670032_INSPECTIONS_20171231

NORTH CAROLINA
r_�
Department of Environmental Quai

Type of Visit: C pliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &KRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0Denied Access I ,�
Date of Visit: Arrival Time: un Departure Time: County: �Uyy Region:
Farm Name: F Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: iA 1t Certification Number: 1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urreat
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity op.
Dairy Cow
Wean to Feeder
Non -La er
Calf
Feeder to Finish
—Dairy
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P.oult; .
Lavers
Design
C•a aci
Current
P.o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 1� No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes iNo
❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility`Number: Urit7 Date of Inspection: B 1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: oht
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 Im No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes biNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ANo ❑ 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
l ❑ Application Outside of Approved Area
12. Crop Type(s): .Q- Iryla.�t����. � t 1/ ,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes OkNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ck�4o
❑ NA
❑ NE
[:]Yes
ONO
❑ NA
❑ NE
Required Records & Documents 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 kpNo ❑ 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 [P�ko
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONO
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNO
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to
o [3 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0:14A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �yo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes 'VNo ❑ NA ❑ NE
❑ Yes �7No ❑ NA ❑ NE
❑ Yes Wo
❑ Yes 2!pNo
❑ Yes �1$0
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date: `J)
21412015

Typebf Visit: Q'Cgmpliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: C+>[ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
1111S Joo
Date of Visit: Arrival Time: Departure Time: County: ONSO-1k Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: K-E ILfL Y lam'_.[.. LE j
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: 1�
Certification Number: V 2L4
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pog.
Wet Poultry
Capacity
Pop.
"'Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultr.
Ca acity
P,op.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2 /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes L o [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continuer)

Facili Number: (p - Date of Inspection:
Wastd Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 °St/r�ucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L_ � j LA(yooIJ Zi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 151 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 ff 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 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesYN9
❑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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
r'X
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
N
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
V
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
c
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ 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
EKO
❑ 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
214120I5 Continued

Facility Number: Date of inspection:
24. Dili 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
tht 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? [3 Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /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 7 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 �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 'I No [] 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?
❑ YesVNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �,_j 44N FA —io(,_L(__
Reviewer/Inspector Signature:
Date:
Page 3 of 3 t - 21417015

Type of Visit: Q Co pliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up () Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O 5 County: QWTL_p u Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: kE�Gz'�L� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1(10 L q
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P.ouitry
Layers
Design Current
C•.a I P,o
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
JPullets
Beef Brood Cow EEJ
Other
F—FO—ther
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑x1o❑ NA ❑ NE
❑ Yes WNo
❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: 1 - Date of Inspection
{ S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[:]No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C,a,ear (A6,,u
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ed No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes VNo
❑ NA
❑ NE
Re wired 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesV
o❑ NA ❑ NE
Page 2 of 3 21412014 Continued

a
Facility Number: - Date of Inspection: all-,j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA f6r 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? ❑ Yes YNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes jNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [I Other:
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? C]Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑Yes ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.'
Use drawings of facility to better explain situations (use additional pages as necessary):
t.O C.ATC ?.m V`f C,, C Aar '?Ew-rAz-1; . ?tom ws.T H 2E rc_oS,,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone.CL I b ) 9 b- 1 J -60
Czt." Date: 3 ) S
214/2014

Type of Visit: (3 Co�pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tt Arrival Time: Ib35 Departure Time: 2.o County: Of,� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �� �j-� �- ( Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Cattle Capacity Pop.
Da' Cow
Da' Calf
Feeder
o Finish
r
j
Dai Heifer
oWean
o Feeder
Finish
Design Current
D , P.ault . Ca aci P,o _
Layers
D Cow
Non-Daio
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 3,
fill +
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: LW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
LA GcVA
❑ Yes
Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes
(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
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
21No ❑ NA
jNo ❑ NA
❑ NE
❑ 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 o ❑ NA ❑ NI
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ 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 0 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q 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
❑ 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
��N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of ins ection: 1�
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Yo ❑ 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?
ElYes �No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes []/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ;3 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 C�/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 [xo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility -to better explain situations (use,additional pages as necessary). _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhonL: L )1%
Date: 3 1
214 01l

Type of Visit: Q C mptiance Inspection O Operation Review 0 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: Arrival Time: O Departure Time: ® County: 00-Q450y Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: KCPA'� GTL(�`Q`�, Integrator:
Certified Operator: Certification Number: Ito 01)4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Feeder
FFeeder
o Finish
o Wean
o Feeder
Wet Poultry
La er
Nan -La er
D , P,oultr.
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,o ,
Design
Cattle Capacity
Da' Cow
Da' Calf
Da Heifer
Cow
Non -Dairy
Current
Pop.
Farrow to Finish
Gilts
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
Qther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E!J'No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 10 ❑ NA ❑ NE
❑ Yes 0 ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 3 a jDate of Inspection:
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: (�scRW 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13S�-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[?I/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [] YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El 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 0 Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes W
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes I_ Ngo
❑ NA
❑ NE
acres determination?
-.I
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes V
❑ 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 3V ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C2/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-cornpliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes do ❑ NA ❑ NE
❑ Yes (/No ❑ NA ❑ NE
❑ Yes Ey"No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
To ❑ NA ❑ NE
[To ❑ NA ❑ NE
Comments .(refer.. to question.#): Explain any YES:answers and/or, any additional recommendati6ns:orrany,,other comments"
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonec 910a
Date: S
2/4MI J

f Type of Visit: (25 rRoutine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
(Reason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Ememencv 0 Other 0 Denied Access
Date of Visit: a 1 Arrival Time: ® Departure Time: [7 d County: t)Lpy.% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: «Ege'q (�.�L�,[--'��� Integrator:
Certification Number: a
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►apacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design C►urgent
D , P.oultr. Ca aci. P,o ,
Layers
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
jBeef Brood Cow
Other
Other
Dischar2cs 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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes [:]No ❑NA ❑NE
[:]Yes YN ❑ NA ❑ NE
Yes NoNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

F cility Number: _'] Date of inspection:
t
Waste Collection & Treatment
Ar 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LACopJ LA( o<%J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4 t>
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CfNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
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) 1
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
�
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes u 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 CD44o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes F3"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �N
❑ 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 VNo
❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes UrNo
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Q
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection: ;1aj III_
.14
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 E�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ YesVNo
❑ NA ❑ NE
Other Issues
/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
3 ❑ 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
O�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:
;1>)We
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or"any other comments r l
Use drawings of facilitv to better explain situations (use additional pages as necessary). §5�47z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

,. Division of Water. Quality
Facellty Number O Division of•Soil and Water Conservation may"
O
Other ,Agency
Type of Visit C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0Otth]jer � t❑ Denied Access
Date of Visit: Arrival Time: Vt� Departure Time: iC J � County: Ot/J k) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: Krzmy �=-u—.f-ZE
Integrator
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = d Longitude: = ° = d
*Current
Design Current =Design Current Design„
Swine Capacity Population Wet Poultry Capacity gI'opulatjon Cattle �"Capac�tyRo _ulation
Wean to Finish
Wean to Feeder
° IL I Farrow to Wean
ILJ Farrow to Finish I
JL J Non -Layer
Dry;Poultry
J Boars
] Other
Non-L
Pullets
Turkey Poults
Other
Dairy Calf_
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes n No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
❑rNp
❑ NE
❑ Yes
❑ Yes
LrJ❑ NA
❑ NE
❑ Yes
IJ No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: (a — Z Date of Inspection 1 l
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UZ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 277 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ( QCi<MJ LiJ I LAG —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 `1 L4 O
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 jNo ❑ 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 X
o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
_WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ja No ❑ NA ❑ NE
maintenance/improvement? �,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes Ur ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑No
❑ NA
ElNE
❑NA
El NE
VNo
❑ NA
❑ NE
Ed No
❑ NA
❑ NE
O'No
❑ NA
❑ NE
Comments° (refer to question #): Explain any YES. answers' and/or any recommendatloas or any other comiiments
Use drawings. of facility to better situations. use. additional g tyexplain'( pages as necessary)"
1
Reviewer/Inspector Name Phone: a1D ,73 tJ
Reviewer/Inspector Signature: Date: L4 1
Page 2 of 3 1, 12128104 ` Continued

Facility Number: — Date of Inspection
Required Records & Documents
j
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
LJJ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
f_✓J No
❑ NA
❑ NE
the appropriate box. . ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
ElL�
,�,�
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R N
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El
No .
❑ NA
ElNE
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
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q N
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ 'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2 N
[I NA
El NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Additional -Comments and/or Drawings ;�.0
Page 3 of 3 12128104

tl
M.
Type of Visit 0
,Coo pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: 9 Db Departure Time: County: OMS(-W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: LLC R tt-"? G _T LL c-iCE _ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = i = Longitude: ❑ ° [� o ❑
it
Design Current
Design C►urrent
Design Current
Swine Capacity Ropulation
Wet Poultry Capacity Population
Cattleltapacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Nan -La er I
I
Dairy Calf
® Feeder to Finish
r44,�A91400
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑
❑ Turkey Poults
❑ Other
er of Structures:
Other
-um
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El,_
Yes
,(
IJ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ENo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q(No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: (p — 3a Date of Inspection g lO
Waste Collection & Treatment
\, 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA CyyujJ 1 I ACx=r/ I-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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
RNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Ld 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�
C3 o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes U No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
2No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[E( No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
Zo
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments {refer ta..questian #) Explain any YES answers and/or any:recommendattons or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)
45.) CQ*-ftEC r St.upGE SU2ve ON r%Au iJouses. h AVf L6R.n_t-_LT OWtom-
C.V EIL ra,l CLA_'1d` 06 _DATE AND 0 uwt.8�.2J PotA IM hIC g
ector Name bN >�.r lr,� �� 9� ?96--)� f
Reviewer/Ins Phone:
Reviiewer/Inspector Signature: Date: l7 9
Page 2 of 3 I'i«v4 Uunrinuea

Facility Number: `] — �j a Date of Inspection tt)
t ' Reid Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA_ ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [:3 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ 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
LI No
❑ NA
❑ NE
/WC
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I:f
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
RfYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the hermit or CAWMP? ❑ Yes LEI No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
O o
El NA
El NE
and report the mortality.rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
t_t 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 12178104

F
ype of Visitn for Visit VC�o/mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
easoRoutine Q Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: 3 3 b9 Arrival Time: Departure Time: County: of.A w Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
On site Representative: . V CanGC �s 2t� rC Tt� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: o =] " Longitude: [= ° [= , =
Design C►urrent
Swine Capacity Populationtry Capacity Population
Design Current71FE-In
Design
Cattle Capacity
Current
Population
to Finish
❑Dai Cow
EWean
an to Feederr
❑Dai Calf
® Feeder to Finish
a�`-�'a
M60
❑ Da Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
La ers❑
PEI Non -La ers
Pullets
❑ D Cow
❑ Non -Dairy
❑ Farrow to Finish
Beef Stocker
Beef Feeder
❑ Beef Brood CoTurkeys
Number of Structures:
Gilts
Boars
Other
urke Pouets❑
ED ther
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑NA
ONE
❑Yes
❑ YesWNo
o ❑ NA
❑ NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ,—y
� — �JoZ. Date of Inspection
.i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C4o ❑ 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: 1A6,gotJ LArffntJ Z.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
L�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
E! No ❑ NA ❑ NE
8. Do any of the stuctures 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
ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
_ f
LEI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E No ❑ NA ❑ NE
ET'
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[a'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
e o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
'Comments,(refer to'question-#) E plain any YES'ansvters and/or any recomttiendationssor'any other comments:'
,Use drawtogs of facility to better explain sttuattohs (use-addrtinnal pages as necessary)" `
SwDGE SL)"Cl+( Dotje, VOo ou3L 7LEQvr�R .S 'fd OAS StuoGE
C'0rc.t,/ c.(t-aPs
Reviewer/inspector Name I To po Phone: ib -7 3 XJ
Reviewer/Inspector Signature: Date: 3 a
n __ 1) _r z 17/7RA)d C'nnd""Od
in— - -r

L
Facility Number: 63 — Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes [;YNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ 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?
El Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
L7 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
['No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑'�4o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3'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
UNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings: �.
Page 3 of 3 12128104

Z'
Type of Visit erco
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0A3$Lo`J
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: k&_rt& y Gmf'u i -rc— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 i Longitude: 0 ° = , = "
Design C+urrent
Swine Capacity Population
Wet Poultry
Design
Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ La er
❑Non -La er
❑Dai Cow
❑Dai Calf
® Feeder to Finish
XLt eZ
27/"
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Gilts
Gilts
PEIBoars
El Feeder
❑ Beef Brood Co
Other
❑ Other
umber of Structures:
I
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
L.
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
:�N
❑ NA
[3NE
ElYesNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facigty Number: (,,I — 32. Date of Inspection � z
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes E 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
Coo
Identifier: t1ACKro-0 i t.AC,o 'J 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35 3
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 ttltcat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes {1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require No [I❑ NA NE
maintenance or improvement? ❑Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
LQ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
56o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Al.) GET �rocl�G+l(r R10LA&( fog. 1,W_1 kvo Kcf UP 7AO 8
Reviewer/Inspector Name I 646N eZjJ4-. t%.-- , I Phone:
Reviewer/Inspector Signature: Date: z
Page 2 of 3 12128104 Continued

❑ Yes ENo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Facility Number: Date of Inspection to 1401
Re uiped Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps [I Other
d
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
,[3"No
L2 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

y�
If acility-N-tiffiRef
(%Division,of Water• Quality—'—-
0 Division of Soil and Water Conservation
0 Other Agency
hype of Visit ecompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit dRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3�� a� Arrival Time: Departure Time: County: 0#JSL4
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: isc*Rr'r_ L-f---ME
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number: _
Latitude: = 0 0 1 =di Longitude: = o
Region:
Design Current Design Current Design Current.
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish lyay 17.00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes rJ 1Vo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
[?'No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection J 7
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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6.6ord i L,W('rtrowi L
Spillway?:
Designed Freeboard (in): I q ,'I-
Observed Freeboard (in): 3 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l /J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�/
6. Are there structures on -site which are not properly addressed and/or managed ElYes LJ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes "No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C 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 Apnlication ,/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes [] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 CA WMP?
❑ Yes
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,El,
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Yes
,0<0
IC,/No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
D No
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E lvo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
I Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name "JOHij rAA#1JC—LA,_Phone: CQtb 6 —�S
Reviewer/Inspector Signature: Date: 31-;" 107
12128104 Continued

Facility Number: (,'� -- 3 Z Date of Inspection 3 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes VNo
/❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [I Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E]'No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
G] //N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
allo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,/�
Ld No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[]'No
❑ NA ❑ NE
Comments and/or Drawings:
12128104

* Division of Water Quality
=ILiimber �'� 3 Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,Compliance
U Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other [I Denied Access
Date of Visit: Sai3 O% Arrival Time: / / yr Departure Time: County: WSL01-� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: _ k c &&,Z_ f*,Z_,1L& TCG
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = « Longitude: o 1--] E u
Design Current Design Current Design Curren#
Swine Capacity Population Wet Poultry C►apacit- Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer ❑ Da' Calf
❑X Feeder to Finish14,016
' IOD
❑ Da Heifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets El Beef Feeder
❑ Beef Brood Co
El Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
100ther Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑Yes
El No [-I NA
❑NE
[I NA
❑ NE
❑ Yes
❑ Yes
VNg, ❑ NA
❑ NE
❑ Yes
,_,,.,
L�'N0 ❑ NA
❑ NE
12128104 Continued L

Facility Number: Date of Inspection �3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ 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(mc:,-J i
LA 6-cOM 2
L A&ao.N 3
LA C W y
Spillway?:
Designed Freeboard (in): j -7
�`j, ?
U
Ye S
Observed Freeboard (in): 3V
3.5
GL45EO
CLOSED
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ERNo
❑ 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
C; Mo
❑ 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
eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance/improvement? ,�
H. Is there evidence of incorrect application? If yes, check the appropriate box below. Cl Yes L"J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a CG7 elAlLIA t'E S W c CG
13. Soil type(s) G a A Pe,
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
1 NNo
❑ NA
❑ NE
LdNo
❑ NA
❑ NE
D/No
❑ NA
❑ NE
LJ No
❑ NA
❑ NE
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any othercomments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a 660 Tt'
3 suit.& ra 06 _TJJ
5 a. t> --o ZC JFo
L f1 A0C'4_ uP G° M'TaJ (s
2><rtk G-r [.at.lErt.ED GApA CXTV. 2 tea � S
GoPSC-S aF PEE ,5 DEAkt1Nt., W3Xj1 CA_oSV:_f-.
r� r.rtYt�► tr o F FZCoC aft- DUCE-, D C^tVA C,�t" C Y
CA-0SCD
r_
Reviewer/Inspector Name l ,4140 iA IZAIIP_ � Phone:
Reviewer/Inspector Signature: Date: $� Z3 104
rage 6 of s l_'1a61u4 uonnnuea

Facility Number: — 3Z Date of Inspection
Re 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 ll components of the CAWMP readily available? if yes, check Yes El No [I NA El NE
the appropriate box. have
❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ll No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ffNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P�T
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
�dNNo
LI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ld No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,�
! �rNo
❑ 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
Z No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EKo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Y
Divisvision of Water Quality
acility Number (p1 3a , Diion of Soil and ateC r onservation
Other Agency
Type of Visit �C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t'J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S O5 Arrival Time: ® Departure Time: �� County: 0A_Jj(, aj& Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = � = Longitude: 0 o = i 0
Design
Design. Current
Design . Current
%urreit
Swine Capacity ulatianWetuPgultry.,,:d:Capacity
Pgptil ra on'
Cattle Capacity Population
❑ Wean to Finish
JE3 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er I
I
Daia Calf
Feeder to Finish
Ki 9
❑ Dairy Heifej
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
El Farrow to Finish
❑ Layers
El Beef Stocker
❑Gilts
Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ILI Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ 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
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElL/J"Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
y�No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Date of Inspection O
Facility Number:
s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: oo A3 I LAG ao xi -Z LA Goof 3 G oo ni
Spillway?:
Designed Freeboard (in): �"7 f C1'• a c,
Observed Freeboard (in): 3 ti 3 3 33 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 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
12(7110 ❑ 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
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA El NE
maintenance/improvement?
VNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or to 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) &rL.MyCl A C G� MAT VA FES G d
13. Soil type(s) p a o A
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 2No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes dTN, o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes zrmo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes (J/ Co ❑ NA ❑ NE
tags GGQ4j c Ur C�c P'T& 5 Fo (Z_ �3+J�� z� GS 3 S.�►v 8�� .
��i,,rv�, looKS GQdo AaD �-EC..�tt-�5 uP To �ATE�
Reviewer/InspectorName `jbll,t� f�v Phone: Me)34. 3�t6o a2��
Reviewer/Inspector Signature: Date: S S to
12128104 Continued

! Facility Number: — Date of Inspection Ct
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes Zo ❑ NA ❑ NE
the appropiiate box. ❑ WUp ❑ Checklists ❑ Desi n ❑ Ma s ❑Other
g p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[21
Cl NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
Zo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A
2NE
Other Issues
�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
P No
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
L►Wo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
To
❑ NA
❑ NE
AddihonalCotnment5 and/or Drawings:
12128104

t
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Pi Routine O Complaint O Fallow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: O Time:
O Not Operational O Below Threshold
C*ermitted Wcertified 0 Condition
ally Certified [3Registered Date Last Operated or Ab_ovle Threshold.
Farm Name: L..`��tir4tS.eE7G...._...1 1`I.��!"� ...1,*..� .... County: _....1..4N
OwnerName: . .................� ...... _..... .. �. �.� ....._. --� •.. Phone No: _.__..._. ...._........ .......................
Mailing Address:
Facilitv Contact: ..... ...................................... .............. _...._.. Titre: Phone No:
Onsite Representative:..X ..... GZ r,.. . integrator: ... Mj).9?.k ....
Certified Operator:._._.. _... �...... "......... ......... Operator Certification Number:........................_..........---....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude ' ' «
Design
Current Deagn sCurreait', Design Current �:
®
alat,an. .';Poultry, �t r_Ca ci Po elation= _=Cattle . _ u _ :Ca aci Po V tton...
❑ i ayer ❑ Dairy
Feeder to Finish
❑ Non -Layer ❑Non -Dairy
Farrow to Wean
z y
Other
YTotal Design Catty
x a 3 x
>T
�� �Nnmber of Lagooiis•�
Wean to Feeder
-
Q
3
Farrow to Feeder
Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �NO
Discharge originated au [I Lagoon ❑ Spray Field El Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway 01yes ❑ No
Structure l Structure 2 Structure 3 Stricture 4 Structure 5 Structure b
Identifier:.................I.. ................ ................ ......................$............ _....... ........ ................................
Freeboard (inches): �� fy 0
12112103 Continued

Facility Number: (0'7 --3
Date of Inspection `
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need 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 maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Exces!
12. Crop type
13. Do the receiving crops differ with
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 Imsues
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 /No
❑ Yes JgNo
❑ Yes &No
❑ Yes 59 No
❑ Yes WNo
❑ Yes RfNo
❑ Yes ONO
1059�wC��
❑ Yes eNo
❑ Yes ❑ No
R'Yes ❑ No
❑ Yes ❑ No
❑ Yes EfNo
❑ Yes Z No
❑ Yes ONo
❑ Yes 9No
❑ Yes gNo
❑ Yes gNo
❑ Field Copy ❑ Final Notes
L�Vj lreQr.J�e -Ove 7 n Rm ' FJu l�G ( ao,.� �
.s�af�}cF wr�2 69, s�s �� o� # NAs T
A9
r✓� ,O�✓�.,Q.7f�J r iQo/'�` 0552�`i !✓ � t}-�oOI`a
/79Ac' wecezve
R F � our��
F2t&
LOW '�"
� ��, L},v.0
o�
Reviewer/Inspector Name
Reviewer/inspector Signature:
Date:
16/1Llui %.uluMaea

* I—
IFacility Number: 7 —32 Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
.0<0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(iel WUP, checklists, design, maps, etc.)
❑ Yes
E
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;dNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Zj No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ZNo
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VrNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
"VNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Xyes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
j(No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ZNo
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...ZNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dd�uonal Commentsand/asDrawtngs
G
?,3) A)j,4eO 'I'v d6F- t_c" S' zz-
�PLSN C-, 1,00, � z_ � � R
Y)
V '6Q� �rf� n1 c`- LSF �R�2, j�u5�5 V-i�/��r
Alla
12112103

Type of Visit Acompliance Inspection O Operation Review O Lagoon Evaivation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
,} Date of Visit: Time:
Facility Number
Not O Perational 12 Below Threshold
0 Permitted 0 Certified [3Conditionally Certified O Registered Date Last Operated or Above Threshold:
i
Farm Name: ( �\\ 5 ' i,►► x _ County: C1
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
� ( Phone No:
f " Integrator• —Al
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 0" Longitude 0a 6
Design Current Design Current Design Current
ine Ca acity Po ula 'on Poultry Ca achy P,o tul 'on Cattle Ca achy P,o ulation
❑ La er
❑ Da'Feeder
rWeantoFeeder
to Finish
❑Non -La er ❑ Non-DaiFarrow
Other
Total Desin CaaciGilts
Total SSLW
to Wean
[EO]Farrowto Feeder
Farrow to Finish
Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ La ova Area 10 Sprav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes ❑ No
Structure 6
Identifier:
Freeboard (inches): 2_2 151-
05103101 Continued

Facility Number: (p — 3'a Date of Inspection C�
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
"i'aste Application
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVUMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage &: General Permit or other Permit readily available?
❑ Yes
❑ No
=: 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WCiP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21,
Did the facility fail to have a actively terrified operator in charge?
❑ Yes
❑ No
22.
Fail to notit- regional DWQ of emergency situations as required by General Permit?
(ie% discharge. freeboard problems. over application)
❑ Yes
❑ No
23.
Did Reviewer,'inspector fail to discuss review•linspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
better
❑ Field Copy ❑ Final Notes
1
a c �kc
Vets
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
OSIV3101
Continued

Type of Visit 'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit j2KRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number '% 3� Irate of Visit: J ! 25 DZ Time: / 3 ' V S
rO Not Operational JQBelow Threshold
❑ Permitted ©Certified I O Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: G 'fc'r e "� I � County: 0 f"k4ew
Owner Name: C e c�r G e �,e Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: <e ✓e-`-I Integrator: M ✓ e-�t Tng
_��...
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• �" Longitude C ~ 0 �"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ElSpray Field ElOther
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: / Z -7 q
Freeboard (inches): �y 3 3 3 q8 35-
0510310.7
❑ Yes 'J6No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes Fe"flo
❑ Yes U'No .
Structure 6
Continued

r '
Facility Number:
Date of Inspection IQ Z7,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding
12. Crop type .bcr-'tj'�6q G/"a
❑ PAN ❑ Hydraulic Overload
.r of ?.e
��a I I G r�s �'•-. L
❑ Yes XNo
❑ Yes ZNo
❑ Yes �No
❑ Yes No
❑ Yes )eNo
❑ Yes No
❑ Yes No
L/67 e, d , F--P- .stave Len u
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WIT, 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?
❑ Yes Z No
❑ Yes ❑ No
'12Yes ❑ No
❑ Yes ❑ No
❑ Yes Z'Ro
❑ Yes &No
❑ Yes ,ForNo
❑ Yes,&No
❑ Yes _ZNo
❑ Yes �'No
❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 'ONo
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 XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �ZNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cominents'(irefet to question #) IEiip1AW any Yn Answers andtotr any reccomendations_or any other;cona€nrtents.
- a _ r ,
Use dmwiu s of fact} -to better ezplatn srtuattons. (use kddid6"l pages ss necessary) z .
g ❑ Field Conv ❑ Final Notes
fi),;J jlar" iX ver-y weIl m i�n4g,'-�eA. `r_�%e ►-ece5rds e?l'e to
9odd 6vdee- Tt,c st,.jieic kottie )eeejr^" �a�aohS q✓'e weI/
►�►�;►�;�v/'ed . The reeer'vin- e�d�J �,,•-e ave��'al
e-Ver�s 4O /'•►n A �'✓! �Gl,�t T"!�' /c"" 1 1t� Oz7/&✓'del, aj1-e ev,'de-t-4
Ti,e we4able lic4e7r4ill rune4-r l0 6e Gne-yeryeled
me. G ,'((e# e sti y .s 41,gt CPS wdllk he s 6 ee`\ tone -btl-1' �>✓��-��� r�d�)
Reviewer/Inspector Name =°S a_>-tcW.rs t A
Reviewer/Inspector Signature: Date: /D �5 D
05103101 Continued

Facility lumber: 417 —3 Date of inspcetion
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
-Additional Coetiinents,and/or Drawings
10Yes ❑ No
❑ Yes Z'No
❑ Yes ATNo
❑ Yes ,ZNo
❑ Yes "B"No
❑ Yes J2"N o
❑ Yes ❑ No
✓)at.J )�Xa-C }� C,+-�A� iS sv0 / �Sedi -to 6e Gar-tp le-jlv�5
41,e c.,. of 1 s ets ��( 6 e CIO-l'r 1 C-d w �'-�� rnlk+CG ; n� ILV o x4e-
p1,n,n v d ke11 qS Sa4n
4LArY 1 y f4'. '(,COL!✓ ewer,',.
13: Y5 16: 36
Z
05103101

b�A. �+.°`•-
1 < '� -
SwF' �.- "5 Pei
s^r F€ 1�tl -'w
(� D9tvtston nt.SOI�1 and Water
Conservatmn
m t
..
w
_
Type of Visit qkCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: U Time: 'a-G 4
ip Not operational Q Below Threshold
0Permitted 0 Certified © Condi
tio
n
ally Certified Q Registered Date Last Operated or Above Threshold: .........................
FarmName: ....... -.. 14\t"C 2........................................................... County:.....0.^?...................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: „ �,; -- Integrator:.,.-..i-s
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �' �«
Design Current
Swine Capacity Population
❑ Wean to Feeder
RFeederto Finish
4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons- . ❑ Subsurface Drains Present❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps I0 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 now in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structur,e, (2( Structure 3 Structure 4 Structure 5
Identifier: .......................................... ...
Freeboard (inches): - 33 a8 Ll I 0H
5100
❑ Yes �Klqo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
11No
❑ Yes
ONo
❑ Yes NNo
Structure 6
Continued on back

acility'Number: 6? — 3a. Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
❑ Yes KNo
❑ Yes 9No
XYes ❑ No
❑ Yes KNa
❑ Yes ,4No
❑ Yes WNo
❑ Yes allo
❑ Yes R No
❑ Yes "KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )4No
❑ Yes KNo
❑ Yes X No
`V'Yes ❑,No
❑ Yes P�No
❑ Yes eNo
❑ Yes )4 No
❑ Yes JqNo
❑ Yes 'j No
❑ Yes 4No
❑ Yes t No
❑' Iio *i6 ati0ns or &Qe ndt,s mere noted- during �bis:visit; - Yoe ' iil-teceiye fiti Furth& - - - - .1
correspondence. a 6a f this .visit.
Comments:(refe"rto question #): Explain. any YES answers and/or any recommendations or any othercomments.
Use � _ ,._ -. .
,drawings of facility,to better explain situations. use additional pages as necessa ' -
w �1�•� + v\LA.Q.Y
Ste- �vtJ •- �S G� jO1Cn1•'� f i � l� �Y �`l1 S C� l
Reviewer/Inspector Name ja'--N w'�c I<Q
Reviewer/Inspector Signature: Date: 5/00

Fariliiy Number: Date of inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 9Yes ❑ 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 ONO
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 PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments or Drawigs:
G kL-QAa
t a
i
5100

Q Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of , Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: ��J I'imr: ® Printed on: 7/21/2000
Facility Number
O Not Operational Q Below Threshold
*Permitted [3 Certifed 13 Conditionally Certified © Registered Date Last OperaFi.....................r,
bove ThresholdFarm Name: .................... Count3'..........w .........-.......... ........... ...............
.....
OwnerName: ........................................................................ Phone No:....................................................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:.................................................
MailingAddress:....................................................`.-.......p.................-.-.... .......�...(.........
Onsite Representative: ................. )a! ....`............. .........-................ Integrator:... „"'..-..... .
�................................
Certified Operator:...................................................................................................... Operator Certification Number:........................
Location of Farm:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��= Longitude '
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish O ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present I ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation? ❑ Yes 0No
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, norifv DWQ) ❑Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system" (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 10No
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
Structure I Structure 2 Structure 3 Structure 4
❑ Yes b(No
Structure 5 Structure 6
Identiricr:......................................................................
Freeboard finches): 11_x 33 u3 30
5100
Continued on back

t
acilif�Number: Bate of Inspection .Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 1'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 J�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes EXNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes D(No
Waste Application
W. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Hydraulic Overload ❑ Yes jXNo
12. Crop type nr
r I I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement'?
16_ Is there a lack of adequate waste application equipment?
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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ict 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?
�i16.i1 olafigris;oi'- deficiencies *i re noted-dit-ritiii �his;viisit: ;Y:oix %J l-t&6ye rid wither
: correspvndenke.about:thiisvisit.-:•.•:•:•.•:•.•.•. .:::: . .•:•:-:•:•:- - - :-:- - .-.-.•.
❑ Yes No
❑ Yes EgNo
❑ Yes ❑ No
❑ Yes ❑ No
:iti��1�0
❑ Yes XfNo
❑ Yes ONO
❑ Yes XNo
❑ Yes XNo
❑ Yes _h�rNo
❑ Yes ONO
❑ Yes YNo
❑ Yes ONO
❑ Yes VNo
❑ Yes allo
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):
rid - Lk
V�-�ra��iCt�- G\C�S.���c � •�
i
Reviewer/Inspector Name
Reviewer/Inspector Signature:
qa 39 S �t6G �
Date: 9-1 5100

• Facli4ty Number: [)ate of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below V-Yes QNo
liquid level of lagoon or storage pond with no agitation? qK
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes lvfNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes %No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0 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 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [ No
MonaComments and/orDrawings: -
Zl
'
�� GldCi c1 lZ .
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 0 - e3a Operation is flagged for a wettable
Farm Name: 6 �- - e acre determination due to failure of
On -Site Representative: Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: kiLcliz,
Date of site visit:_
Date of most recent WUP:
Annual farm PAN deficit: �'a-`�� pounds
Operation not required to secure WA
determination at this time based on
/ exemption E7 E2 E3 E4
✓ Operation pended for wettable acre
determination based on a (2� P3
Irrigation System(s) - circle #: 1. hard -hose traveler; _2. center -pivot system; 3. linear -move system;
stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
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 D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3
Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4
75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part li - F1 F2 F3, before completing computational .table in Part 111).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements.
WA Determination .required .because. operation .fails nne of the .eligibility
requirements listed below:
_ F1
Lack ofacreage=whichTesultedin7overmpplicationmfvvastewater_(PAN) on:spray_
field(s)according #ofarm'sdasttwo :years nf-trrigation-xecords:-:
F2
Unclear, -illegible, -or lack of info rmationlmap.
F3 Obvious -field -limitations -(numerous:ditches,failLire -to=deductTequired_ -.
buff er/setback-acreage;-or25%_of#otal;acreageidentified_in--CAWMP::includes _
small ,-irregulady-shaped.fields _ fields less -than 5acres -for travelers-or_less-than
2 acres -for -stationary -spin klers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part ll[.

Revised April 20, 1999
Facility Number-7
Part 111. Field by Field Determination of
75% Exemption
Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER''2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
Mo
tf
3.91
3.0
� .qc(
00
a
ea )
-
I
I
I
I
!
I
A
I
I
FIELD NUMBER' - hvdrant. Dull.zone. orMoint numbers may be used in Dface of field numbers deoendino on CAWMP
and type of irrication-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.
FIELD NUMBER2 - must be clearly delineated on map. -
COMMENTS' - back-up fields with CAWMP acreage�exceeding75% of its total -acres and having received less than 50%
of its annual PAN as documented in the farm's.previous.two years' (1997 & 1998) of irrigation Tecords,-cannot serve-as'the
sole basis -for requiring a WA Determination:: Back-upfields-must-be -noted in the -comment section -and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1 Plan,.lacksfollowing-.information:_ �_�v
P2 Plan -revision may_satisfy7.5% rule based on adequate overall PAN deficit -and by
adjusting -all field acreage -to below 75% use rate
P3 Other (iefin process of installing new irrigation system):

1
[
Lagoon Dike Inspection Report
Name of Farm / Facility Gillette, George (Murphy) 67-32 A
Location of Farm / Facility Sr 1317 796. 2L97-2198 _
Owner's Name, Address
and Telephone Number
Date of inspection
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 )
9 / 28/ 99 Names of Inspectors Patrick Crrogan
Janet Paith_
5-T Freeboard, Feet 3'
< 1 0 Top Width, Feet 8
2 to l _ Downstream Slope, aH:1v 3 to 1
Yes X No
Yes _X No
Yes _X No
Excellent -grass
Did Dike Overtop? Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X— No
Engineering Study Needed? Yes X No
t
Is Data Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments New River overtopped lagoon. No struc=aJ dam $e
_ Owners have straight Biped Mower the level on
DM's orders

Lagoon Dike Inspection' Report
Name of Farm / Facility Gillette. C&Qrge (Murphy) 67-32 B
Location of Farm / Facility Sr 1317 2196, 2197 2198
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:l V
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?
9 / 28/ 99 Names of Inspectors Patrick Grogan
anetpaith
5-7 Freeboard, Feet 3'
1.0 Top Width, Feet 8
_2 to 1 _ Downstream Slope, x.H:ly 3 to 1
Yes 2 No
Yes X No
Yes _ X _ No
xcellent - gram
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes _ X _ No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments New River g—vertgpped Iggoun. No 9nLc=a]
Owner have straight pied to lower the level on
DWO's orders

Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm 1 Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
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 )
- Did Dike Overtop?
Gillette, George (Murphy) 67-32 C
r1317 2196 2197 2198
9 / 28/92 Names of Inspectors Patrick Grogan
et Paitb
13' Freeboard, Feet 3'
< 1.0 Top Width, Feet 8
2 to I Downstream Slope, xH:1v 3 to 1
Yes X No
Yes - X No
Yes X No
Excellent - grass
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
Yes X No

w-
Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1 V
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?
Gillette. George (Murphy _ 67-32 _D
Sr 1317 2196.2197-2198
9 / 28199 Names of Inspectors Patrick Grog -an
Janet Paith
13' Freeboard, Feet 3'
< 1.0 Top Width, Feet 8
2 to 1 Downstream Slope, aH:ly 3 to I
Yes X No
Yes �X No
Yes X No
Excellent- - grass _
Yes , X _ No . If Yes, Depth of
Overtopping, Feet
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
I
Yes - _ X No

=" ' Division of Soil and Water Conservation - Operation Review
13
Division of Soil and Water_ Conservation - Compliance Inspection
Division of Water Quality-- Compliance Inspection
Other Agency - Operation Review _
JID Routine 0 Complaint 0 Follo%v-up of DWQ inspection 0 Follow-up of DS«'C review 0 Other j
Facility Number i I Date of Inspection If2,151M
_— - -_-- Time or Inspection 36024 hr. (hh:mm)
Permitted © Certified 0 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
..........................
Farm Name: Q� Q "� ! Countv' hJ. dw.............
�- ��..-......,...� tl..-.t........................................ Sl-
Owner Name:.. .........--. ...... Phone No: ............. ..........................
Facility Contact: .......................................--..---..... Title:.................
MailingAddress: ...................................... ...........................................................................
Onsite Representatired..�-�p�r..:.,[,..f a(-
Certified Operator:. ...............................
I.,ocation of Farm: r 1
..................... Phone No:.................................... ...............
................................/................................................ ..........................
Integrator: .......� 1�.L-7'w4 ................................................
Operator Certification Number: ..........................................
r 1......n �3..r....�.-Ss�, ...G'' .. -� .si �... r .. �..�'�,..�-. . ' ..--••••••E ... ..,....... ,1�Qs.........
.
� ............. �,.,.,f....................... ........................................................... .................................................................. ................... .................................
Latitude 0' 0` �:Z Longitude • C i°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I❑ Subsurface Drains Present Il© Lagoon Area I❑ Spray field Area
Holding Ponds! Solid Traps J ILI No Liquid Waste Management System
Discharges & Stream Imtracts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed, what is the estimated ]low in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I `) --1 19-,(—IDL- 3
Freeboard(inches): ........... .................... !:?�................ ............ ...1. ............................................... ..
.............................
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Nr No
❑ Yes 5�No
❑ Yes (K No
Structure 6
1/6/99 Continued on back

n
l cility umber: T, — 3 dL Date of Inspection
5 Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes No
seepage, etc.) YV
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? y ❑ Yes 6 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 14 No
8. Does any pa[t of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? `� Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over applicati n? ❑ Ponding ❑ Nitrogen ❑ Yes M'No
12. Crop type:Cn..............................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes $ No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? []Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes h(No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes WNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®'No
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes O No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes %No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
.1Vn.violatiions:or. deficiencies .were noted during this_visit:. ... wi1freeeive na further .: .
eofrespoiidehee:t3botit:this visit.- ;•;•:•;.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.
.Comments refer to question # Explain any YES answers and/or an -recommendations,-or an.. other eomments. '�= »
Use drawings.of facility to better explainsituations. (use additional pages as necessary)r.' s
3
1� -t►-4- c��! l c,�r lcct,��r iL,a� �l+-�'i� 0►-►2 C� �f c,-� t
414 CJ
Reviewer/Inspector Name j.. a
Reviewer/Inspector Signature: wCa
Date: 7 1116/99

f
❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
JOLRoutine 0 Complaint O Follow-up of IAVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
13 Registered 0 Certified JMApplied for Permit Permitted L
E3 Not (} erational Date Last Operated:
Farm Name: r /�- . County .......................................................
Owner Name:...........Lr..�yc... ..............4�/,r�lf Phone 10:............?!�.�..y�.Z.�...............................
........ ................... ....... .
Facility Contact: `0 .............. ..........................................................
.....�:���..... ....... - .Title• �r-✓.^r�%Z.-.- :............... 'Phone Na:
. . ........
r
Mailing Address: ...... �t`?.�....... LZ4.1,.de ................� .... ...................4.�4.r........ ................
...
Onsite Representative:......: ............... r..'f:........................... Integrator:......... .lf f�.?.. ......................................
Certified Operat r........ ....................... .......................Operator Certification Number ......
.t..�........ . Location of Farm:
Latitude Longitude �• �� �"
Design Current Design Current Design Current
5wme _ = CapacttY. Population Poultry PAM',-
-Ca pacity. Population Cattle, CaPaciiy_Papulatenn,
❑ Wean to Feeder
Feeder to Finish
2DD
22�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
_ -Total Des
❑ Dairy
❑ Non-Dairy
L �
SSLW;
.;.°
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [;I No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9C No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 53 No
c. If discharge is observed, what'is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
❑ Yes [Z No
❑ Yes Q No
❑ Yes J@ No
❑ Yes Z No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97 ,
❑'Yes ] No
Continued on back

Facility Number-
8: Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLa goons 11ol ding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard(ft): ...... .....'..S...........................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
I. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E9 No
❑ Yes
Z No
Structure 6
❑ Yes
0 No
❑ Yes
U4 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers`?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop tyFe......'............. .............................
.. z:............................................................---................---...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or. deficiencies were note'd-during this.isit.- You4ill receive no further
coerespotidence about this:visit,.. :.
[AYes ❑ No
❑ Yes ,Q No
❑ Yes X] No
...............................
❑ Yes .0 No
❑ Yes ER No
❑ Yes 0 No
❑ Yes No
❑ Yes NO
❑ Yes [Z1 No
❑ Yes 00 No
❑ Yes 10 No
Xyes En No
❑ Yes J' No
C6mrnents 4refefto question #): ,Explain any".YES answers andlor anf recor ntte' datrons orany, other comments
plain situations (usc additional pages as neeessacr)
IIse drawings of facility to:better exJR
jV f ?_ D 'fo (spy,: /.� ,,•v T(J �Gr��''—� �/ i r .S (5' r m� G fr,
��� 2LL�i� 1G`�7°i'7 , �✓� �i� I1�-SIB �5 `i . �' i�4w.. � <.l _
7/25/97
Reviewer/Inspector Name Ae,_ ry
�e
Reviewer/Inspector Signature: Date: r

0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
1FRoutine 0 Complaint 0 Follow-u ' of DWQ inspection 0 Follow-ue of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered M Certified Opplied for Permit 13 Permitted 10 Not Opera Date Last Operated:
Farm Name: ..... 4.L..l...`lr.}u_!r ............. J............... ................................ County: ........... ���19�`�1....... .......................
Owner Name :........---Glt ?h- r......... .i.�If I ......... Phone No: .32.g fir : .............................
.................. ............ ..........
Facility Contact......�1. �, Title: .......................... Phone No:
_
Mailing Address:........ ..!�j..... B.'.1A lIz. -� .......k4. . .......... ........................................................ ...... �r .yid
..�..✓�r�- .......r:!:.0 x./1..... .. .... Integrator: %!A ,........ ..............................
Onsite Representative:........ c m ! ..
Certified Operator; ...... �. :. .........- ............... Operator Certification Number;.........................................
Location of Farm:
Latitude 0 4 69 Longitude • 4 64
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any.part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is thereevidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes [a No
❑ Yes ®.No
❑ Yes Q No
❑ Yes LINo
❑ Yes R No
❑ Yes [A -No
❑ Yes [ No
❑ Yes .JANo
❑ Yes if No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑•Yes IgNo
Continued on back

Facility number: L Di
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[ + No
Structures (Lapoons,tioiding Ponds, Flush Pits, etc.) '
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier.
Freeboard(ft):..........3................... .................................... .........................................................................................................
..................................
10. Is seepage observed from any of the structures?
❑ Yes
C(No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
{Yes
❑ 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
R No
Waste application
14. Is there physical evidence of over application?
❑ Yes
XNo
(If in excess of WMPor runoff entering waters of the State, notify DWQ)
,o�
15. Crop type ................... '!•,7..%H... ................................................... .......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
gNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
[Yes
❑ No
19. Is there a tack of available waste application equipment?
❑ Yes
[RNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
�O No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
54 No
22. Does record keeping need improvement?
❑ Yes
O 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
j4No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
25, Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
L'No
No violations or defidencies.were- note'd-dud ng this:visit. - .You.will receive no further
coerespandence a oitt this'. visit'.,.'-
Comments (refer to question #) Explain any ]c`ES answers and/ any reccimmendattons or any other coimepits.
Use drawings of facility'to better explain situations use additional pages as`necessary} � sFs
�d; ..
.fah
j i, I J Z • R r u,.5 9- TAP os: ort rn !,� t-orn� r� e,4, . 0�
�/h�i/p��'i
7/25/97
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �' p

Division of Soil and Water Conservation 0 Other Agency'*
;Division of Water Quality Ym
e � �'�� ,�,���..���„ aw'>�;;;�° Fes, '-'•: �� ."a.-".�....�'T��.�.� � .'S.. cN ..`�s`. 3�e � -.
Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number ro . �
Time of Inspection '�+�7V 1 24 hr. (hh:mm)
© Registered 0 Certified Applied for Permit APermitted 113 Not Operational Date Last Operated:
Farm Name: G/ �I.d�. z County: .............. ..............................
Owner Name:........... .,1�� ..........�i rl.� �(1!7� .......... Phone No: ............ Zq."..y&.z..........................................
Facility Contact:.. .... :�.r'�.�1- FG......... Title: _.,06,xn. ............................... Phone No:...................................................
Maiting Address:.......... :::�.3................� v(. ERR.. ' .� Kz�!... ................... —........................................ .......��`��...
Onsite Representative: ....... kl_14 .................. 3> .... . Integrator:..... ,. ?i i�........
-.....................
.................
Certified Operator;..... .iCcr . ................. ���..:. U! .......................... Operator Certification Number ..........................................
Location of Farm:
Latitude Longitude
Nuber`of Lagoons / Hofdmg Ponds ^� ❑Subsurface Drains Present ❑Lagoon Area ©Spray Fie
ld Area
v d;> ❑ No Liquid Waste Management System r
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
allo
❑ Yes
v-No
❑ Yes
16 No
❑ Yes
U No
❑ Yes
JU No
❑ Yes
Ej No
❑ Yes
®.No
❑ Yes
E9 No
❑ Yes
[$ No
❑'Yes
® No
Continued
on back

Farility�Number:
8. Are there lagoons or storage ponds on site which need to be property closed'? ❑ Yes 0 No
Structures fl_agoons.floldinp Ponds, Flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Ed No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: . ....................................
Freeboard(ft): 3...........
.......... ..........................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
W_N`o
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
+s
gLNo
12.
Do any of the structures need maintenance/improvement?
�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
4No
Waste .kWlication
14,
Is there physical evidence of over application?
❑ Yes
RNNO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type �..4............................... F_'
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
�LN O
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
R No
18.
Does the receiving crop need improvement?
Ayes
6LNo
19.
Is there a lack of available waste application equipment?
❑ Yes
E No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
tZ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(jNo
22.
Does record keeping need improvement?
❑ Yes
10 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
Q No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
19 No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
[� No -violations or deficiencie's.rvere'notei dutring this. visit.--You.wi11 receive no further
correspondence about this'.visit:..
Cot unents (refer Eo question #). Explain any. VES answers and/oar any recotnmenilaiions any other cainiments�� 2
or i
of facility to better:eiplaions n situati(use additional pages'as necessary} s a
Use°dyawingPs
rt . �.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

10 Routine 0 Comelaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection E=
Facility Number
Time of Inspection 101-136 124 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- 0 Registered 0 Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified [I Permitted or Inseection (includes travel and processing)
❑ Not Operational Date Last Operated:
Farm Name: . . ..... . ..... . ...... County:
Land Owner Name: . ..... . ..... Phone No:
Facility Conctact: ... Title: Phone No: Z.... . .... . .....
Mailing Address: le.-5-5 . ..... . ..... ...... . . ......
L Onsite Representative: ... CZE -!LT 7T- Integrator; 4 . .....
Certified Operator: . ..... . . ..... -&LZ/Ot . ..... Operator Certification Number: U
Location of Farm:
....... G...UAX
-4
. ..... . ..... . ..... . . .... . . .....
Latitude 0 , - 4 " Longitude
TviDe of Operation and Desien Canacitv
&
Current PRD61jEa
. . . . . . . . . .. ........
ti
Ca atiaro-P, d U3 6 i'401)uliii CaWe"ortula Ow�
I El Wean to Feeder L
Layer❑ Dairy
Feeder to Finish Jg C)q ❑ Non -Layer iry
. . . . . . . . . . . . . . . . . .
Farrow to Wean
mw
Farrow to Feeder Totalrilmair Vatit . ..........
Farrow to Finish M:ffll gi,
Xotalqssiewlln�;
- - - - - - - - - -
. ...........
...........
Number IRSubsurface Drains Present
Q Lagoon Area pray Field Area Eg
IM
'General,
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [I Spray fleld 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
0 Yes ONo
D Yes RNG
[I Yes Ulqo
0 Yes &Nc-,
0 Yes
OMo
[I Yes
Lallo
0 Yes
GINO
0 Yes
01140
Continued on back

ity Number: ... LO....
.F_. 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Bl o
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [i No
Structures Laaoons and/or Rolina Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑'o
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
....?...L....� . _�_..... _.`1` ........ ......... ......... .._......
- ....�_.... _.........
10.
Is seepage observed from any of the structures?
❑ Yes
ONO
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Res
❑ No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
[lTo
(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?
0 Yes
EJN-o
Waste Application ,
14.
Is there physical evidence of over application?
❑ Yes
9-KO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
P typet' F S�cJ4—
Cro ........... ....._.... ►h. _.... ...... ..... ......... ._....
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Q-90
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
B-5-0
18.
Does the receiving crop need improvement?
❑ Yes
9-Mo
19.
Is there a lack of available waste application equipment?.
❑ Yes
[}N—o—
20.
Does facility require a follow-up visit by same agency?
❑ Yes
&NU
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P-95
For
Certified Facilitifs Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
Q'11;ro—
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P<o
24.
Does record keeping need improvement?
❑ Yes
['To
Use drawings of facility to better explam situations. (use additional pages as necessary) _
�Opvtt 15r-44LL �r_,2oS1a,t> f1e—fAS a Z ,,r.£ �.eG[s, Wt„C x (y,//-f77'F S
jgwA,e JE r1,.) ;:� Z v%_ 4> 94C-ce, j r? £ P t4 d 2, n 4r. "T H Of f- c ZY-Ot b +v r.
--j2A1-r. ,3,.✓iZ+, !�10 .pPZA-,rT2S u,tir-nie
.S /a,ft,?It -r ;H15 T-1 c,
cc. Lnwston of water Vuattty, water Livattry Jectton, Cactttty Assessment Unit 413U/97

DS E WAnimal
I Feedlof Operation' RiMew,
3
UDVQ'Aifi0'Fe'6"dlot ra ton: iie: In
spection
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3Time of Inspection 24 hr. (hh.-mm)
L
Total Thne (in fraction of hours
0 Registered El Applied for Permit (ex-.1.25 for I hr 15 min)) Spent on Review
Farm Status- f4 Certified 0 Permitted or Insl!ection (includes travel and processing,)
0 Not Operational Date Last Operated: .... . ....
Farm Name- 4.L11f_:r1_L County:
Land Owner Name- Phone No:
Facility Conctact: ... i z 6z j. L,-. z L j; = _. _. _Title: Phone No. A5
Mailing Address: . ..... ..... .
Onsite Representative: ... (Z E Integrator:....... L11-
- f -- ---- ----
Certified Operator.Operator Certification Number.-1(62-41
Location of Farm:
Latitude s 0 - __' __ 4 " Longitude
TvDe Of Operation and Design C2D2CitV
'iirr'en 17!�Pt
Design it I ,
Ou ess...%
aati�'FK"lati W'WE'_ eiw�P6 bul ation­�_,�"�&' 1."14 Ci
El La er -EID
❑ -]Non Da
0 Wean to Feeder Nd y I I
®Feeder to Finish C)q (pNon-La er
Farrow to
� AW.''
M
o 'AM"
x.
N
Wean
Farrow to Feeder
w to Farrow Farrow
t Finish
JEI Other
V
Number of A ULagoons,! v InPonds
RaSubsurface Drains Present
LagoWpray Field Area
CR
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field [3 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsen--ed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge b}Tass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[]Yes 13-NO
]--]Yes EgNo
El Yes Ea-lqo
El Yes [9-Ko
El Yes
M1170-
El Yes
9NO
El yes
GI-N-o
El Yes
ERNO
Continued
on back-

Facility Number• _b_7 :73?_.... D
!6; is ticility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes TO
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [91�o
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[}No,
Structures {[,aaoons _and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
[4-o
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
G-No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
O'�Y
❑ No
12. Do any of the structures need maintenance/improvement?
❑ Yes
[9"90-
_ (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 Iiquid level markers?
❑ Yes
EINo-
Waste ADnliCation
14. Is there physical evidence of over application?
❑ Yes
9-Ko
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
IS. Crop type _ .t £ Sc-tJ`t . ti
............ ...... ...._..... ....... ..... ...................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[a -No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
B15o
18. Does the receiving crop need improvement?
❑ Yes
RN-0
19. Is there a lack of available waste application equipment?
❑ Yes
❑'it-
20. Does facility require a follow-up visit by same agency?
❑ Yes
GW6
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
i- o
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,Q.,�
LKno
24. Does record keeping need improvement?
❑ Yes
B lqo
Comments (refer to'questton,Explatn any YES answers and/or:anyreeommendahons or any other commentsh
Use drawings of facility to,better ezplam srtuattons (use additional pages as necessary) � ��,�fr� �� � ,h� �� ` � � � �°' �
115,
s
IttAc T_- oA;f T/3Cr� aP� rr1 s CAM ��Rp
0-,1 t Gti. U . AT i nr%s I
a
cc. uiviston of water j!uattr}, water Lyuaru3, .Section, Facuuy Assessment unit 4/3t}/9I

Site Requires Immediate Attention: A/
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 ZS , 1995
Time: 4 S
Farm Name/Owner: ��� l`7'� 4 V-ms G► /
Mailing Address: C - 2-AS`5"0
County: D N 5 c_.a f'o
Integrator: M �P-M f Phone: 2 `9 ` - Z///
On Site Representative: Phone:
Physical Address/Location:f"rnJOx, tu. n R-tan 5iRIL? r//aw Br-,-`necle-A-V f—`-d.6,?w/es
Type of Operation: Swine _� Poultry Cattle
Design Capacity: _/oho? `/ _ Number of.Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:.3 q ° 49 Longitude: 77 °I ' a[ Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es r•No Actual Freeboard: 2 Ft. _ 0 Inches
0 Was any seepage observed from the lagoon(s)? Yes ar NJ' Was any sioobse ed?s r No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings c Ye r No .
100 Feet from Wells? Yes No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orn
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or. Na>
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ar No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spe(jfic acreage with cover crop)? Yes of No
Additibnal Comments: / K R CI ilk�G�_ �/ /� Uu-�'C._ .e-�-•-�
111"AA 10_�M,cI l' -(.c.c� Uri
Inspector Nam
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS- BRANCH - WO Fax:[phone]!!2 Jul 24 ' 95 1� :16 P. r i7f1
Site Requires Immediate Attention .yv
•
Facility Number:
SITE VISITATION RECORD
DATE: Sum 1995
z 67-
Owner: nr (. a .r,cE: r•¢ Farm Name:
County: 0,Vr 4 ow
Agent Visiting Site:., A14 e-r .. „ Phone: _l9/0 ! 5',-1' - Yy_ Z.c
Operator: Co' r o,c 6r GJ,z' Prone:
On Site Representative:.x g.--,: .-: r - Phone:
Physical Address: , a g � e�I—A0,WgA" ze-1 9 779r- +•
`/'_^!�%% � � f�f:OQ�,t%uy �J�f�it�r' MA �/ �,�'•C1[..+s !s .t %/��r.d t.�r
Mailing Address: G ,rJ 49o.40
Type of Operation: Swine Poultry Cattle !zoo Fay .�
!- /x,od �fy'S " � W
Design Capacity: �y ve -_ Number of Animals on Site: 1/1s ( _
Latitude: :3 ±0 14 7 36 " Longitude: 77 d "
Type of Inspection: Ground f' Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot f $ inches) Yes or<fFo> Actual Freeboard: � / Feet _4 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 o�Was there erosion of the dam?: Yes orig)
Is adequate land available for land app ication' (z. or No Is the cover crop adequate? Ye r No
AddHiL111al CttI11I1jC[1U: /"X. C 151,gr �'I —A � ACa-1-f
fL tti —�3� iY/r TrE.h/. STe11t4s� , .4.rry�_ /i7.+c• --Gy .CL�s_T% —
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Fax to (1)19) 715-3559
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10
Site Requires Immediate Attentio Nd
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Farm Name/Own(
Mailing Address:
County: `Z
Integrator: MPn•DE 1t -- Fit ca s i P��. Phone: _ � -
On Site Representative: 1� C'tV G'db" _ Phone:
Physical Address/Location: rtow" JIAZ -tk' ,., V'0-;4 S1Z13 ZA
Z, & �
Type of Operation: Swine �� Poultry Cattle
Design Capacity: 52 44�6Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 q 4�r Longitude: 77 Z9 Zo " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ee)or No Actual Freeboard: _._,-Ft. ' Inches
Was any seepage observed from the laaoon(s)? Yes or119 Was any erosion observed? Yes or�No
Is adequate land available for spray? Yes r No Is the cover crop adequate? Desr. No
Crop(s) being utilized: r —
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine? Yes ooNo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or- If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on soecific acreaLye with cover cron)? Yes or No
Inspector Name Signature /
cc: Facility Assessment Unit Use Attachments if Needed.

OPERRTIONw BRANCH - WQ Fax:[phone] Jul 24 '95 18:16 P.07i18
Site Requires Immediate Attention WO
. Facility Number:
SITE VISITATION RECORD
DATE: Su4 1995
Owner: r •_ d ,� � r _ Farm Name: xx .4 rr�-_- .. 7- 33
County:.r 4 aw
Agent Visiting Site: Aoo4 er -Phone.-
Operator: Co' �-"0 6r .c�r_-Ti •� Phone:
On Site Representative: fir- c •f � s-.c� _ Phone:
Physical Address: Co
Mailing Address:
Type of Operation f - Swine o .::1 . Poultry Cattle - I °
F? r
Design Capacity: F_!,-ZVYr _ Number of Animals on Site: 40'5�zf_
Latitude: —3-Y0 - i4 l _' 3 6 Longitude: 77 0 -Z y_I •z D "
Type of Inspection- Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +$ inches) Yes orb Actual Freeboard: _y Feet 4_ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section_
Was any seepage observed the lagoon(s)? Yes oNvas there erosion of the darn?: Yes o&
Is adquate land available for land application? Fir No Is the cover crop adequate?(!G�br No
Add" fiLML11 Cumij7eDts:.�l.rt. C I,(�. i '/_= �S/�y ,s' rys rr_' �a�..3� o.�t 00..4e
Fax to [phone] Signdture of

Site Requires Immediate Attention- w O
Facility No. t
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
\ DATE: -7 i z5 , 1995
Time: 9 I d
Farm Name/Owns
Mailing Address:
County:
Integrator: G_Ut2j: , (4,4 4 . Phone:
On Site Representative: G.ia&. e Gdldh. _. y Phone: 3 'I_`( ``N
Physical Address/Location: cz-�f sW 1.329 �� u
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:- � " Vq ' 30 " Longitude:-7 ? " 0--( w " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: `^ Ft. tZ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes 00
Is adequate land available for spray?C es or No Is the cover crop adequate? �Yesr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?09or No
100 Feet from Wells`YYes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o(Do
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orr 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
Additional Comments:
z4 "'A
Inspector N e
Signature
Z7,
cc: Facility Assessment Unit
01
Use Attachments if Needed.

OFERRTIONS BRANCH - WQ Fax:[phone]` Ju1 24 '95 1S:16
Site Requires Immediate Attention A10
Facility Number:
SITE VISITATION RECORD
DATE: 7 . 1995
CF It # I 7- 5e
Owner: ^A. alg1c.,x Farm Name: ED
County: Q Vy 4 aw
Agent Visiting Site: , ►user •Phone: _ 9lo 91t; 9,4
Operator: Phone:
On Site Representative: G.yv�r .�_ Gs-oe .w:re - Phone:
Physical Address: .9/_=19-CZ104-.41:1-' %;f'V.++
Mailing Address: �f�,,r„r &AAoAsep
Type of Operation: Swine Poultry Cattle %xO° ��«
/- /Zoo �—'z `fIt- 9
Design Capacity:?- ne�.j� v_ Number of Animals on Site: _, 5�zr __ _4r3 _
Latitude: -3 1 t3 a Longitude: 77 a ?% Z b "
Type of Inspection: Ground .. ' Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storin event
(approximately 1 Foot + 8 inches) Yes orb Actual Freeboard: �4 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 o>�Was there erosion of the darn?: Yes or la
Is adequate land available for land application? (! or No Is the cover crop adequate?( e�>r No
Adrli[ioiial Cum ments: zp7•�. Cz e4,t r,,-1-�5/•�r .-r��� eoo..�, a�.E a,.-.�
T t� t4,e4r /v ry Ti�t4c.? �4ncr /`'lAc. �X".C6.3`i i r`
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Fax to (919) 7I5-3559
Skin cure of A