility Contact: Title:
Onsite Representative -
Certified Operator:
Location of Farm:
one No:
Integrator: T
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �' OK Longitude '
"Design Current Design Current Design �. * Current
Swine Ca' acity Population Poultry Capacity Population = Cattle Capacity :Po` utad
Wean to Feeder ❑ La er ❑ Dairy
b
Feeder to Finish ❑ Non -Layer L I ❑Non-Dai
❑ Farrow to Wean
` ❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish Total Design`Capadty
❑ Gilts
❑ Boars Total SSLW
It 7�Number��of Lagoons ❑Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area
,Holdmg PondsY7 Sulid Traps '�� ❑ No Liquid Waste Managementg System
r. �.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ElLap-oon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ,,,,❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ YesXNo
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes YNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches):
05103101 Continued

1
Facility Number: rp Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenccof over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type / �fJFwl 1_4 l ei T JL�
❑ Yes X_
❑ Yes yJ No
,VYes ❑ No
❑ Yes No
❑ Yes ILJ No
❑ Yes ,ANo
ElYes ,�J No
13. Do the receiving crops di&er with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
El Yes
>z.
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
o
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Cl Yes
R( o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El;'WNO
o
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
,_,('
(ie/ discharge, freeboard problems, over application)
El Yes
I[J No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comiine�ts ` efer to" gti&fii rf Explan any YES sns very an�or any reconnm ndahons r any other c minents ' t ;,
as`
Use drawings of facility tobetter ea Iatp sttiiattons.,(use addtttonai pages necessary) Field °nY ❑Final Notes
t
o.Pfc
/p [.- aza e �e
Reviewer/inspector Name ! r
Reviewertinspector Signature: Date:
05103101 ` I F / I Continued

Facility Number: l -- Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
,..,�(
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
1L I No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
ElYes
YNO
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNO
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
o
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 CnmmenWandlor Drawings: .
PF4,O��
rl�F a �- ,� ��� ��,� �' c�� �•o.
0510310.1

d
Facility Number Dale of Visit: Time:
Q Not O erational Q Below Threshold
#Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName:.....1.�-#...�°�t)r.................. ............................ County:`'1.................................. ..................... .
OwnerName: ................................................... ........................................................................ Phone No:............................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No: ................... .............. » .. .
MailingAddress: ..............................................................................................................................................
OnsiteRepresentative: C. k� ...L<, .......................................... Integrator: .... Pv- . ... ..................................... ........... ..
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �Du
Des 'go.. Current Desigir. Current Desiga Current
PulPopulation :CapacityCatle Population
. Ca"ci y - Po'ialation: `'.
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish d ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars TOW -SSLw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed• did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
J4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes
PNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
dNo
Structure 1 Structure 2 Structure 3. Structure 4 Structure 5
Structure 5
Identifier: ..................................................................................................................................................................................
....................................
Freeboard (inches): "i 3
5100
Continued
on back

Facility Number: 3 k Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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?
❑ Yes
kNo
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
JKNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
&No
elevation markings?
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
V No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
,KNo
f
12. Crop type C ! w Ski
_ _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
dNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
,kYes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
DjNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
9Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
WNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
kNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
JRWO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
IXNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24. Does facility require a follow-up visit by same agency?
❑ Yes
9INo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
q viola>iioris. dgfc�e�c; s w r P9te�i a4H`i�r�g th�s:vj�s�t� Yo> wi# > eegiye too ful�tb lr
coriespimsYeuc� about this visit. . ..... • • • • • , • • •
menu , r*r t0onAjg6 #) :Explain any YFS.answers and/or any
irawiii s 6.f Ucilit- better expWn.situation& (usc additional;pag
"r anyother cflmment<

I Facility Number: Date of Inspection 7- G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below gYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or kk
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
Additiona[Commentsand/orDrawings: _ � _ _ ---• _ �{ _ — -
q
14) X"'( AV A-I't C'-�14es.
A - L_1
'N
J�
c}er�
p �
T
5100

t�
,Division of Water Quality
Q Division of Soil and Water Conservation -
Q Other Agency
Type of Visit GLCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 16 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: /O kl& Tiine: ��Printed on: 7/21/2000
Not Operational 0 Below Threshold
0 Permitted ❑ Certified [3 Condonally Certified 0 Registered Date Last Operated or Above Threshold: ..... •.•
.......... .........
Farm Name k1aY ....................................................County:..l�r.�rc-.................... .........
OwnerName:---........................................................................................................................ Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:....
Phone No:
Mailing Address: ..........6'r,
........................... ............................
Onsite Representative: Integrator,....•....f t 5
P i'/.�/....... r�/�................................ .
Certified Operator: ................................................. . ......................... Operator Certification Number:.......................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 4i Longitude • 4 44
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population -
❑ Wean to Feeder
_
❑ Layer
I
I
❑ Dairy
eeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons bsurface Drains Present ❑ Lag-nn Area JE3 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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' discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
`1414 -
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �5-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structure I SLI'nCLurc 2 Structure 3
Identifier: !/
❑ Spillway ❑ Yes ,WNo
Structure 4 Structure 5 Structure 6
Freeboard (inches):
5100 Continued on back

Facility Number: — 7 I)ate of Inspection Printed on: 7/21/2000
Sr' -Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 yes (�'rlo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IR110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes jr 0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
I 1 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes kNo
12. Crop type I IGIJD
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes <No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
QKNo
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
El
o
15.
Does the receiving crop need improvement?
❑ Yes
SNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
1� 0
/�
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
14 No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement`? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
tj�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J�No
2I.
Did the facility fail to have a actively certified operator in charge`?
❑ Yes
�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
ElYes
(ie/ discharge, freeboard problems, over application)
KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
)KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
❑'R\ o
:..10 . ...io ..... .. ... were nofed duftng �his;visit: Yoi� wilt receive Rio further ;
corres 6ridence' aNaut 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):
14 __ A� A4U,_ A,
`D
Reviewer/Inspector Name �`' [! -r
Reviewer/Inspector Signature: ^��,/�j l'pA Date: /d d WIU_ 5100

Facility Number: — Date of inspection v/d�
Printed on: 7/21/2000
v
Odor ISSUes -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Atlor below —d Yes— KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [yNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
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.) Cl Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes allo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional omments and/orDrawings:
5100

. Division of Soil an' Water.Conservahon Operation Review
E .'D:DiviAo, of Soil,and Water Conseryahoa <Compliance InsgecUoa
Division -of Water Quality .mp Coliance Inspection
- _
Other Agency. = Operation Review n
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
i
Permitted [3 Certified © Conditionally Certified [3 Registered 10 Not O erational Date Last Operated:
c. V
Farm Name: ..... .. County' ................................................................
.........................................................I.......................-._.. .
r..i.'�
OwnerName: ................................................... .. .............................
FacilityContact: ............................................................................
Title:. ................
'Phone No:.. .......................
Phone No: .................
MailingAddress:........................................................................................... ............ .................... ..........................
... ...... ...
Onsite Representative Integrator:
+l ..`a.il ..........................
. 1............ Integrator: �¢.................................................
�"
Certified Operator:.....................................................................................................:.......... Operator Certification Number:..........................................
Location of Farm:
r...................................................................................................................................................................... ...............................................................
Latitude a �` �•� Longitude 0
Design Current. Desi .
g gn urreut._.. DesignCurrent-
'Capacity Population' Poultry Capacity - P6pulation -Cattle Capacity Population—
❑ Wean to Feeder
Feeder to Finish
FWt
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
d Number of -Lagoons
❑ Subsurface Drains Present ❑Lagoon Area
❑Spray Field Area
❑ No Liquid Waste Management System
Hold�ng:Ponds LrSolid Traps
�.._ .
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Qther
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ANo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: - LN
Freeboard(inches): ....................................................................................................................................................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
byes ❑ No
seepage, etc.}
3/23/99
Continued on back

FpMity Number- 3 ` —r)Date of lnspeetion C�
i
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
[<No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
k1Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenaricelimprovement?
❑ Yes
N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
DdNo
�Vastc ATplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[gNo
11. Is there evidence o over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
;KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
XNo
Ge/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
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
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j�No
24. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
.. �. . yiol.. . .s...... en. mere noted du >tng �his;v......... r. . . . e Rio fui
eorres 6fideirce about this :visit ..:: _ . ..
oments (refer,to question #) Explain any YES answers and!©iany iecominendatwns:or any"other eoimrnents:
FuUcse,'d'
t=awings of"facility- to: better explain situations {use adilitional`pages.as necessary)
07 Thy wAi Kic., L-ep- Armck, 5 .
i Otic� NOD
CIS
R
is s P;6� WoVk S4,OL\Ur t
V
�- SlZ
Reviewer/Inspector Name I
• ,- , - �O - �=3�Taa _ gab -
Reviewer/Inspector Signature: Date: _9
3/23/99

Facility Number::7 — Date of Inspection
Odor Issue's
25.
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?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
U(No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
RTNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan btade(s), inoperable shutters, etc.)
❑ Yes
ONo
.31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
X No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
Additional. _.. ©mments an or= rawin 3 _ _
519
57 At
mil' hew �aw , vas vel
3/23/99

Ili
• (] Division of Soil and Water Conservation ❑ Other Agency
a(Division of Water Quality
IGE Routine 0 Complaint 0 Follow-un of DWO inspection O Follow-up of DSWC review 0 Other
Facility Number Date of inspection 10 )-,?-
Time of Inspection 004 24 hr. (hh:mm)
Registered © Certified © Applied for Permit `Permitted 113 Not Operational Date Last Operated:
Farm Name T��G 4-�isCounty:.........1!°,L�................................
Name: ................................. .. ....................
Owner Name:.. \�. ....... F'S '"Q:,Sc� Phone No: �..1...L.... 63�..................................
...............?.................................................. "-
FacilityContact: .........................•................................................ Title: ................................................................ Phone No: •--............... ................................
Mailing Address: ....... C....-.1 C'3 [ � �' 1. C�.��.....�L� ....... �3 G s ..........---.... ............. I............
...............................................................................................
Onsite Representative:1'9..............4... Integrator:....��....................................
Certified Operator:............................................................................................................... Operator Certification Number;.......
[ ti n o arm:
•.. ...QS4•.y--'�.........��......1:..
................ ................................_........
a
-�36s...........................................................
.................. .
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes UNo
2. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes bqNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) []Yes IqNo
c. 1f discharge is observed, what is the estimated flow in gal/min?IkA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ONO
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IX No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes O(No
7/25/97

Facility Number: 3•- 6e
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
hNo
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
% No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft):...........s.........................
10.
Is seepage observed from any of the structures?
❑ Yes
1ANo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
0 Yes
❑ No
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 or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ONO
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
LNo
(If in excess of WNW, or runoff entering waters of the State notify DWQ)
t f
15.
-
Crop type....CG.!.:.�!^^'-1.�y........................................... .................... .......................... .......................................................................
................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
5(No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Klo
18.
Does the receiving crop need improvement?
❑ Yes
C&No
19.
Is there a lack of available waste application equipment?
❑ Yes
too
20.
Does facility require a follow-up visit by same agency?
❑ Yes
tjeNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
22.
Does record keeping need improvement?
❑ Yes
Wo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
DINo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IgNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
ONO
0•No.violations•or. deficiencies:werenotedduring this:visit.-You4411 receiye'no-ftirtfier
:�:•correspQridehceaboitt�this:visit:•::•..:-.•: . � ..: :: .•::�.� ..:::•::: �•:•;�:�::�.: :•
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C ".
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

10 DSWC Animal Feedlot Operation Review .
® DWQ Animal Feedlot Operation Site InspectionM.s
® Routine 0 Complaint 0 Follow-u of D%V(2 inspection 0 Follow-up of DSWC review 0 Other
b Date of Inspection
L- 7 Facility Number Z3'
Time of Inspection i Z 24 hr. (hh:mm)
Registered E] Certified 13 Applied for Permit ,IRPermitted 10 Not Operational I Date Last Operated: ..........................
y
Farm Name: .Li.—C1 ....... t.... .. ... .. ..... County:..._Lltt.im. ........................ :.......... �...
Owner lame:...... .5..c . ......................... r....�..F .. Phone No: ....I-1.. ia.r� C....... ........
FacilityContact: ..........................................................................vv.. Title......................................... ............. Phone No:..................................................
i4iailingAddress: .....ka........ !.-.....y..D.,�.......11.t......................... M., L�....i..,.Q.�....t�1.C-:.................. ..�..�..
OnsiteRepresentative: ......R-.!... cam ............. .ra.Y-rs........ .. ............. integrator:..... .Y` .S. rJ-9...�---................ ........................
Certified Operator-- l.c�... `J p �� -. ...... !?Y.�1.. .. Operator Certification Number,...�..$...D..I... ..... ....... ................
Location of Farm:
....I.A1.u. .
0
Latitude •L E�' Longitude �':°
Design Current
Swine: Capacity Population
❑ Wean to Feeder
[R Feeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
.Designs Current';
Cattle "Capacity. Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity L4 9 p
Total SSLW 5 p
`Number of Lagoons IHolding Ponds �_J IN Subsurface Drains Present ❑ Lagoon Area IMSpray Field Area
❑ No LiquidWaste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes M1 No
2- Is any discharge observed from any part of the operation? ❑ Yes �RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes P9 No
b. If dischargc is observed, did it reach Surface Water? Of yes, notil'l- DWQ) ❑ Yes 5�No
c. If discharge is observed, what is the estimated flow in gallmin? b3.1A ^�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes W No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes allo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 91 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 10 No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IR No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes WNo
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? . ❑ Yes I�No
Structures LLagoons,tiolding Fonds. Flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes M.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):........................ ...............................................................................................................................................................................................
10. Is seepage observed from any of the structures'? ❑ Yes B No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes ElNo
l2. Do any of the structures need maintenance/improvement? RZYes ❑ 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 CqNo
Waste .Application
14. Is there physical evidence of over application? ❑ Yes 9No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type s. c..v`................................. I ........... ......._....... ..................................................................................---••---................................................----..
16_ Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Q Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes JgNo
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3 No.viol ations or. deficiencies.we're-noted- during this:visit.- You.will receive no further
correspondence. about this:visit:
Comments ('refer to 4nestion #):'ExplaiWany;YES answers and/or any recommendationslor any;i
i1 evdrawiugs p€facility to better expla�nsituation�s. (use additittnal'pages as necessary}
❑ Yes 4 No
❑ Yes allo
12 Yes ❑ No
❑ Yes KNo
❑ Yes ® No
❑ Yes &No
❑ Yes X No
❑ Yes IN No
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US �60,•-• 0.i �05�%ti.LC
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k-R-� 4 p , .
7125197
Reviewer/Inspector Name t
f
Reviewer/Inspector Signature: r} p„�,�, Date: q Z b 1