310761_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

Type of Visit: )pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ZRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: in Arrival Time: Departure Time:® County:
Farm Name: C1y( Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Title: Phone:
Location of Farm: Latitude:
1{� Region: U co
Integrator: z
Certification Number: �/D ✓�
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design
Dry P,©ult , Ca aci PL©,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Other
Turke s
I I Turkey Poults
Mher
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
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili _Nonber; - Date of inspection: llll'gl (-
409,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
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
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
hNo
❑ 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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): le�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
4 Yes
❑ No
❑ NA
OK
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[;�FVE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
KNE
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
❑ Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
NNE
ElWeather ode
❑ Rainfall []Stocking 0 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
DNA
NE
Page 2 of 3
21412015 Continued

lFacilityNumber: -I
jDate of Inspection: 11
24!Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:]No ❑ NA VNE
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. 7�
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
J❑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)
3 L 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? ❑ Yes ❑ No ❑ NA O ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes K No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes D No ❑ NA ❑ NE
Comments (refer.to.questi.6d#): Expla►n siiy YES -answers and/or"any additional recommeiidations:or.-a'ny other comments . '
Use drawings of facility to better explain_iituadons'(use additional pages as necessary). .. -
❑ Yes Z No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA XNE
❑ Yes [�QNo ❑ NA ❑ NE
—3erMudwpari� MA weed "I �' "rerW&_[j
VON w ((
Vh„ove, �-�,^ fitld rya.,-tr�t,vjw.
I�csrd4 w�.� aN�lafe -��- rev��cw. Will came l�c� sa�n
� Wuw a I I M 0 rzk:
� �.e�arn►�e,��.�Yhr�f caul�c� c�irn swardsC��� for curt
tev1W 9l0—q-1 0 ziU8) and co>,-f-act an A rr Nn:r-f-
Add a4l'im�j-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � 19 —1 r
Date:
21412015

Type of Visit: U Com ce Inspection O Oper n Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `�--r--`�-' Arrival Time: / 3U Departure Time: j Zp U County: Region: WI
Farm Name: E Owner Email:
Owner Name: Y /y/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �/ 2-26&
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
CapacityIMPOUM
C►urrent
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Zqo
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oul Ca aci_ P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ❑ No E] NA 24
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
D 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
Ej<E
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
R<
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IF21cility Dumber: - / Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
Ej"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
2<
(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
['IE
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
ENE
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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E5No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1.5Q N. ❑ 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? If yes, check
the appropriate box.
❑ Yes
N
❑ NA
�E,
❑ Yes
j'Zo
❑ NA
[rNE
❑ Yes
EoKo
❑ NA
EZ'NE I
❑ Yes
No
❑ NA
�NE l?j•
❑ Yes
eNo
❑ NA
24E `
❑ Yes
00-
❑ NA
OE
❑ Yes
1�0
❑ NA
Ea"NE
❑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 [✓] NZo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaSility Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E�rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No F✓ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA [r NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E�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
[�o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Ko
[DNA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
:�o�EINA
❑ NE
Comments (refer to question # ):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
AOIIS1114 -
j5-hA (/L4
Phone:
Date: l %
21412015

A ypr Ul V 131 L. k-J %-ULUPAI i UCt! 1MPMALUII `J WPt3-1LL1U11 1lCVfiVW LJ AL1 UULU1 V L' V U1UilliUll LJ l CL:L111C7L111�Sl�Lillll:C
Reason for Visit: <51woutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: O Departure Tim . rl County: Region:
( Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: _ _ z �� I i! % u [� S Integrator:
Certified Operator: Certification Number: �d3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
El
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Castle Capacity Pop.
airy Cow
El
Wean to Feeder
Non -La er
airy Calf
NJ
I Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
O . Pju-I GAP. P,a ,
Layers
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 IQ 1 o ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ Now❑ NA ❑ NE
❑ Yes 0-<o ❑ NA ❑ NE
❑ Yes D-111a ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'1 0 ❑ 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 0'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7 j N - ❑ 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 � A�o❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QNb�__[:] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O15o ❑ 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?
❑ Yes
❑ No
❑ NA
E� NE
❑ Yes
❑ No
❑ NA
[]'NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes ❑ No ❑ NA
[:]Yes [-]No ❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ❑ No ❑ NA
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 ETNE
❑ 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
NE
Er -NE
,2�N
E
Page 2 of'3 21412015 Continued

FaMiiy Number: jDate of Inspection: Z. o r!G
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA g�N�E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ❑ No ]NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA fNE
[:]Yes ❑ No ❑ NA /
[:]Yes Noo ❑ NA
[:]Yes 13'No ❑ NA
6--Yes [:]No ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: -- Date: 2 �b
Page 3 of 3 21412015

Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: rrival Time: �/ s c-L--� Departure Time: Countyb'4P�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: ry C 1 11�C
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region • —azz?y
Integrator: ��/J z2z _
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►apacity Pop.
Dai Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
eCS
Dairy Heifer
Dry Cow
Non -Dairy
lBeef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , Pooult Ca aci Po ,
I Layers I
Gilts
Non -La ers
I Beef Feeder
Boars
IPUIlets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes �No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes 7No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes f No
❑ Yes WNO
a
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412014 Continued

Facility Number: 3 J- -4a Date of Inaction:
Waste Collection & Treatment
4. Is storage.capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �ffNo
a. If yes, is waste level into the structural freeboard? ❑ Yes Z"No
❑NA ONE
❑ 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 t e 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 ONo ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,'notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ;n No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 Vj No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 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 ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes K o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes, ❑ No ❑ NA ❑ NE
25. Is the -facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes A No
❑ Yes I/I No
❑NA ❑NE
❑ NA ONE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes VNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E? f No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes U/No ❑ NA ❑ NE
Comments (refer to question, ft. Explain any YES answers and/or, any additional recommendations or wady other coimments
Use drawings" of facility to better explain situations use additiona1pag
ty P � ( es as necessary):`:'" ,.. -
w 6cd ok-fofAyll(X)o,"
6T� t i r
1� 1- / z
3/7- a,o I
2,0 Z
Z t o ,3
Reviewer/Inspector Name: 0 Phone: Q
Reviewer/Inspector Signature: _ _ f _ Date: w Z(p / }�
Page 3 of 3 21412014

Type of Visit: 0 2*Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:4* Arrival Time: ® Departure Time: © County:., Dwlz) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: CLL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Igo5G
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish I JLayer I
Wean to Feeder I INon-Layer I
Dairy Cow
Dairy Calf
Feeder to Finish
Heifer
—Dairy
Farrow to Wean Design
Dry Cow
Farrow to Feeder Dr. P,oul Ca aci Plo
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turke s
O#her Turke Poults
Other Other
Discharges and Stream_lmuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes y
o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes WNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: IDate of Ins ection:
Waste Collection & Treatment
4. s 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
Strucd
ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C�[�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �fNo ❑ 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 EjNo ❑ NA 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes dNo ❑ 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 �No ❑ NA ❑ NE
maintenance or im rovement�
p
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?
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? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes VVO
f❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes o ❑ NA ❑ NE
[:]Yes ]�No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
[::]Yes FdNo ❑ NA ❑ NE
then-
21. Does record keeping need improvement? If yes, check the appropriate box below. IffYes [:]No ❑ NA ❑ NE
❑ Waste Application ❑ eekly 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 E, ° ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes WNo 0 NA ❑ NE
Page 2 of 3 21412014 Continued

lFaelty Number: jDate of Inspection:
24.-,pid the facility fail to calibrate waste application equipment as required by the permit ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
�No ❑ NA ❑ NE
o ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to 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 Zo ❑ 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 No
0 Yes ;NcNo
❑ Yes [�No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
[] Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
N
❑NA
❑NE
❑NA
❑NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other -comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
1 L)FDATC MW `t_W S .
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412014

41
(Type of Visit: JO Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: QrRoutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:,�7 M� Departure Time: County:
Farm Name: 1% Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator: r"A
C + C1G�/�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current Design Current
Net Poultry Capacity Pop. Cattle C►apacity Pop.
La er Dairy Cow
Non -La er I DairySalf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
Dr. P,oult . Ca aci_ Pao , Non -Dairy
Layers I jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Putlets Beef Brood Cow
Qther
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 7No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes �No ❑ NA [3 NE
c, What is the estimated volume that reached waters of the State (gallons)? CC��
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes PTNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes VT. No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r
Facility Number: < j - t (.7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9_"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:` r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 347�`
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes FfNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes VfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
E!fNo
❑ 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
2INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U!pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f No
w ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
'I� No .
❑ NA
❑ NE
the appropriate box.
j�"'
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑'NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 E3—No ❑ NA ❑ NE'
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

x
Facility Number: jDate of Inspection: ���J3 _ j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 00!No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ 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
)2f�4o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
FrNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�fNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
f�'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
P!rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
;�J'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
7T No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA ❑ NE
R�
Reviewer/Inspector Signature: Date:
Page 3 of 3 214 OII

Type of Visit: R.Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: � County: T
Farm Name: evg(Z-L AL) Is Ey- } Owner Email: �-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: E A.[ZL 01
Certified Operator: 'EQ it L C'i�s A Ul S
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrators�:(
Crtificati n Number:
Certification Number:
Longitude:
Region:
gas&
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
Non -Layer
DairyCalf
Feeder to finish
Farrow to Wean
Farrow to Feeder
Design
D . P,oalt , Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Furke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes tNo
o
❑ Yes
Yeso
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - (Q Date of Inspection: [p
r �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ YesP�o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; bF !
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): jo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 4!�No ❑ NA ❑ NE
maintenance or improvement?
Waste Appcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
IN
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Fonding ❑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): �F X �C ( o bG Qx� (Ll// _ N�
-- --
-
13. Soil Type(s): U &41 1L_L.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes, No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes . No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0"
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 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No
❑ Waste Application 0 Weekly Freeboard [] Waste Analysis 0 Soil Analysis ❑ }rite Transfers
❑ Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No
❑NA ❑NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: Co
24. Did -die facility fail to calibrate waste application equipment as required by the permit? ❑ Yes kNo
o ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ta No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations, or any. -other comments.
Use drawings of facility to better explain situations (use additional'pages as necessary).
w. A.
51g'l,a 2.3
P19-7b9 3- i
nJ�al►'� ��a
sh31f, a� I
tc� T !o rl
t�rvt E � Dpc.vN
n6fp c) G G i c�Acoo�l Q
V�'_'gsUo4m: S�14SpN
mw A�N a �c• S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Toy�LEp9-G ofl —
Phone:hl
Date: J-4 p(
21412011

sDivlsion of Water Quality
Facility NUM Division of Soil and Water Conservation
Q Other Age„cy
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:� Arrival Timer Departure Time: County:�UC7C/X/ Region:
Farm Name: p ig U ! S Owner Email:
Owner Name: a ac L C . Phone: 96 90 — Mo 4
Mailing Address: _ &o lS C (_1 LL-� U) S 'Zo5e NL LL , /VC Q "/SIR
Physical Address:
Facility Contact:
Title:
Onsite Representative: EkgL 'big 01
Certified Operator: G a (L. t._. C . ;�J a Ul S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Cerfificati �n Number:
Certification Number:
Longitude:
I�C�360
Desig© Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Wean to Feeder
Non -Layer
iry Calf
Feeder to Finish L d
Dairy Heifer
Design Current Dry Cow
D , P,oult C•_a _aci P,o , Non-Dai
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
i urke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes INo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facility Number: -3 1 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r67_C_K_-U ;_ Bev_(?) �P� S4 Fy_(1(J)_ �3 eo(r) _
13. Soil Type(s): [V1 i4a UL\A/ / A_At C-kU J L l C
14. Do the receiving crops differ from those designated in he CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents 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
[_1 Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0
No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ /aste Transfers [] Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections [3 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

jFaciW Number: - Date of Inspection:
� �r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a
llo ❑ 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 �kNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [—]No NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
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
0
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
0 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ 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 z
Use drawings of facility to better explain situations (use additional pages as necessary).4
C_AN Fdc EYE fAVY,Oy Fo�66G Sk�zu�
11� i1U 1.1 =79
1:STC1 C i ( Goo n� D pow g �oR
�\Lk�UUc4VC- s C ASCYV C ArV pvmp �c-c�
�1 A VC C7
u -o 31
S ro�> ?LA. MP
A/G-Cr_7D -Tv 5�q4� F-0Q- wEF-'�SS
A!G 6 n Tv ("C Lw u06"JS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A rh g 1vo,4 Qlw
Phone: T/V
Date: 75/5//
21412011

IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit .Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q /Q [Arrival Time: I pa Departure Time: County: � u� Region:
{s
Farm Name: rr(�QL 1JA U 1 S Poem Owner Email:
Owner Name: A<L L- C` � Ay 1 S Phone:
r �`
Mailing Address: 1 A Q-L bA O1 S � "SE �-L- , � j( _ OS yS O
Physical Address:
Facility Contact: Title:
Onsite Representative:(�ti2 L D R U I
Certified Operator: 4��CLL E� • �/}U1 S
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
ao).0 �031�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' [� Longitude: = ° ❑
Design Current lDesign Current Design Current
Swine Capacity Population Wet Poultry Capacity PopWa#Ian Cattle Capacity Population
inish
❑La er
❑ Dai Cow
eeder
❑ Non -La er
❑ Dai Calf
Finish ❑Dai Heifer
rWean
Wean ❑ D Cow
Feeder ❑ Non-Dai
Finish ❑ Layers
El Beef Stocker
Gilts Non -Layers
ElBeef Feeder
❑ Pullets
E-Boars-_ El Beef Brood Cowj
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes kNo
�No [INA ElNE
ElYes '\ ❑ NA ❑ NE
12128104 Continued

Facility ;dumber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ko [INA ❑ 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-S
Spillway?:
Designed Freeboard (in): 9. S
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 ANo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 9No ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 'of Wind Drift ❑ Application Outside of Area
l2. Crop type(s) S C1 F'r scL"�G (A ZG2LP")
13. Soiltype(s) i r igcLu
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
,TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(?rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
-Comm_ ents refer touestion.#-Explain an YES:ansjrers and/or an recommendations or an other comments sew
Use drawn s of facrl ty to betterex arn situations. use additional; ° a es as°nec y
g P '_( p �g essary):� ,
M.>
Reviewer/Inspector Name jj �/C
Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: ?Zp{ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes lfNo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ V�aste Transfers ❑ >r!'iival Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections Q Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;S(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
'K}
[]NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
No
X
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit R Compliance inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit xRoutine O Complaint O Fallow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �Tr!(�1 1 Arrival Time: Departure Time: County: u N Region:
Farm Name: C AFL 1 l A U S l A� m Owner Email:
Owner Name: V I S Phone:
Mailing Address: i EPac.ZflurS V-8 )AiLL, %/C_' DN5
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of farm: Latitude: = [= A 0 Longitude: [= ° [= [ = {f
, .. . e._ -..
Milill
2Des!gn Current
....
Design Current
Design Current
Swine apacity l'op�ulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish d 0
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
-
El Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12178104
Continued

Pacility"Rumber: 31 T to Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ElNE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tAGC�nd
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) A
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑NA [INE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes tN
o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYeso I --] 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 gNo ❑ NA El NE
maintenance or improvement? ``""
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes _KNo ❑ 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) �LSLI.�E C A SC
13. Soil type(s)
1L-CL
V
13 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 4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes I" No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo ❑ NA
❑ NE
W.A.
aJ19109 a,Li
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
NFEi� Somme w� GcW7V_Q __-- MiL- bAv3S "A f
r=_ fnou E � SOPA C—_ CsOtA,�_%
Phone: I/U' y 7{7' f ]o► y
Date:
I2128104 Continued

5
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists El ``
Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑/aste Transfers ❑/nnual Certification
❑ Rainfall 0 Stocking El Crop Yield 0 120 Minute Inspections 0 Monthly and i" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNA
❑NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes§No
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
�['�11
El NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
14No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
8�No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
6Division of Water Quality
O Division of Soil and Water Conservation
0 'Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: =y Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: VPLt—)�&o I
Certified Operator: VA(?L- C - % 4L3l %
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone:
Phone No:
Integrator:
Operator Certification Number: 196'slb
Back-up Certification Number:
Longitude: 0 ° = 4 = «
a
Design Current Design Current ' Desagn� �t Current Si
}'Swine -Capacity ` Population Wet Poultry Capacity, Population Cattle �. Capacity �l'opulatron��s
] ❑ Wean to Finish T❑ La er
" ❑ Wean to Feeder I ! ON on-Laer
Feeder to Finish
❑ Farrow to Wean I I Dry.Poultry
❑ Farrow to Feeder
Gilts
Other
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
IE]Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoY4
- -----
i
;ram
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
ElNE
❑ Yes
10
❑ NA
❑ NE
12128104
Continued

Faei* Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Oo W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
KNo
ElNA
ElNE
❑ Yes
� No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes bKNo ❑ 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 ElNA [INE
maintenance or improvement?
Waste ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O(Na ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 ,kNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,E�'No
❑ NA, ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to betterexplain situations. (use additional pages as necessary):
JIVITIA(- "1NFAL.LOU&?— 1"
c eoQ
t�14L GEC d/v
NeC-,D A L ITT L-E 1>KUT d-Qt_-I�eT0110r4 TO co,,,?V?R-a(- CL,6�S►QvVeW n[ KIS W4kc_3-
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: 5 1QE
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection d
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PqNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Cl�o ❑ NA ❑ NE
the appropriate box. ❑ yelp ❑ Checklists ❑ Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�<No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
]b No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
' \
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agencyb1z
Type of Visit Z Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ,0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S"0�1
Arrival Time: ,� Departure Time: 1 ounty: Region:
Farm Names _LN�i �JAd�i �/1.4iY1 -„ __ Owner Email:
Owner Name: ✓�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: I Phone No:
OnsiteRepresentative: /I %�L �i7t✓v5 Integrator: ��QP `>l — 'f5C'udAJ!
Certified Operator: /1105, - t/j Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = . = « Longitude: [� o =1 =
gfi
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 19 1`—
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry. Poultry
Layers
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?
Design ,Current
Cattle Capacity Population.:
❑ Dairy Cow
❑ Dairy 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?
0
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
ko
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspections O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
St�c/tore 1 Structure 2 Structure 3
Identifier: _ ,,,,//
Spillway?: 410
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes /6No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE .
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )2TNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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? 0/yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PPNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo []NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �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 Hare Soil
❑ Outside of Acceptable Crop Window ❑/�E'viidence of Wind Drift ❑ Application Outside of Area&4_zz
12. Crop type(s) ��iPrfIUQi4 1(ti242i �r 4fw) . � 6, >tli`/�Sf��J) /"� SC!/E
13. Soil type(s) T
- —
14. Do the receiving cropsdiffer from those designated in the CAWMP?
El Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination: ❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E(No
❑ NA
❑ NE
/tom x �G �s r /�,er --�� G,� / �D S
/f-LL '4'Z/J �7�GC_ / i`/"J-G}� .G�tJ ��� /V 11%;S C/G� S�B•P��/�C�•-� .
M64011
4
Reviewer/Inspector Name ,rf����/� dit,/.. j .„ �' Phone: of g
Reviewer/inspector Signature:
Date:
I
Continued

Facility Number: —;7-Date of inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0Yes ❑ No ❑ NA ❑ NE
❑ Waste Application Xweekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
1�No
�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
)ZYes
❑ No
❑,NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
IffNE
Other Issues
,_,(
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
j�J No
[--]:NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑,NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑,NA
❑ NE
If yes, contact a regional Air Quality representative immediately
=
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
7
;
32. Did Reviewertinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
,
-91
1c,9_V i" c6YiV l 35 2-00 tl-'-

09h7I1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 07
-9600dlro (R/8o;; r
OrIfe
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION: re'af I 1,�)
DATE of FIELD CALIBRATI
(mm/dd/yy)
FLOW METER SERIAL NUMBER: D -Q 6 =J 4
EQUIPMENT
NUMBER: Aed #
MEASURED RING SIZE: OF- inches
Is wring size within 0.0111 of original manufa Lured size? t/ yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: /Za psi
At Traveler: psi(if applicable
At Sprinkler/Gun: _ psi
EXPECTED FLOW RATE(frow manufacture chart) D r GPM
MEASURE FLOW RATE(from flow meter): / 9 q- GPM
Flow rate variance greater than 10% yes no k1-11-
EXPECTED WETTED DIAMETER( from wetted acres determination):
ft.
MEASURED WETTED DIAMETER: _ ft.
Wetted diameter variance greater than 15% yes no ✓
IF YES IS ANSWERED TO EITHER FLOW RATE OR. WETTED DIAMETEI
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
r
Calibrator:

09/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 08
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM .
LOCATION:��
DATE of FIELD CALIBRATION:
(mm/dd/yy)
FLOW METER SERIAL NUMBER: D Lf
EQUIPMENT
NUMBER: ¢
MEASURED RING SIZE: _ /,/X- _ inches
Is ring size within 0.01" of original manufactured size? L-- yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: psi
At Traveler:
psi(if applicable.
At Sprinkler/Gun: _^ .Sri _ psi
EXPECTED FLOW RATE( from manufacture chart) CX- GPM
MEASURE FLOW RA.TE(from flow meter): C gs GPM
Flow rate variance greater than 10% - yes no
EXPECTED WETTED DIAMETER( from wetted acres determination):
O _ f.
MEASURED WETTED DIAMETER: ft.
Wetted diameter variance greater than 15% yes no
IF YES IS ANSWERED TO EITHER FLOW RATE OR NETTED DUMETEI
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
Calibrator:

09/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 09
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION:
DATE of FIELD CALIBRATION: � -
(mnUad/ }
FLOW METER SERIAL NUMBER: 4 -d
EQUIPMENT
NUMBER:
MEASURED RING SIZE: LIP- _ inebes
Is ring size witblA 0,01" of original manufactured size? yes 'no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: kzl-. psi
At Traveler: psi(if applicable
At Sprinkler/Gun: _3-0 � _ psi
EXPECTED FLOW RATE( from manufacture chart)—,2 Qj GPM
MEASURE FLOW RATE(from flow meter): GPM
Flow rate variance greater than 10% yes no
EXPECTED WETTED DIAMETER( from wetted acres determination):
32 ft.
MEASURED WETTED DIAMETER: ft.
Wetted diameter variance greater than 15% yes no ..�
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEI
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
Calibrator:
(signature;
--s'

09/17/1999 11:22 9102934383 $RENDA WILKINS SMITH PAGE 10
IRRIGATION EQUIPMENT FIELD CALIBRATION FORM
LOCATION: G , r L _ l_
DATE of FIELD CALIBRATION:
(mm/dd/yy
FLOW METER SERIAL NUMBER: 4 -D /D f
EQUIPMENT
NUMBER:#-D
MEASURED RING SIZE: _ _ _ 1. I p inches
Is ring size within 0.0111 of original manufactured size? v yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: j. 3 psi
At Traveler: psi(if applicable:
At Sprinkler/Gun: ,Sb psi
EXPECTED FLOW RATE( from manufacture chart)(2 GPM
MEASURE FLOW RAT'E(from flow meter): _ L j - - -- GPM
Flow rate variance greater than 10% yes I no
EXPECTED WETTED DIAMETER( from wetted acres determination):
_ 13 GCO ft.
MEASURED WETTED DIAMETER: ft.
Wetted diameter variance greater than 15% yes no
IF YES IS ,ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEF
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE
Comments:
Calibrator: $c,
(signa

`09/17/1999 11:22 9102934383 BRENDA WILKINS SMITH PAGE 11
IRRIGA'TI'ON EQUIPMENT FIELD CALIBRATION FORM
LOCATION:
DATE of FIELD CALIBRA
(mm/dd/yy)
FLOW METER SERIAL NUMBER: d —dom
EQUIIMENT
NUMBER: geel
MEASURED RING SIZE: Le inches
Is ring size within 0.01" of original manufactured size? yes no
IF NOT REPLACE RING.
PRESSURE GAUGE READINGS At Pump: . f a-0 psi
At Traveler:
psi€(if applicable'
At Sprinkler/Gun: _ S_ 3 psi
EXPECTED FLOW RATE( from manufacture chart)_ 1 o.r GP1VI
MEASURE FLOW RATE(from flow meter): 1 `1 f-GPM
Flow rate variance greater than 10% yes no L.-
EXPECTED WETTED DIAMETER( from wetted acres determinatioe):
a ft.
MEASURED WETTED DIAMETER: --Z 2 !f ft.
Wetted diameter variance greater than 15% yes no
IF YES IS ANSWERED TO EITHER FLOW RATE OR WETTED DIAMETEF
VARIANCE, CONTACT AN IRRIGATION SPECIALIST FOR ASSISTANCE.
Comments:
Calibrator:
(signature)

Facility Number
_J _0
0Division of Water Quality
Q Division of Soil and Water Conservation
D Other Agency.
Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit qfRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 3 06 Arrival Time: D/ Departure Time: County:
Farm Name: ��� � l �`%►'�/'.' ' _� Owner Email:
Owner Name: L Phone: _
Mailing Address:
Region: 1211,O
Physical Address:
Facility Contact: Q Title: l one No:
Onsite Representative: �Ntl .l` JZZLJ 1q1`j4_6AAntegrator: //l/liPio�Sf ol�J cJ
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` [=gi Longitude: = o 0 t 0
dg
Design Current Design, Current; Design Curren#
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
Wean to Finish ❑ La er t,
Wean to Feeder ; ❑ Non -Layer r
Feeder to Finish Q 1Q
Farrow to Wean
Dry Poultry
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
s
❑ Other
❑ Layers
❑ 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 -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co l
i
Number of Structures`
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )2fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No [-INA❑ NE
❑ YesXNo ❑ NA ❑ NE
12128104 Continued

s
Facility Number — p
Date of Inspection 7J Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;1No
❑ 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: A�e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
[INA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
,_,;(
❑ Yes J[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?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
'XNo
❑ Yes �No
❑ NA El 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 PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
+
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence o Wind Driiftt Outside of Area
12. Crop type(s) CTIPi¢ W*1
❑}Application
�(r. Nt1,Fi�S
r—,E5C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
iNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations.6r any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
1,5)
49
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2128104 Continued

Facility Number: — y`i� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfaIl ❑ Stocking ZCropYield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
X No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
VYes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_"No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
!
❑ No
❑ NA
Other Issues
XZNE
28. Were any additional problems noted which cause non-compliance of the permit or CAWNiP?
ElYesNo
X
❑ NA
- ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
X
❑ NA
ElNE
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
td No
[3 NA
El NE
If yes, contact a regional Air Quality representative immediately
T
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
!$ .221 "o �fjo�0-G 1�5f �aG�� ��Oui� �E�S f �Pi✓l� �v /l�, fJ
�I� �� � �� G p • .+L fG�I�Q �,��,Sa�� W��i�L
Page 3 of 3 12128104

r
Lof Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
n for Visit 91Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access %
Date of Visit: f S Arrival Time: Departure Time: 2 f County: Region: wwd
Farm Name: ��� L �:Ji4�/ZS �i4/r1 �- Owner Email:
Owner Name: _ FBa��%zs _ Phone: _,
;Nailing Address:
Physical. Address:
Facility Contact: Title: Phone No:
nn !
Onsite Representative:.�,[1RL 44G"76 __ Integrator: OWE" r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Weeder to Finish
(P b0
pip
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ -----
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Ii Longitude: [= ° = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
6
❑ Non -Layer f
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: ®1
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 F(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
12128104 Continued

N.
Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
❑ Yes JVNo ❑ 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?: D
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [(No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes El No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes oNo ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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) f�Scae (600zi) s% e1 K,oa CA% Oe o 2 �� . Some, �44Z", Loa���
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FA No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
A No
[-I NA
❑ NE
f, Nofoeyo % l Y'alnp AA_-'Rk_ yvS. Ca.�i✓�e�s irrP, / s
V7Sk{l�E.O.1
Reviewer/]nspector Name `
,F�7fi2 , z " �"`• Phone: O- O
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the 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 VrNo
❑ Yes 0 No
❑ Yes VfNo
❑ Yes ZNo
❑ Yes �0 No
❑ Yes ❑ No
XYes ❑ No
❑ Yes Z No
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑NA El NE
❑NA El NE
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No
❑ NA
❑ NE
❑ Yes /11 No
❑ NA
❑ NE
❑ Yes ko
❑ NA
❑ NE
❑ Yes 73 No ❑ NA ❑ NE
Z)1*4o r A�4a UOP YO�O � 0�5 �,� 114Y( f7"-cL0f_`D
" Nam,_-� � L4s� Coa�c
©� '��� a�o c f
2�) Duo I �'�/� i �/�'FlJ 5 lc� �f F'ntovf/� � �n� G�i✓DC,D
12128104

J•
Type of Visit .6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of visit: 2 d % Time: �+
Q Not Operational Q Below Threshold
Permittedip Certified ,© Conditionally Certified © Registered Date Last Operated or Above Threshold: ---- ------ ...._.
Farm Name: .. A �;1�1� ._.T nR - ................ .... - - - County: S k `............_.................................»......... ...
OwnerName: ..Efi.L............... ........ ........ ..... ...... I_.............................. Phone No:.......................................................................................
MailingAddress:...................................................... .......
Facility Contact: W ......._ Title:Phone No: . W.��W �_ �,...........
Onsite Representative: ... tegra Ao''j rf
- - - — -- - _-- ............... .. W - ..��.. In tor- - -- - — .. ,........... -- •.........---._.................
Certified Operator: .................. ..... .......... ..-..... ----•--­-......................_...................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 4& Longitude • 4 6�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;KNo
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 XNo
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 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......_ ................................... ..� ... - - _.._....
Freeboard (inches): 22
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 VfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes RI 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 ONo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes J'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes o
elevation markings?
T
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes )KNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes/No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ESL�E(6a¢Ax�E}, �E/Lih+I,rjA�CxQAz.f%,WiyoACNAij. SM/�ALL, �P-A.Td 0-1&XSEE)
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 XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes )2rNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes PINO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )ITNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INO
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.
.Comments {refer o gneshon #} Explain suy YE.S answers and/or any,iecommendaf<oas gr any:other coonments.�r µ r_
Use draiwurgs of faiLty to better explain sitnatioas. {{use addiLoiosi pages as necessa ) 1.
ry ❑ Field Copy ❑ Final Notes f.
()W0t1L_ TO a-* SLOV64 Sua,JFY AJb CAL7r_9RA7ZW
owl4rg- 9E cmEvE !) s; acKzNfi REco ft FRom '_LP7C_4VXA rail •
RE r a-DS CWK GodD.
---.�-� -
Reviewer/Inspector Name43,
Reviewer/Inspector Signature: Date: VI-S d
12112103 Continued

Facility Number: r -76 Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes J6 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 XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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 ANo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes INO
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 ;KNo
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 ANo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
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

► r
Type of Visit Z Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 01Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 t (�, l Irate of visit: 21 O Z Time: !
- .� . . Not erational Bel vc• Threshold
, 0 Permitted ❑ Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: C— ,A V S -e' .. County: -9 v 10 t;11.
Owner Name: Cur pa ° Y Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ��r t D a V t s Integrator: 13r ow"l '-r Oif eq.-0 -1
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude o• �• �� Longitude
Design Chrrent Design Chrrent Desrgn , . Current
_ W:
q Stue= Ca acitz Pa ulai�on. :Poiiitry Ca sctty :Fo tilation " ��C�ttte W -ACs acaty Pu' Matron
W ❑ Wean to Feeder W !;, ❑ Layer ❑ Da' r tl
❑ Feeder to Finish i - Non -Layer [] -Dairy
"
❑ Farrow to Wean _.
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total D6ign Capacity kO
❑ Gilts
❑Boars Total SSLW ,
Nutubei-of Lagpvns ❑ Subsurface Drains Present7jEl Lagoon Area ❑ S rav held Area=;
Hording Ponds l Solid',Traps W ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 2 (p
0510.3101
❑ Yes ❑'-io
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ErNo
❑ Yes ONO
❑ Yes ONO
Structure 6
Continued

Facility Number: 31- Date of Inspection 21 OZ-
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, notih' DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type re-4-6 V C IT` e. ov rp Vg r +^, v* �Gi S 1 ► •��'t " �! /7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
..5-..
❑ Yes ',�No
❑ Yes _,Q'No
❑ Yes ZNo
❑ Yes ONO
❑ Yes -6 No
❑ Yes"E'Ro
❑ Yes -ONo
� Cry �'1 QL! ✓sue
(CAWMP)?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes -2rNo
❑ Yes O'No
❑ Yes ICJ No
❑ Yes ,EI-No
Yes ❑ No
❑ Yes ,ONO
❑ Yes ,2 No
❑ Yes �2rNo
❑ Yes _E3No
❑ Yes,dNo
❑ Yes _2rNo
❑ Yes ONo
[:]Yes JZNo
❑ Yes ❑ No
❑ Yes O-No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
e-
C6mments',(refec to question #):: Explain arty YE3 snswet-s andlor:an recomnteudations er any'other comments.
Use drawings of facrutty to.better_ezplarn situations: use additional pages as necessary) " I0 Field Copv ❑ Final Notes -
15. e Jr 4 lack of be--^✓•1cl
eId JPvI IS (oA, ?A� A"Ld Aq _ -r 11 os-/ inslOCCa;pri5
also - AIse, SiCa, �i �or4ior pe 9-,-e PuII : needs 7v
t-)it ve r<'�sGve br cor 2.s�4�l�s�e� AJ �'S G r�rre�t�17 /�cc�;.�g �,',
Areoj . PjcA.5e
Name Reviewer/Inspector m - {w
p ...r�es rim /5
Reviewer/Inspector Signature: Date: '� 0Z-
05103101 Continued

Facility Number: 1 —rf j Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑JNo
❑ Yes No
❑ Yes , 'No
❑ Yes x No
❑ Yes Z"No
❑ Yes J'No
❑ Yes ❑ No
Additional Comments: andlor'Drawingst_ , _` 1
flav;.v sC,-YJ A i s g bak� to 54a�Ve yj i a4 J,•s 44.�n,.
elsewh-e-,
��er �kg riG��ed r am`! 44e -FGeOt'4y , re► t="1'�'l�l bevP61Udl{,
';e1ds, a�� reGv✓ds °'preQ- well ke,4 J
11. T Ae 1<9- 2 /s 4'oe o! - 'O 1-e L20447 fee(
05103101

Facility Number 31 (o Date of Visit: D Time: 35
Q Not Operational Q Below Threshold
0 Permitted 0 Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ................
Farm Name: Vic. i �� s Fc� -''''' County:.. I `L
...._......._................................................................................................. P.........................
OwnerName- & ") J.,rv,'„$................................................... Phone No:...................................................................................� . -
•................................................. .
FacilityContact: ............................................................................... Title: ................................................................ Phone No:
MailingAddress: .......................................................................................................................................................................................................... ..........................
OnsiteRepresentative: C!` c,v s........................................ Integrator: 3r°w..v, 9 of-/:r,'ro.jl.'?�........
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 46 Longitude ' 4 64
Swi_ne ,, Design "Current. ` -Cur_.._ tDesiCurrent .
.
l&dCattleCapacity Po -population Poultry, Ca actPo ulation Ca aci :Po an= ❑ Wean to Feeder ❑ Layer ❑ Dairy
❑Feeder to Finish ❑Non -Layer 10Non-Dairy
❑ Farrow to Wean `
Farrow to Feeder ❑ Other
❑ Farrow to Finish Tot8l=Des1 Ca aCi
❑Gilts - P ty
❑Boars Total W.
Numberof Lagoons = ❑ Subsurface Drains Present © Lagoon Area I0 Spray Field Area
Holduig Ponds / Solid Traps: JE1 No Liquid Waste Management System
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: .............. I ................... .................................... ................................... ....
.........................
Freeboard (inches): .39
5100
❑ Yes 12(No
❑ Yes No
-s
❑ Yes No
31 I�
❑ Yes gNo
❑ Yes IRNo
❑ Yes p�No
❑ Yes 7No
Structure 5 Structure 5
Continued on back

Facility.Number: 3 Date of Inspection Q O)
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J2fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ONO
(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 Zr No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes j2rNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes JXNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes gNo
12. Crop type �esGt,G f �S-�ure t $e,rw,�•d� PA i vie � T3e►��..,•,dk Nay t .s►�-�I 1!
rl'rC4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO _
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ONO
b) Does the facility need a wettable acre determination?
❑ Yes ZNo
c) This facility is pended for a wettable acre determination?
❑ Yes 2 No
15. Does the receiving crop need improvement?
'Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ,INO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes dNo
(ict WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes JZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes J3 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes o No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes_ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes,,Z No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes A No
yiQla�iQnjs:oF d fcpeucic -*'re poled•il>s 669tms:Awlt;-Y00 wilt•t &eiye too futthgr
. .-.-Comes' inideirce: al�Dtit: this visit`
{refeeto.queshon#)i-Ekplaiii,any YES answers andlor any recommendations or any other Comments:JR
IComments
Use,d swings of facili to:better.:expiaia sitiiatioas {u§e additio ial pages as necessary)
Is. wa,-k 4o G/ -m_;-% 4e +"e-cc ,�e r ks v -,r 4 be4er
e:54c4l.-A --re5c,ve. here, AIse) k r,eeotr 4o be a ie e,4e-►i[
c,C (,e�►�tvd4 Lc�y ��e1d -tro 6cl�ew eS-�a61; rL, berwwd� , Gio -��%'s i''L
s�r��•g Paz.
Reviewer/Inspector Name „ -is A1.;�q ..;
Reviewer/Inspector Signature: _ Date: 1611101 5100

1/
Facility Number: 6 Date of inspection Ia Ol
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes'ONo
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'P`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JZ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) Cl Yes -RfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
I-Additionid C omments an or= mw ings• - -
.r
S/00

.. _. -
x- , r Division of -Soil and,Water"Conservation-'Operi ion Review y --'
�Div�sion of Soil andW�t�r_Conseivatioii---Compliance Inspecbonr 'Y
- T�D�vesic►n of Water Quality _Compliance Inspection
R 1 Other Agegcy Operat,on Review
10 Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Other
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
*ermitted © Certified 0 Conditionally Certified 0 Registered [3 Not O erational Date Last Operated:
..........................
Farm Name:, IV� Count
�... } ''�^.5.... �................................................................... 3 :............N"s .....!><.....................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility Contact:
i
...... Title:
Phone No:
MailingAddress:.................................................................................. ,...................................................................................................................... ..........................
Onsite Representative:. tiZ�{ ...........,b?� 's....................................................... Integrator........�<Sc.... .......
........................................................
Certified Operator:.................................................:................................................I............. Operator Certification Number:..........................................
Location of Farm:
........................................................................................................................................................................................................................................
..:....... ........ .............. ................... ....
Latitude Longitude
- -- Desi urrenY
=<Swine --CapacityPopulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
- Nuntber_of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponids LSolid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DW Q) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (II' 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 tKYes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier: j
Freeboard(inches): 11-1 ........................................... ................................... .................................... ..................................... ...............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

(Facility Number: 3 —% Date of Inspection
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ No
❑ Yes
9Yes
❑ 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?
16. Is there a lack of adequate waste application equipment?
Renuired Records & Document,,;
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0;Rio violations;or def genctes -were noted during this; visit; - Y;oif W ill :r; eeeive ii6 further - : ; ; .I
corr6sQ deRce: abotit this :visit .... J
Commen6-(refer to.queshan #): Explain any YE5 answers and/or any'cecornmendations or any other comments
Use.drawings of facility to°better explain situattofis�{use additional pages as°necessary)°_ ;_� ;.,
4.�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
w ' 777 =-_.. _ . _: T
Reviewer/Inspector Name
Reviewer/Inspector Signature: A. Date: '�-a"(

Division of Water Quality', a
0 Division of Soil and Water Conservation'
0 Other Agency = - _
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit `Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 j Date of Visit:
Permitted 0 Certified [3 Conditionally Certified [3 Registered
Farm Name: +V0.ra!r' Fa '�
t.. �...............r....................................................
Owner Name: BL r.1........��?. �, V ' S
..........................................................................
Facility Contact: .....
................................... Title:
MailingAddress:...............................................................
Onsite Representative: ... ��, ,f.I.....Dto -Y ; s
Certified Operator: ......................................................................
Location of Farm:
�{ tfli Time: �A Printed on: 10/26/2000
0 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County: ...... Dli P)� )
PhoneNo:................................................................................
Phone Na:
...................................................
.................................................................................. ..........................
cc
Integrator:.... O?-t,r`f.... r'...a....................
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' &Z Longitude • 4 44
Design Current
Swine Canacitv PODulatiOn
❑ Wean to Feeder
Feeder to Finish
4qoo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 4USubsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps JE1 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 ElSpray Field [IOther
a. If discharge is observed, was the conveyance man-made'? ❑ Yes 19No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) [:]Yes 91 No
c. If discharge is observed, what is the estimated flow in gal/min? ►1 a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes YfNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,S No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:......................................................................................................... .
Freeboard (inches): 37
5100 Continued on back

Facility Number: 3 J 1]�_ Date of Inspection J/ 3 Printed on: 10/26/2000
f
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes IN No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application_
10. Are there any buffers that need maintenance/improvement? ❑ Yes "wNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )9No
12. Crop type QcV°►n V4Ct, PA -0 V I-r' 6erMV44 qAy� S-qI I 61raln --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,VWNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes J? No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�: �'�To yioiations'o dgficiencies wire hotel di>K`ing this:visit; 'Will •reeeive fid further
icor'resaoridei�ce: about this visit::::.:::. ...::::::......::::::...... .
Comtnents-(iefer to question #): Explain any YES answers and/or amy,"recafiimendations or any other.cotriments
uii
A,a vmgs,of facility to better explain situations: (use additional, pages as'necessary)
❑ Yes EfNo
❑ Yes KNo
❑ Yes ,n No
❑ Yes VNo
Not
Yes ;KNo 'r/7
❑ Yes 29 No
❑ Yes 19 No
❑ Yes 94 No
❑ Yes 44 No
❑ Yes • f No
❑ Yes QfNo
❑ Yes K No
IU4e = ovt.,_recA heed`s 4o 16%x4*4 -to tee-iA-t
AS
! S. ; s t' e) nth . 6 r ewe •r 1 nd c4i lce( A q4 Ae &m y
L,jl,l3 -io Ge ¢serve r0e .ru-e WeLi4c Ala., -6 •f7e161 �rrA64, ce
e.9reE4 r.gcJ444;n +hiS F�Ord.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ,'l 30 DQ 5100

Facility Number: — Date of Inspection J r? p Printed on: 7/21/2000
CAdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or bflow ❑ Yes VfNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [:]Yes 2T"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,EfNo
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 ,5 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes EgNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZI No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes fNo
rs. COO) clisu-'e a '90a0( or be-V"UO(c, as) d;sLelJi' f'clrjS
N y d rA-14 a feBi J a i �� Cif
or( .
5100

Division of Soil and-Water.'Conse6ation -`Operation Review.
Division of Soil andWater<Conservation.- Complianee.inspection
4013tvision of Water Qoaiity Coaapliance Inspection
13 Other Agency Opeiadoit-Review r k_ -
outine 0 Cam laint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
ti
,i Permitted RCertified 13 Conditionally Certified © Registered 10 Not C► erational Date Last Operated
y Farm Name: ...... ��4�..............................................L......a-.......-
Owner Name: ..............
.... Phone No:
.......................................................................................................
jFacility Contact: ..............................................................................Title:...................--------................. Phone No:
` Mailing Address:
Onsite Representative: ,,,....,,��t- D .y •.. ..... Integrator:....�a-5►...1. ,5.... ..Cs} � �.�,f.+ ........
9
x
' Certified Operator:................................................................................................................ Operator Certification Number:...................................
Location of Farm:
Latitude ' 4 .4 Longitude ' ° &4
Design Current,, Design Current ,_ Design Current
Swine ---- Ca acit Po ulatton "
p y = `Poultry Ca acity - Population Cattle Capacity Po ulatton
❑ Wean to Feeder :]Layer ❑ Dairy
eeder to Finish ❑Non -Layer I - ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish -=- Total -Design Capacity -
❑ Gilts
El Boars - '_' w ;: Total SSLW
- Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area TOSprayField Area
�•
-,Holding Ponds / Solid Traps m ❑ No Liquid Waste Management System
_ .._ -,-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches): ...............t�,I...............................................................
Structure 5
❑ Yes ,dNo
❑ Yes INNo
❑ YesfNo
❑ Yes No
❑ Yes
❑ Yes 9Io
XYes ❑ No
Structure b
................................................ J5 ..... XA&L:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes ❑ No
seepage, etc.)
3/23/99
Continued on back
r.

Facility hiumber: 3 1 76 f Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public 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 AURlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�: �'vo violaftoris:oi deficiencies were noted during �.... s.. Moir will receive �.. f.. .. �. .
correspondence. A' f this visit. ... .. ... .. .. .. .. .. ,
❑ Yes �No
D(Yes ❑ No
❑ Yes Plf4o
❑ Yes / No
[:]Yes ;No
❑ Yes 0"No
A Yes ❑ No
❑ Yes ;3No
KYes ❑ No
❑ Yes VefNo
VYes ❑ No
❑ Yes 0 No
5p)fes ❑ No
❑ Yes ZNo
Oyes ❑ No
❑ Yes &No
[]Yes PNo
❑ Yes JZNo
❑ Yes �No
[]Yes ff No
❑ Yes ❑ No
Codiments (refer to question #):.Explain any, YFS awers and/or-any`recommendattons.or any other comments:
_. ns:-_ =
Use,drawifies,of facility to_betterex lain situations. use add tional�'.a esias necessary)' _ A � , ( P g�
a nICG W AT4C L [ N.t 41rJrl' E fA _
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(f! R a � RVC+°rN i IS a i S a 1,fEi D S rr Sonw i pS NiE�1Js "7 A�Mrri J f
Reviewer/Inspector Name' � b1+1+� it T7F -� � J7
Reviewer/Inspector Signature: /].':X_ —)1 /—t Date:
3/23/99

PAVr�
Facility Number: Hate of Inspection '7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes P"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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INo
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes RfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
AdditionaL; Comments and or rawtn Vie.. --A.
-3 I) -54F1 Ga-,A% 4 q�W I -ATA TW.�-C JCEJ>S rx> 9? C L4E�G� "P-
O'-. i �j,�r•i c,, 4 I— e2Ec�,J +rL OAc`^ C�£S7
aF Pr11�n c.,,l
icf K MAcx-kk a.b O Pee' .. t9rtq orst_.,l .WASH ` c�
-
�t� sn; aAAPt£ t� OT7
I+IEEp is JfawT r. 4sTv— AWuCR-n'zr% CM-C4
ZM-F—S %sfL- MARx-" Ar�P APK.i L6Z4F-40Ts, e7~
4`1 Gk1A-t.r T? ,S r^tDp'CATED Dos<$ �lor PP!'»P� !`o {laiE oVM AFF ED ,
5� I�ArS i�:c.o Tti �� 6¢.A�s arJ �N�~s sPo�- ��r Jrr�U�GESSI�
WAS Z sa
3/23/99

31-- -76
0
•
Site Requires Immediate Attention:
' Facility No. -- y
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA OIXS SITE VISITATION RECORD
DATE: , 1995
Time: _ �/ V30
Farm Na
Mailing
County:
Integrate
On Site ]
Physical
Type of Operation: S e Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: ° �' Longitude:0l Q 7 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have efficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Actual Freeboare j _Ft. Inches
Was any seepage observed from agoon(s)? Yes No Was any erosion observed? Yes r No
Is adequate land available for s ay es r No Is e cover crop adequate? es No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings`? Ye�)or No
100 Feet from Wells'' Yes;br No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? '—es or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Sign
1
cc: Facility Assessment Unit
Use Attachments if Needed.

0
0
Site Requires Immediate Attention:
Facility No.P/
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - : 1995
Time. j d
=ti
Farm Name/Owner: L_ f !
Mailing Address:
County:.
Integrator:
On Site Representative:' L �/
Physical Address/Location: 1Z J
Phone:
` • ZAiAFA2
Type of Operation: wine V Poultry Cattle
Design Capacity:Number of Animals on Site:
DEM Certification Number: ACE . DEM Certification Number: ACNEW
Latitude: ° c'7' 33 " Longitude: ° 491 ' /o " Elevation: Feet
Circle Yes or No
Does theAnimal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)oesrNo Actual Freeboard )_7fj_FFt. Inches
Was any seepage observed from the agoon(s)? Yes r N as any erosion observed? 6�)r No
Is adequate land available for s ay? Yes or No Is the cover crop adequate? es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingsrFe4 No,
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r 1Vo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific ;76:�
th cover crop)? Yes or No
Additional Comments:
i «.�-m s
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.