670030_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

(Type of Visit: Q Co (hpliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7-1 Arrival Time: Departure Time: ® County: dNSL&J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: -�TWJ Ld t_J A V T
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 Q ! ! 1 g
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pap.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity- Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
X
Feeder to Finish p
Farrow to Wean
Farrow to Feeder
03
Design Current
Dr, $oultr, Ca aci P.o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
TUrkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

• Faciliq Number: - D Date of inspection:
-,,'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E71/No
0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structtur__e``I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: cp Cst;1
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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ YesVNo
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
%0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Oth :
21. Does record keeping need improvement? If yes, check the appropriate box belo 7es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Wil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectiogo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Vacility Number: 6 2-ZipDs ection:
74. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t 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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
UNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
ZNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes I No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes Eo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes fNo ❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations ar any other comments_.
Use drawings of facility to better explain situations (use additional pages as necessary)...
�[ � Sic s-A wL . N FE o C -o gc-y-r
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Date:

0
(Type of Visit:Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for:Vtstt: URoutine O Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: /[ Arrival Time: Q Departure Time: j�(j ACounty: Region: �-
Farm Name:
Owner -Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 54 n he C—k � 3 Integrator:
Certified Operator: Certification Number: 9 �� I
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pap.
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop:
Design Current
Cattle C-apacity. Pop.
i Cow
Wean to Feeder
Non -La er
tryCalf
Feeder to Finish
j (19
759
Dr, P,oWtr,
Design
C•_a aci
Dairy Heifer
I Dry Cow
Farrow to Wean
Farrow to Feeder
P,op.
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
I
INon-LaXers
Beef Feeder
Boars I
Other
Other I I
jPullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
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 lfl- 10
❑ Yes E: fNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: -3 J9 Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity p g p heavy } adequate? ❑ �N ❑ ❑ g p y (structural plus storm storage plus hea rainfall Tess than ade uate. Yes o 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):
1�
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E 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
❑,1Vo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[9-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
ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ED"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 D 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
[D"'No
❑ 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
E:fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[21 No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[�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 [v]'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F31io ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 7 - 3.o jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes []'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?
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 [OX6 ❑ NA ❑ NE/, -
Yes ❑ No ❑ NA 0-NE
❑ Yes [J No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [J] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [2 o ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: O ZRoutine
Hance Inspection O Operation Review O Structure Evaluation 0 Technical AssistanceReason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer-1� County: UVc'Lgkj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
l
�T
OLc
6R6fi Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: -! 6 f 9,7 p
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
Layer
C►urrent
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P.outt . Ca aci
I Layers
P,a ,
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:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [✓ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in) -
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
❑ Yes
Structure 5
/�No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
[] Yes ZNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentthreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes 0 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 21 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesg�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
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 7No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis []Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA .❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - a Date of Inspection: JiLj
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 �zo
❑ NA ❑ NE
2? 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 ❑ NA [3NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were CAWMP?
Yes
NA
WE
any additional problems noted which cause non-compliance of the permit or
❑
❑
❑
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
FNo
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: �% !
Reviewer/Inspector Signature: 9
wk S:L4
Date:
Aq
Page 3 of 3 1
1.
21412011

ITYP e of Visit: U Co�pliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emerzency O Other O Denied Access
Date of Visit:
Farm Name:
Arrival Time: L�.� Departure Time: L. County: 0AJ5L,61d Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 15�oj U_- -} C aA f-lb Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Design Current
D , Pioult , Ca aci P.o
Layers
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
I _jTurkey Poults
III 10ther
Beef Brood Cow
U_the
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 ❑ ❑ NA ❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility -Number: jDate of Inspection:
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L2f/No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
StruFcturree,I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �_A Cs��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoD
❑ 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
P/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes VN�o
❑ NA- ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffets, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z] o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ 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
❑ 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
o ❑ 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 ❑Ot r:
21. s record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El VX0
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDateof Inspection: (41,5-113
24 Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
[:]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesrZo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E5 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [; ❑ 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 ZNo ❑ 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 nNo ❑ NA FINE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 61;Z ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings, of facility to better explain situations (use additional pagesas necessary)...
VGA r Co- u W6T- J_'0C
TO(- ov-T NO dewH
J wt'� V�Qp
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
V Phone:�
AlDate: /tO
Page 3 of 3 1 2144?011

Type of Visit: QCo iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Ro ine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: (@ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: STAt)Vbtl CgBrt
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
j
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Design Currcnt
D , P,oulti. Ca aci P,o
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
keys___
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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)?
❑ Yes M/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ o ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ YesVNo
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4f Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C 40 ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure` 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 6 No, ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 [2/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 o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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
I o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box Belo Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ eekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [�rop Yield ❑ 120 Minute Inspections Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes FJ'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: w
Y
24.'Did the facility fail to calibrate waste application equipment as required by the permit. ElYes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 7No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes 2teNo ❑ 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):
�, I#pgTC YW LP. I''aiyl.s(k- M-0AJ Xk6275 TP. $16 POPt Wdr V
VA`J_?b po- 5ov_ sAmPtc-.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % W—
Date: ,+Z✓
21412011

Division of,Water QAality
i�
Fay N itMber-- (o'j 3 O 0 Division of Soil and Water Conservatton
Other•Agency
_,
Type of Visit Co liance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assis=Access
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denie
Date of Visit: 1 Arrival Time: i Departure Time: County: DA/JLIO>ti1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: STPg)UeV CAA Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0' =]« Longitude: =° =, =
Design CurrentDes�gn Current ..
Swine . - Capacity ,Population Wet Poultry Capacity opu tittle
... �.�. P latiori, C
❑ Wean to Finish : ❑ La er Mt ❑ Dairy Cow
[3 Wean to Feeder
❑ Non -Layer
❑ DairyCalf
d ®Feeder to Finish
(' b 1 lei-:
El Dai Heifer
El Farrow to Wean'
Dry
; ❑ Dry Cow
❑Farrow to Feeder
Poultry< �r r
. ❑Nan-Dai
El Layers
❑ Farrow to Finish❑
Beef Stocker
El gilts.
' ❑ Non -Layers
❑ Beef Feeder
El Boars
" ❑ Pullets
❑ Beef Brood C
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other
�`w ❑ Other
Number
Discharizes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued
0

Number: (p — Date of Inspection
")Facility
Vr' ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes JNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-16=d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a-1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JNo
❑ 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 t reat, 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [/To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
[ No
❑ NA'
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
3/�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
f
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Commen
ts,(refer to_questi6u #) Explain any AYES answers and/or any recommendations ©r'any othentomments
Usedrawings of facility to better:explain situations (use additional pages as necessary)Oil
�e
1 SSED A5%- rVA4 vJ&p kX" 6IL clC Vt L 00tJa4C- 4JUoor✓ PLEaStM Of CAA ELA, �
J f Eh1-25 N UZlt- Z. f6p­ 3 APPS Sic/ y EeT'
�q
Reviewer/Inspector Name �/ � - d Phone: q(-D
Reviewertinspector Signature: Date: O- I atk 111
Page 2 of 3 I2128104 Continued

Facility Number: b1— 0 Date of Inspection t/
1,
Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, gWaste
the appropriate box below.
El Waste Application El WeeklyWeekly FreeboaAnalysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
❑ Yes t J No ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
[Yes ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tNo
❑ 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
ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
]V
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L3No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[/r 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
0<0
❑ 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
ElE Yes
No
El"
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
r
Additional Comments and/or' Drawings':' .
�� � �-� - �� � � �„�;,
Page 3 of 3 12128104

7 H '6
Type of Visit 0 ,/
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .t0 Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 49F
Arrival Time: Departure Time: County:Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6-PAA)U 1 Cf��
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 I 0 « Longitude: = o =' =
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry.. CapacityPPopulation
�.
Cattle Capacity Population
❑ Wean to Finish
Laer
❑Dai Cow
ElWean to Feeder
Fo Non -La er
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
_j
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
WNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WN o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — 3v Date of Inspection dZL la
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2<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: Llq�r/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El NA El NE
dN117No
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[I Yes
❑ 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 #hr at, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
' N ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
L [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
0 Yes
2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[TNo ❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
EkI es
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any recgmmenaat�ons or any other comments .,
Use drawings ©f facility to /letter explain situations..(use°addrtional pages as necessarv.) {
/V- IAJOIZ-LL off/ Sc I/C
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: to l
Page 2 of 3
7WR/OQ Cnnthined

r•
Facility Number: —36 1 Date of Inspection 710
e uired 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 D�Ko ❑ NA ❑ NE
the appropriate box. ❑ WUP Cl Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ea> ❑ 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
U�o
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
0 Noo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qo
Ell NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ErNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
l jo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
EJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
00
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality.concern?
❑ Yes
o
El
El 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
L No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
;/No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes,
No
❑ NA
❑ NE
al�.Comments and/or Drawings
Addition, ,....
Page 3 of 3 12128104

I
I
IType of Visit 0 Co pliance 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:
Farm Name:
Arrival Time: ® Departure Time: County: tl,/�RAI Region:
Owner Email: —
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5t n hg CkA 67
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c = 6 Longitude: = °
Design Current.
Design Current
Design C►urrent
Swine
Capacity Population.
Wet Eoultry Capacity Population
Cattle Capcity aPopulation
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
LI
❑ DairyCalf
Feeder to Finish
/gyp
Dry Poultry
❑ La ers
Non -Layers ers
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
El Stocker
ElBeef Feeder
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
PE]Boars
El Pullets
El Beef Broad Co
-
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Numher of Structures:
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
HNo
❑ 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
Z No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
.12128104
Continued

'Facility Number: — d Date of Inspection Zs
r
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
C
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes WNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, 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 EZ/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 CJ/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�rNo ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U140 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or l 0 lbs El 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
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CJ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ NA
❑ NE
Does the facility lack adequate acreage for land application?
El17. Yes
�o
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J No
❑ NA
❑ NE
Comments (refer to quesi�on'#) Ezplamany YES'answers and/or any recommendahonssoranyrother comments.
6Usedrawmgs of factltty tobetter explam sttuahans: (use addrttonaiipages as necessary,)��,
Reviewer/Inspector Name - -- Phone: /0 .�
Reviewer/Inspector Signature: Date: 'L70

I
r
f
Facility Number: — p Date of Inspection 2 f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑p ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 � o El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes y ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VVO ElNA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 7No ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes UNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LQ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Lf 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
L/J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
P/No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I
v
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: b Arrival Time: Departure Time- County: JpsRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ S' rA N (r G" FT
Certified Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E] 0 0 ' [__1 " Longitude: [= o = ` = N
Swine
Design Current
Capacity Population
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer I
I
❑ Dairy Calf
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ ❑ Non -Dairy
Layers
El Beef Stocker
❑ Non -Layers
El Pullets El Beef Feeder
El Beef Brood Cow
Li Turke s
❑ Turkey Poults
1 10 Other Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �NO ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
[I NE
❑ Yes ❑ o
El
El Yes
❑ NA
❑ NE
❑ Yes WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 62 — 0
Date of Inspection 3 i
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: ! ��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which'are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes 1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes [� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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? VY
s No El NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? s Zo
o El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z o ❑ NA ElNE
ElYes Yxo ❑ NA ❑ NE
l5'.. � �-d_.''��"'r'i•I.SW:e-j�+�,°,�".:�. o:R`�f£ ac�fl�..Ai-w"srdFK+i
hComments (refer toaquestton #) Egplaennany YESanswersand/oranyxrecommendattons orany tither comments
-a». k¢ ;;,ce,'r _.. .r�,.sa
Ilse drarvmgs6of faili cilty ta�bette]P ezpiam,'situationsa�(use7addttionalcpages assnecessary,} s ,'
.�:.......:L .'4 ...:::: �.-y�=L.,. .4' .. ....,ss�m �.^W-: 3...5.......+. s.wY:-Y�1�..�w.t'k- - �.�v,'a►f,'rtkNk'{sr�'�":G.n:r.LStl '�..�... � �'f4 _
rS,) APB 1 �✓� » rL sC� NE6 n NA RJE t,
j1e_01 rf StaGiLSAJ F oz,wJ.
w
r
Reviewer/Inspector Name a � f t,,/ A 6Qn1b W Phone: 91b 7 qi " 13 f l
Reviewer/Inspector Signature: Date: Y Z a a +�
Page 2 of 3 112128104 Continued

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

f
Facility Number. �p
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency l
Type of Visit Arcompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit /Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I(Q/(p/O� Arrival Time: ; Departure Time: �ounty: i1_✓.r-GP66J Region:
Farm Name: AID 4Rn1 Owner Email:
Owner Name: r FA 6-1Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:11-�MZ-6v ��.KT
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: = = F = « Longitude: = ° 0 ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La er
Other
❑ Other
Dry Poultry_
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ' Current
Cattle Capacity .Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy 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?
❑ Yes 1�1 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
El Yes � No
❑ NA
❑ NE
❑ Yes �ZNo
❑ NA
❑ NE
12128104
Continue

• Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No - ❑ NA ❑ NE
Stfucture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �,,`
Spillway?: _ !VO _
Designed Freeboard (in): ZO 12" rr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o ❑ NA ❑ NE
through a waste management or closure plan?
I_f 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 El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes `�VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /P'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [ No ❑ NA ❑ NE
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ['No
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) r
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside of Acceptable Crop Wind/ow `❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) �54/_/
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes )ZNo
El 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 better situations. (use additional pages as necessary):
-explain
�� `Y.' /� f�� �G /i.�s 7 1��piLT • �/3� sj� ! �i✓ L-Zrn ice,
/"/Zz0 fj
Reviewer/Inspector Name Phone: D � - 732 ;4R
ewer/Inspector Signature: Date: (p
11/18104 Continued

Facility Number: — Date of Inspection I l0/ate/Q�-
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo ❑ NA ❑ NE
❑ YesXNo ❑ NA ❑ NE
❑ Yes )21'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?
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 gNo
❑ NA
❑ NE
❑ Yes No
NA
❑ NE
,,,❑��
El Yes ICI No
El NA
[I NE
[:]Yes VNo
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
❑ Yes ❑ No
gNA
❑ NE
❑ Yes
No
Aj
❑ NA
ElNE
ElYes
No
❑ NA
❑ NE
❑ Yes
/11 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes �No
❑ Yes ,6 No
El NA El NE
❑ NA ❑ NE
Additional Comments and/or Drawings: Q
&ems uQA %�Z �4�5 Ct/, l 11�,r.�7� s����i� DF
04Z ZF f '
.r l �Rn� Ln� r�,x, ,✓I kc�i ����%`2, t'0521v l'ale 17`4ts ` �.e6 o
ZclP
e4w 119"'P
12128104

Facility ,Number 3O
J Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit A Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' Departure Time: /7� /QQ„� County: zUe—doed Region:d!/�
Farm Name: "`- Owner Email:
Owner Name: �� ��� Phone-
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative,
Certified Operator: GG
Back-up Operator:
Location of Farm:
Title: Phone No:
JQPGL /9
Integrator: ( dC IJ cL/�1J4
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = 4 Longitude: 0 ° = I = "
Design Current;; Design- Current -
`§ Swine Capacity Population Wet Poultry/ Capacity Population
❑ Wean to FLayer
�y
s ❑Wean to Feeder ❑ Non -Layer
Feeder to Finish
Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
- ❑ Gilts
❑ Boars
"Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Poults
JTurkey
❑ Other
Discharses & 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
❑ DaLry Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: p Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
[IYes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: F' I
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in): Z
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.)
to
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?
9Yes ❑ 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 /No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
Y.
ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
❑ NA [I NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
Acceptable
12. Crop type(s)
STi¢GGz-S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
/1"No
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 o
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes 7No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
'7110P,9 �4Zx1��¢zn.��.,25
Reviewer/Inspector Name LMA Phone•C
Reviewer/inspector Signature: Date: Z © o
Page 2 of 3 12/2404 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No 0NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to
El NA ❑ NE
the appropriate box. ElWUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [1120 Minute Inspections ❑ Monthly and V Rain Inspections /0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes'VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No VNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑NA
❑ NE
ElYes ❑No
VNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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
❑ NA
❑ NE
❑ Yes
,,,�No
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
0yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�i4l�L�<i2,
fog /00/fizw. � s zvsJ s J9.0
l
SoZ
,Q
T`G � �GG/OGI ��fG1 A"—F /I12.D s.
qaj C.C/Z LL � � � •C.Jai�/•.
�a f�2 �.��i•J
�aGCGrrJ -- �P !/ z5t y /`��zzo2 ,9�ra
Page 3 of 3 �6 Dw� �/ P �Zli✓� A �B�Z�/�(o• 12128104

Type of Visit / Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ' eparture Time: County: SLQ Region: rL �
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,2 Title: Phone No:
Onsite Representative:23_ 7_1 �T /� Integrator: .Q
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = g =,A Longitude: 0 °
Design Current
Swine Capacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ DairyCow
❑ Non -Layer ❑ DairyCalf
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ DairyHeifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
El Pullets El Beef Feeder
❑ Beef Brood Coyd
❑ Turke s
❑Turke Poults
❑Other Number of Structures:
❑ Gilts
El Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b- Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE,
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q�No
❑ NA
El NE
ElYesXNo
❑ NA
❑ NE
12128104 Continued

Division of Water Quality
File ty, Number (p' E O'Drvision of Soil and Water Conservation
, Other Agency. s
Type of Visit Compliance Inspection 0 Operation Review Structure Evaluation Technical Assistance
Reason for Visit 0 Routine 0.eomplaint Q Follow up Referral Emergency Other [I Denied Access
Date of Visit: OIJAjv
Arrival Time: `� eparture Time: County: SLo Region:
Farm Name: tOwner Email:
Owner Name: Phone:
Mailing Address: W
Physical Address:
Facility Contact: _ Title: Phone No:
Onsite Representative:f tQT//a , t��/� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude:'• E—] 0 Longitude: = °
Design Z.e
Desigr[r' `Current -' •; Desihml
Swore"'`'•Ca aci Po ulation Wet=foul Capacity Population!�'"Cattle Capacity
❑Wean to Finish �' ❑ La er
❑ Non -La on -Layer
Dry Poultry
❑ La ers
❑ Non -La on -Layers
❑ Pullets I
ition
❑ Dairy Cow
❑ Da" Calf
❑ Da' Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Turkey Poults —
l . -
Other �` Numberof Structures _
Discharges & Stream I_mpa_cts
1. Is any discharge observed from any part of the operation? `• ,
❑ Yes
9No
❑ 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
❑ YesXNo
❑ NA
❑ NE
" other than from a discharge?
Page I of 3
12128104
Continued
FA

Facility 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?
Stru e 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 42
Structure 3 Structure 4
Yes ❑ No
0yes
[INo
Structure 5
[I NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? //❑ Yes No ❑ NA El
(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 I�NE
maintenance/improvement? Z
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA yJ NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? JAI Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? /EPEE❑[:] yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ No
❑ NA XNE
❑ No
❑ NA ❑ NE
❑ No
❑ NAg NE
❑ No
❑ NA NE
❑ No
ElNA �:'NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): I'i�'TF/ Sf�L�GiZtJ�
beowe A-�._- CoRPo
Zu- f�/ 02 fZz /7�vp �o.JrOt 49,0 &1�77-V O.eJSGp� L5
Reviewer/lnspectorName Af hone:C
Reviewer/Inspector Signature: r, Date: !aaz
Page 2 of 3 121f810,f Continued

li aea 4 -•�
Facility 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: � /
Spillway?:
Designed Freeboard (in):
Observed freeboard (in): (22
VYes ❑L�lz
No ❑ NA ❑ NE
0Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
El 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?
Vyes
ElNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste,structures require
❑ Yes
❑ No
[:1 NA
�NE
maintenance or improvement? S.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE .
maintenance/improvement? /
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) //YJ
❑ PAN ❑ PAN> 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area�-�
12. Crop type(s) /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA �NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NAA NE
17. Does the facility lack adequate acreage for land application?
ElYes
ElNo
ElNA A NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes_ ❑ No
❑ NA-;4!INE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
' VA"Use drawings of fac]lity to better explain situations. (use additional pages as necessary).
lei
Reviewer/Inspector Name 5 -7-fee OAS _/-O
/i1E Wre
66)e7_ r-�V oitJSGIJGtJ S �
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12AM4 Continued

Facility Number: — Date of Inspectionor
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes
❑ No
❑ NA
PINE
❑ Yes
❑ No
❑ NA
FNE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 1P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ No
❑ NA 1
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA V.
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA'0NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA 91NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA :VNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
3ZINE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
E
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
ex
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
PNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
eNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
PYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
_
Z_4V,
Page 3 of 3 12/2&04

Facility Number: j Date of Inspection
I T�
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
P11NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
NE
1P
❑ 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. P3idJthe facility fail to install and maintain a rain gauge?
❑ Yes/f ❑No
El NA
E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ye/E] No
❑ NA
NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes ❑ No
❑ NA
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
%❑ Yes' ❑ No
❑ NA
NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes f❑ No
❑ NA
�NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
P
El Yes ❑ No
❑ NA
NE
Other lssues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA
VNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ❑ No
❑ NA
[1NE
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
PNE
General Permit? (ie/ discharge, freeboard problems, over application) `
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? _
❑ Yes VNo
❑ NA
1 ❑ NE
33. Does facility require a follow-up visit by same agency?
V�es ❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
��ir7 .mot/�9��� �.i,�z•t1f�2 , �� � �,E
G , 4 C
if L
Page 3 of 3 12128104

Type of Visit A compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )j5 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Le& Arrival Time: Departure Time: �County:
1AA
Farm Name: Owner Email:
Owner Name: � Y4,O) Phone: _
Mailing Address:
Physical Address:
Facility Contact: 4 Title:
Onsite Representative: G eJ Uz ze)_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
//''jjr��
Region:lWo
Phone No:
Integrator: 6wi�;VA K 44 Q _^
Operator Certification Number:
Sack -up Certification Number:
Latitude: = o ❑ ❑ Longitude: = o = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer I EEA:
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
I -
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes zNo ❑ NA ❑ NE
El Yes El No ❑NA El NE
El Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

` Facility Number: —1_30 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
.4Yes ❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 9No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 2+0
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
❑ NA El 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?
ZZ
❑ Yes 51 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 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?
10
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes oNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drin ❑ Application Outside o Area
12. Crop h`Pe(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes '0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[:]Yes )2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes16 No
❑ NA
❑ NE
BsY-'1�4�kT'Y_..,dCh. -iL�'-R�S:.eS:Y�'.-1+'{ Yn :..�:.: h�-,i. L'sG�.. Y i .°s .-�.:.�•bR�-�Or��.Y`JFs �.p'�a'1 _ �Eir.3�°EiYY
/7'� y�7�,O. nA L5 �G 7r FpGt2TF�DT -�7
Reviewer/Inspector Name; Phone: /0' fyli
Reviewer/Inspector Signature: Date: p
12128104 Continued

Facility Number: d Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
X Yes ElNo
ElNA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
the box.
es /No
❑ NA
❑ NE
appropirate
❑ WUP ❑Checklists sign/Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No
❑ NA
❑ NE
❑ Waste Application W Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
,Rainfall ZfStocking ZCropYield ❑ 120 Minute Inspections )z Monthly and V Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes /11 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes A 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?
/0
❑ Yes A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
/11
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ 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 XNo
❑ 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
32.
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes / No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
Xyes ❑ No
❑ NA
❑ NE
Additional Commend: -and/or Drawings:
7) pv to A A,t 44, (.QNT,CoG /"f � � l L� NLs�f C �cI�N� L�� =
52
A440 _71;V7PRar/,E.1_nErvr
/vaco 7f 441V 1 �4 / G��� �° "` uD�n► % cam.��d�A ��EtA
�,,• f,QoN � �6 ��.� h�5� i �fli° >���''� �.r G,�ySG�v�v �A�F Qc�7 �� %�r__
Rio �IQ�P, S,�-�)No � L����� �-Q•r�,�� Z,� /�'s.�'Go �,�aQ,4,e�
/�D�..ND�i►�> �uJCIO �� re�E /L/G�D�D, i>.vcr ,�,��y✓�,.lr �RvP ��s .�i.�/
0,'540
1
4Ftrc1
}r
/.� Gas>f /�•✓n.��.s>'s.
KF.:711V Gvzu / ,g�7 6f ,rU,Ef. 12128104

Facility Number: p Date of Inspection
`dam.
5 /7Q� '' `fie✓
AO-C; r/r/���.
C6001
7/25/97

Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint )6 Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Tune: D�
FFacility Number
Q Not Operational O Below Threshold
A Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated Above Threshold: ........................
Farm Name: .---61...��.s.......... _. ...._... County:......... ........... . . .............
Owner Name: . m.N .....� ...... W W�! ...W ... .
�" Phone No: ,,.
N�Iailing Address: ,, �i Z......,L .R ` �• ZG Aif75
Facility Contact: Title: _ ......._... Phone No:
Onsite Representative:. � ----. �!��+� I"..._. _._. ,. _.. Integrator:
Certified Operator:
Location of Farm:
,........ „ ...................._ . Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • 4 "
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 ; Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Identifier:
Freeboard (inches):
12112103
Continued

w
Facility Number: — Q Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes []No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
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
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?
;ryes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Comments (refer Wgaeshor #)Explaun any YES aasrrersrand/or any recommenda>z©ns or any other cnrtents
:Use drawiags ofsfbdH #o Ibi t er expla�u sttaata s {r�seEarldxtronai pages as necessary3 7Field COPY ❑Final Notes;
pr
-rig LLIJ cj t' L n15�EC7�Dti1 p � vz�kl �d�nAL
d9P G( :Z71'
O/v ` S-r 7e ,' - 2i,r `j�9 I 1t �G-�pr�f�L �C-r4©�+JOMZSPO Lt'o
Reviewer/Inspector Name
s
: ReviewerAnspector Signature
_ zjT
Date:
12112103 Continued

Facility Number: — Date of Inspection
TAT
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
ONo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P(No
28. Does facility require a follow-up visit by same agency?
Oyes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Wow �4 T� D�s�o� Sa�� g �J,4�� e ,��sr,C2c � 01,JAfe v1�
'Ofl }Zr)Ae_1r
�e,,,4 N�4v 5 % B� C'�r � f�
2.3� �tiJN� R �A-t o //�� f�f_ �i95 //�-r�,✓ �j `jflx� �4/1'1 ��
12112103

Type of Visit OCompliance Inspection Q Operation Review O Lagoon Evaluation
for Visit ff Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit:
Facility Number Q
Jd Permitted E3 Certified [3 Conditionally Certified [3 Registered
1
Farm Name: ....._ !Q �i .».. 9,e- . �iL...... G..................
Owner Name:
-Mailing Address:
Time: L!5=
1 Not Operational O Below Threshold
Date Last Operated or Above Threshold: ... .._..................
County: ..�CiG ...............� ... ..».. »_.... ».
PhoneNo: ......._ ..». »........... .
Facility Contact: ........._ ._....... __................._. _. title:...... _....... Phone No:
Onsite Representative:.,Q (✓ .. � (Vl „.. Int tor• Z�� LY Ou✓ �D
Certified Operator: . . ................ . . . ............. . ........... ........ Operator Certification Number: ....... ........................ ....
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 66 Longitude 6 «
Design R Current Design Current Design 'Current
;. F
Swerve Ca aid -Poultry_ ci Po ulatiati� Ca- =Po elation
elation. _ .Ca :Cattle acr , .W
Wean to Feeder
[] Layer ❑Dairy
Feeder to Finish
❑ , Non -Layer j] Non Dairy
Farrow to Wean
- `
❑ Farrow to Feeder
❑Other -
Farrow to Finish
47
-_ f xTotat Desist capacity:
Gilts
Boars
e Total SSLW°}
y A f Jam' .i
A
�F
�Numiser of Lagoons
Discharaes & 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
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes gNo
Structure 6
Identifier: -• ................................. ...-.............. --....... _..._ ........
Freeboard (inches): 2
12112103
Continued

F4►cility Plumber: —OT_3C_lDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IeNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ff 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 'ZNo
8. Does any part of the waste management system other than waste structures require maintenancermprovement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ,2!(NO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes , dNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type(11,40 . ��j
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Odor Issues
Animal Waste Management Plan (CAWMP)?
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes P'No
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
Oyes ❑ No
❑ Yes ONO
❑ Yes XNo
❑ Yes ONO
❑ Yes ;� No
❑ Yes )ZNo
❑ Field Copy ❑ Final Notes
44e,7 i G( la-5 AW �f,�E`�T �1�i�orn/�I�/�� /j7_7iPEQuF
Tp �'7EGP �p�J�iPaG C�/��i�S "ji✓,p �`RO/1147� C�i2�9-55 C�Pr,�,,��
g) GAc.0 0^) A4x�' 6R Lows
, f to qo,,Q T to
vo nJ
Reviewer/Inspector Name`
Reviewer/Inspector Signature: Date:
12112103 V .n 7 _7 7 7

7FacillWNumber: 3n Date of Inspection
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
/0Yes
❑ 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
J9No
23. Does record keeping need improvement? If yes, check the appropriate box below.
Oyes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis oSoil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
,Qj No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
WrNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
28. Does facility require a follow-up visit by same agency?
ZYes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ONO
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:)Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
> �p 5 DZLrOL� /4i�PoR T / n2 2-103 . l V� � lcD � �F
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Type of Visit F ,C,/ompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit to Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: � Time: Laze I
Facility Number
.,.rONotOperational OBelowThreshold
O Permitted [3Cer ' ted 0 Conditions Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: County-
Owner Name: - [�G�iQIG� Q Phone No:
Mailing Address:
Facility Contact: Title: 1 Phone No:
N Integrator:
Onsite Representative:
Certified Operator:
Location of Farm:
Operator Certification Number:
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude a 1
Swine
❑ Wean to Feeder
Li Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current Design Current .
;a acity Population Poultry Capacity PopulationCattle
. Capacity Population
❑ Layer ❑ Dairy
ADO ❑Non -La er ❑ Non -Dal
❑ Other
Total Design Capacity
I ❑Boars Total SSM '
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Fceld Area
- - - kiMidine-Ponds ( Solid TraOs a -Q' ❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes zNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0No
❑ Yes
XNo
❑ Yes
VNo
Structure 6
Continuer)

.1
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
INO
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
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
PNo
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
dNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence o over applic km? xcessive Ponding ❑N H`ydrau�l' Overload
El Yes
o
12. Crop type 41 ��/
L Skid
13. Do the receiving crops differ with tho a designated in the Certified Animal Was# anagement Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
E31No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
El No
15. Does the receiving crop need improvement?
❑ Yes
[ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNO
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
INO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
—No
ld No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
o
23. Did Revicwer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24. Does facility require a follow-up visit by same agency?
❑ Yes
,�iNo
!LJ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
[-fiifut'1Ji8. �St`diHx
Comments {refer to ijuesbon #I)Eaplam any YES ansvFers and/or any recommendations orrany.otl►er co_tnments.,,^.
a,
Use drawings of facihty+to better explain situations: (use addihanai p{ages,as necessary) `
Field Copy ❑ Final Notes 1
�. .
"
....
Godr� �9G�.Sy
o P
Gl�vR r 0d 65 re2
Reviewerllnspector Name i
Reviewer/Inspector Signature: Date: OZ
05103101 Continued

Facility Number: — Q Date of Inspection U*k�
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.)
3 1. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additional Comments and/or Drawings:
AeOM17�,O
❑ Yes ❑ No
❑ Yes X_P�
o
❑ Yes
❑ Yes [ No
❑ Yes XlNo
o
El Yes
❑ Yes ❑ No
G,fc,:29d Z-Oltelz
/ll 1145 4 �5-ra Io
05103101

r Divnslo of Water Qual►ty
rr
- _ -' .�• :: O tvision of Svd and Water. Conservation z ��»,
W.E
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number jDateorvisit: (lo Printed on: 7/21/2000
O Not Operational O Below Threshold
'*Permitted © Certified Cj Conditionally Certified © Registered . Date Last Operated or Above Threshold:
.......................
Farm Name: �....'.st`t�~� County:... _....�-�r......................
Owner Name: ........
Phone No:
FacilityContact:.............................................................................. Title: ...................................................... .......... Phone No:
MailingAddress: ..................................................................................................................... .....................................................
..........................
Onsite Representative: ............................... '` A� -� g 1
.........................•--'.....__...---'-............---......... Integrator: ......................................................
Certified Operator: ........................... ......
Location of Farm:
.. Operator Certification lumber: ..........
[]Swine []Poultry []Cattle []Horse Latitude 0 4 Longitude • ° 46
Design Current
Swine Canacitv Pnnulation
❑ Wean to Feeder
Feeder to Finish
`Q
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non Layer El
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 110 Laran Area ❑ Spray Field Area
Holding Ponds I Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance; man -trade? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State! (If yes, notify DWQ) El Yes ❑ No
c. 1f dischartc is observed. what is the estimated flow in gat/fain?
(I. Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )<No
StrUe:tnrC I Structure 2 Structure , Structure 4 Structure 5 Structure 6
Identifier: ........................................................................................................................................... ......................................
Freeboard (inches): • 36
5100 Continued on back

1
Facility Number:,69 ` 0 Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Q(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
kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
RlYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
XYes
❑ No
Waste Ap2lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Xf No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
)KfNo
12. Croptype ✓__j L, C V � Ae4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N(No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
tifNo
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
allo
16. Is there a lack of adequate waste application equipment?
❑ Yes
jq'No
Re uired Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oyes
NYNoN-�
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Na No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
�4.d MbhifiQris :or deficiencies were notes- during this.visit: - :Y:ou swill-tr. eceive iiti ufther
- coriespoiidence. about. this visit. .................
Comments„(refer to gbestion #): Explain any YES :answers and/or any recommendations or:auy.6ther co�tments'
Usedrawin of facili to, -.better ez lain situations.: use additionalp a es asriecessa )
&s ty P . ( P. g YY
4j
rVIN
ou All, S-1
0-'VQj Vi'A
Reviewer/Inspector Name�Q
Reviewer/Inspector Signature: Date: 5100

1
Facility Number: — Date of Iuspection 011 Printed on: 1 0/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ONo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
§�rNo
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
KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Wo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Wo
Additional -Comments and/orDrawings: -
� a . �-,e,� � � �e see R-e._�►�,�-�� >��� �: CU
7e
J
J
5100

Rv,ised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 6q - d -_
Farm Name:..
On -Site Representative: t
inspectorlReviewer's Name: 1, ` Q
Date of site visit: 7r Y'_O
Date of most recent WUP: G-
Annual farm PAN deficit: :!�Li9 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility itemfs) F1 F2 F3 F4
Zoperation
not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre .
determination based on P1 P2 P3
Irrigation System(s) circle #: 1. hard -hose traveler, .2. center. -pivot system; 3, linear move system;
Ostationary sprinkler system w/permanent pipe; a. stationary sprinkler system wlporiable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
V E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rile exemption as vernied in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checkiist, Part 11 - F9 F2 F3, before completing computational table in Part III).
PART 11. 75% Rule Eligibility Checklist and. Documentation of WA Determination
Requirements. WA Determination .required because. operation fails :one of the .eligibility
requirements listedbelow:
F1 Lack .oiacreage:whichTesultodjnDver:appiicanonmr_vvastaweter_(PAN) on:spray_
field(s):accordingZofarm'sdast-twoyearsmf:trngationzecords.-
F2 Unclear,Jllegible,-or lack of information/map.
F3 Obvious -field -limitations -(numerous:diiches;failuTezo_deduct:required:..__
bufferisetbackmcreage;-Dr25%':offotal_acreageddentmAdari ICAWMR.-Includes_
small: irregulariy-shaped gelds fields:lessihan 5 �cresfor -travelers-nr.lessfhan -
2 acres -for -stationary -sprinklers).
F4 WA determination required because CAWMP creditsfreld(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Rcvised April 20, 1999
Facility Number
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT I FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER'S IRRIGATION ACRES ACRES %
SYSTEM
FIELD NUMBER"- hydrant pull,zone, or:point numbers may be used in place of field numbers dependinq on CAVJ7.1P
and type of irrigation system. , If pulls, etc. cross -more -than one field. inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
riELD NUMBER-' - must be clearly delineated an -map.
COMMENTS'- back-up fields with CAWMP acFeage:exceeaing`75% of its totalzcres and haVing TeCeived less .than 50%
of i*,s annual PAN as -documented in the farm's zprevious:two years' (1997 & 1998) of irrigationTecords,'-cannot serve -as -the
soie basis -for requiring a WA Determ_ination_:Back-upfields -must -be noted in the-commentme:tion7and must be accessible
by irrigation system.
z art IV. Pending WA'Determinations -
Pi Plan -lacks 1ollowinginformation:
P2 Plan Tevision Tnay:S2fIsfy75% rule based on adequate overall PAN deficit and by
adjusting all fieidacreage:io-below 75% use rate _
P3 Other (iern process of installing new irrigation system):

© Permitted Certified © Conditionally Certified [3 Registered [3 Not Operational Date ast Operated-
Farm Name:.......C►.....1,.................... County: CY-�
OwnerName:........................................................... Phone No:-...........-...................__.................................................
Facility Contact: ....Title Phone No:
MailingAddress : ................................................. .......... ..................................................... ......
.. . .......................... ...............
Onsite Representative: -.- . A...G......................................... Integrator:................................................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Latitude • �' �" Longitude I� • �' �"
Desrgn - CtirrenG: Design Current = ,. ;DesignCurrent,'
aaciPltion Capacity, 'oulatonSwine Ca acityrt"Po 'ulatron :,
❑ Wean to Feeder ❑ Layer ❑ Dairy
J. Feeder to Finish Q ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish`
❑Gilts Total rt Design 7Capacy
❑ Boars -.Total �SSLW -::
Number of Lagoons' -. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area w
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes gNo
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)
c. If discharge is observed, what is the estimated flow in pal/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): ...................................................................
❑ Yes ❑ No
Cl Yes
❑ No
❑ Yes
V No
❑ Yes
NJ No
❑ Yes C'No
Structure 6
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: 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenc- e5of by application? ❑ Excessive Ponding ❑ PAN
12. Crop type 11d, 4. __--
❑ Yes %No
❑ Yes
KNo
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
P(No
13. Do the receiving crops diffWwitYi those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there'a lack of adequate waste application equipment?
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?
yi014004s' jr 0& cjjeundts -W*re ngte(I chwmg his:visit, - Yoir will-reegiye iio further
.. coriespon�tienrre� about. this :visit: • • � • ' - . - ' - ' - - ' ' - ' - - - - ' - '
`V�- vqr &f
Yes 0 No ��
❑ Yes ANo
❑ Yes VNo
❑ Yes qNo
gYes ❑ No
❑ Yes VO
❑ Yes �(No
❑ Yes KNo
Yes (XNo1kZj-_
❑ Yes 9No
❑ Yes PKNo
❑ Yes KNo
❑ Yes PrNo
❑ Yes ONo
❑ Yes gNo
Reviewer/Inspector Name ­'' ' Y, �° q s '
Reviewer/Inspector Signature: Q Date: —1 t GQ

' Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below >Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )(No
28. Is there any evidence of wind drift during land application? {i.e. residue on neighboring vegetation, asphalt, ❑ Yes kNo
roads, building structure, and/or public property) 4-No
29. is the land application spray system intake not located near the liquid surface of the lagoon? ElYes
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 ANO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes X� No
_Additionalor rawings:
ly
�U
l
co
<k
A-11-eya
— ro--� � ���� � ►�.�-� ���� Cam ���
v C �� s
3/23/99

[3 Division of Soil and Water Conservation -Operation Review.
[3 Division of $oil and Water Conservation Compliance Inspection ffi
D.Uivision of Water Qualify 'Compliance Inspection e r o
D:Otlier-Agency - ppirkiiin-Review s
. F
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other J
Facility Number O Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted ® Certified D Conditionally Certified D Registered [3 Not O erational Date Last Operated: P ..........................
Farm Name: g..,,YhN....SW Ihl................�1.<.................. County: -Q. - .... .....................- ©.....
R ........... U 1.... ............................... .. .................�........
Owner Name: - G 1-A C C ..........J3. RYi4 4...... ............. ...........
Facility Contact: .K..UABJ. .1=.. X-`r'........ .. Y . .......... Title: - ...........
Mailing Address: ... 2.3.Z........L3.IZ`�At4 ��
Onsite Representative:..........................................................................................
Phone No:....1...�.Z4...r.r��E?.� (J
Phone No:
.... Integrator :.................................................
2.85 -74
Certified Operator: Gt-Ptz+�>vG� 1 RYa! Operator Certification Number: � -7 98
.................................................................. P....................................
Location of Farm:
.....,5RGK........��.{......JR...S.Q....120g..........U.... �
....'-..FARM.....%..T.... C....1.�...... p ...... ! ..............
Latitude 34 • �' 4 8 Longitude E T7 • 4 3 L7�
Design Current
-Capacity Po ulation
❑ Wean to Feeder
® Feeder to Finish
-0
dQ
❑ 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
- 1E] Non -Dairy
-
❑ Other
Total Design- Capacityk
Z b D
_
Total'SSLW0
40
�Numbet of Lagoons ID Subsurface Drains Present ❑ Lagoon Area
Holding Ponds / Solid Traps ❑ 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)
Spray Field Area
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 ! Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ......... Y.. ................................. ..................---..................................... ............I-- ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
i\ 3/23/99
❑ Yes [XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
RNo
❑ Yes
-�Wo
❑ Yes
�No
Structure
6
...............................
❑ Yes -\1Vo
Continued on back

Facility Number: 6 —
Datr 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 replication
10. Are there any buffers that need maintenance/improvement?
$�flo
❑ Yes
k'Yes
❑ No
[:]Yes
IVo
❑ Yes
kNo
❑ Yes
VNO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [-]Yes ,j'No
12. Crop type BY, r,# J_ S
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 6(No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
*0
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
kYes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
kNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
NfYes
❑ No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yesio
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�io
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
1
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0: Rio yi6lati6ris:oi- def eiebcies were noted• di.iWirig •this:visit. Y:oir :Wiil-recei.ive rio further -
.
• co rrespontience. abiji tf tlris visit. • . • . • ........................... ... • . • .
Use diawiisgs of facility to better explain situations use additional pages as necessary)
_.
a marltcQ tFo alb,A.
fI-41
Reviewer/Inspector Name;'_
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: �,— Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below )Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes `No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Ycs VrNo
IV
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 J�"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 4— ❑ Yes ❑ No
ti
onal Comments and/or awrngs:..
0
3/23/99

Lagoon Dike Inspection Report
Name of Farm / Facility Dgnny Bryan 67-30
Location of Farm 1 Facility SR 1245
Owner's Name, Address
and Telephone Number
Date of Inspection 9 / 29/ 99 Names of inspectors Patrick Grogan
Janet Paith
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
7' Freeboard, Feet 20"
2.5 Top Width, Feet 8
2 to 1 Downstream Slope, aH:1v 3 to 1 _
Yes X No
Yes _X No
Yes � X No
Excellent - grass
Did Dike Overtop?- Yes X No
Follow -Up Inspection Needed? Yes _X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
0
Yes X No

Lagoon Dike Inspection Report
Name of Farm / Facility Dgnny Bryan 67-30
Location of Farm 1 Facility SR 1245
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:IV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes)
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?'
4
9 / 29/ 99� Names of Inspectors Patrick Grogan
Janet Pakh
7' Freeboard, Feet 20"
2.5 Top Width, Feet 8
2 to 1 Downstream Slope, xH:ly 3 to 1
Yes X No _
Yes X No
Yes X No
F-xcellent -gEass
Yes X No
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? _ Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
:j
Yes X No

❑ Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
ULRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other itld c)
Date of Inspection 0
Facility Number
Time of Inspection 24 hr. (hh:mm)
D Registered Acertified © Applied for Permit © Permitted JUNot Operational Date Last Operated:
Farm Name: .....�Je j. '-?�.....h.`.�....(.. 2 .......,���? �:_.................................. County: ............. 06:5 �S?�"....................................
C>.....
Owner Name:.....f ........ r......l- . �t ......................................Phone No:........ .2. ...--•.......--........................
Facility Contact: ......g9... QQ... ....... ........�rr�,............. Title• L7Z„1�..................... Phone No:
Mailing Address:.....c.<. 7 ......�' .r..s .............. r.� .......................
Onsite Representative:.J. .� 25�. .� r r� a ................... ............. Integrator:...k).;f_(s E(5� fp ......................................... ......
Certified Operator...... }�l�G:d{r.......... ...�jY c�..fit............................ Operator Certification Number:.........................................
Location of Farm:
� 11 C
C
Latitude 00=1 " Longitude 0• =' =11
y
; ..<'Designti , '' Current = Design : Current
�- �'
Design wCurrent
Swine ., W - Capacity P©pulatioQ
Poultry " Capacity Population . `` Cattle • m Cipactty Population ' ,`'
❑ Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish
"'
❑Non -Layer
❑ Non -Dairy
El Farrow to Wean
❑ Farrow to FeederRe
❑ Other
47❑
Farrow to Finish
Total Design "Capacity
❑ Gilts
E
❑ Boars
b,Q Total SSLW
rZN 10 Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
❑ No Liquid Waste Management System
i
_.
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
EtNo
2. Is any discharge observed from any part of the operation?
❑ Yes
EdNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
XYes
❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5_ Does any part of the waste management system (other than lagoons/holding ponds) require
D4Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
R No
7/25/97

r
Cumber: 7- -:So
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes qNo
Structures (Lagoonsjlolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes AQ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: c�
Freeboard(ft):.......L........`..............................................................................................................................•--.------..............------•-- ........................... _.......
10, Is seepage observed from any of the structures? ❑ Yes 4Q No
11. Is erosion, or any other threats to the integrity of any of the structures observed? BYes ❑ No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
i1 No
Waste ApplicatioII
14.
Is there physical evidence of over application?
❑ Yes
K(No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop tYPe................ 5:..��':...............................
------------------------------- ---- ------
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
0.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
14 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
R1 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
22.
Does record keeping need improvement?
A Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
WNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E9 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Sallo
0- No.violatioits`or' deficiencies4ere noted -during this:visit.- You.vn`H recei've•ino,ftirtlier' . -
e6frespurideuce: about tbis'viAL- " . .
G I?A`:;S w 5oc ,k s.cl -F 1,166- 151-0` E5E
#1 iAOYL� `T/f-��7%✓�1 0y4 54A 1,9- -4-,)11:4, WA/IS
� .1 f� • S� rG,� �:.1�s ,v,c�� 7v RC- � G—,rwss ; s � ,^n n • � -ri)
Sv6:,,i'V �3
Z✓i %sr .i-�...,f�,.L /�-�i,Jr�� .���'�r�L i'�P �Q.Us �.r � �F3� 'r'S �4t°� ite_�f',45 cv�vC�7
Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date:

® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection -17
(Q
Time of Inspection a=24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: R Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational !Date Last Operated- ..... _.... ..... _ ................... _...............__.................... .»......
Farm Name: +fin 1rL ».»+11.. »...., ..»__............._ County:.__...E2 �..�»4a�.»_.......».».», »»....._ ..... ».
Land Owner Name: �.- s .... » (�..;t ».».... .... Phone No: :� Z �..... 7.4� �'.. .
Facility Conctact:-� t �srl�} .. 11itle: Phone No: ` `
Mailing Address: �r...._t1kk......».»L ......... ............
Onsite Representative: .Wt..1[n� ...._ ... _ Integrator•ai..
Certified Operator: 1 ». .., Operator Certification Number: ......... » ».... �.......... _. .
Location of Farm:
Latitude 0 4 Longitude �• �� ���
Type of Operation and Design Capacity
� � � � Design
Swine
Current � � Destgny,µ.� Cttrrent � �� m '`�-XCurrents'
foul Cattle
x a y„F, .. Ca act <Po ulatton "•. Ca act Po 'ulatton
❑ Wean to Feeder
❑ La er ❑ Dairy
3.
Feeder to Finish
❑ Non La er ❑Non -Da
mm.,` .�
Total Design pacify x
Farrow to Wean
Farrow to Feeder
10
Farrow to Finish
Tokal SS W t:
Owe
�.. -:: %s �" x,o, ._' ��' '4'm� ..��'•c` .- x;
❑other
Y,.-e':_ •'i.PF„";n: "-".�`� „!'ga'..%:
,worv�__:-.-N _-:Qaw-.,,.-�,
aa.o ,:.�.F
a. Numb of Iag�ovns/ Hoo dPtinds ❑Subsurface Drains Present
3
,
❑ Lagoon Area ❑ Spray Field Area n
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoonstholding ponds) require
4/30/97 maintenance/improvement?
❑ Yes G! Ko
❑ Yes [-10
❑ Yes RNo
❑ Yes [Kio
❑ Yes
U o
M-Yes
❑ No
❑ Yes
B NO
[jrYes
❑ No
Continued on back

C
Facility Number: ... —.....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONo
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Struch�s_([,a;oons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
❑ Yes EM
❑ Yes [►Tia
❑ Yes [I -No
Structure 5 Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wastes pplication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... • ........ ..... ._ ..... — ........ _ — _........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes M-No
❑ Yes ❑-No
❑ Yes ®'No
&Yes ❑ No
❑ Yes [la -No
❑ Yes Dlgo
❑ Yes [_} No
18. Does the receiving crop need improvement? ❑ Yes 11 - 0
19. Is there a lack of available waste application equipment? E2'� ❑ No
20. Does facility require a follow-up visit by same agency? [9'T'es ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes R&O
For Certified Facilities OnIv
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
24. Does record keeping need improvement? ❑ Yes No
Comts,;{ menrefer to question #f) Explam.any YES answers and/or: any recommendahons'or anyother comments:
Ilse drawings of facility to better expIam situations (use additional pages as necessary)
5.`°'..
�4W -C , 44'
s /�T AIXAX.Nv0" LGvFiL AivD �fc,DS ' /SE
Teo & ; ,v � � ? r�fA- kDgrgw
5f,�£ th�_5 4AJO a y/P�
�
yfiG ,�ov�� Nf��� n ise Dfs/Odsf,v pa
cc: Utvtston o) water vuatity, water &!uattryaecaon, ractltty Assessment Unit 4/3U/9 /

Site Requires Immediate Attention:
Facility No. (o 7 - 3o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: ' z , 1995
Time: fS—
'Farm Name/Owner: RR YAt G .5r viNE l'O, �y/vN y -�'LA� La eWS/,91V
Mailing Address: Z3 z 007? - Ae.VIYAf eD
County: NS 4-0w
Integrator: Phone:
On Site Representative: Ph;ne: I /d - A;? y -•36 /o
Physical Address/Location: p� c < _W4,Vd (ORitNUNVlrL AT�7i/E GNo a/ _
Type of Operation: Swine Poultry Cattle
Design Capacity: Z S Z o Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3� _' �"� Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: -'�- Ft. (o Inches
• Was any seepage observed from the lagoon(s)? Yes orWas any erosion observed? Yes of to
Is adequate land available for spray? es r No Is the cover crop adequate? Yes ooNo
Crop(s) being utilized: I.cu a et�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Na
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orc
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices?. Yes o 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 o -No
Additional Comments: o 40
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Urt�:HIlUN'; bf HNI-H - WU F•ax:91'j-T15-6048 Ju1 24 '95 1p.Ut,/1
Site Requires Immediate Attention �[D
Facility Number:7
SITE VISITATION RECORD
DATE: syz- 1995
Owner: Zxr6,ycjt Farm Name: ' ' r4l�i 1 NC'•
County: OA15LUZ E
Agent Visiting Site: 60CS 'Phone: S ;-,
Operator: _ �� r �e� e, �f R X/ Phone: 9/
On Site Representative: Phone:
Physical Address: ¢ C a �- �/-r- z- l cv,3,ft 7. C,l 'I ze � � --
Mailing Address:
Type of Operation:. Swine ✓ Poultry Cattle —
Design Capacity: Z S-Z 6 Number of Animals on Site: 1 Z 6 f e c.r N + $
Latitude: _3 L_° rt g `f5 -" Longitude: `77 e tJ -' G 0
Type of Inspection: Ground Aerial
• Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot +9 inches) Yes or Cqo-) Actual Freeboard: --Z_ Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes orb Was there erosion of the dam?: Yes or co)
Is adequate land available for land application? T5or No Is the cover crop adequate? �5 or No
Additional Comments:
Fax to.[phone]' Signature of A�int