670034_INSPECTIONS_20171231

NORTH CAROLINA
.r�
Department of Environmental Qual

Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 4 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: h.x.�DI-�,1�1 �(�V✓h^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: j Title:
Onsite Representative: D
Certified Operator: Ce� b C� u CL./x x,.74
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Region: �Ll ep
Certification Number: ` 4q 16
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I iNon-Layer 1
Dairy Calf
eeder to Finish
i
Design Current
Dr. P,oult , C•_a aci P,o
I Lavers 11
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Da'
113eef Stocker
Gilts
Non -Layers
1
Boars
Pullets
ood Cow
Other
urke sUther Poults
H-Turkey
Other
11
"Beefder
Discharges and Stream Imoacts
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)
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes M No [_]NA ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �§ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

r -
Racili umber: Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes b<No
a. If yes, is waste level into the structural freeboard? [-]Yes ""```❑"CCCCCC No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes �QNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do -any of the structures need maintenance or improvement? ❑ Yes ff No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �WNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 'WNo ❑ 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 EyNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes §No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes V7No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VfNo
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 00o
❑ NA.
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �&o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fjtcili jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JKNo
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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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 Signature:
Page 3 of 3
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
XNA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes [gNo ❑ NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
[:]Yes [9 No
❑ Yes [§No
[:]Yes N No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Vr'
Date:
21412015

(Type of Visit: !Z) Corppliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ©Departure Time: ® County: U?JX4 K) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: V a -9te CUQ,- A1J0S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: o-C-1(4 ()
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
C•att€e
Da Cow
Desigu Current
C>apacity Pop.
Wean to Feeder
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D } P■oult 1 Ca acit P,o
Layers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pouets
Other
I
M
Dischar2es and Stream_Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes VN 0
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: 6- Date of Inspection:
Waste Collection & Treatment
4. Is, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure`�I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 0 cYy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes do ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 RNo ❑ 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes O/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 FZ/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ❑
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes �fNo
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ 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
❑ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ; No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNc�
❑ NA ❑ NE
i, �7o25. 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F2/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 VNo ❑ NA ❑ NE
[:]Yes Vo ❑ NA ❑ NE
Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes M<o
❑ Yes rNo
o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
NEBr> r- -Pd
Reviewer/Inspector Name: �I�►j20�}C L-
Reviewer/Inspector Signature:
Page 3 of 3
Phote: f 1l? ? 1 b —13
Date: . A / S0
21412015

Type of Visit: 0 Co�pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ir ! Arrival Time: ® Departure Time: ® County: 045C 4,d Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: M A Gk G U'k&i;14U S Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
9 +l 1D
Swine
Wean to Finish
Design C►arrant
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
C►attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
INon-Layer Eli
Dairy Calf
Design Current
D . P.ouitr. Ca aci_ P.o
Layers
Dairy Heifer
Dry Caw
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 MNo ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o
❑ Yes
❑ Yes VNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
06 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
N
❑ NA
❑ NE
$. 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
QINo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
PJ/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesrNo
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EKo'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo—/
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
I ENO
❑ NA
❑ NE
the appropriate box.
777"'
❑ WL P ❑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 El"NoZo
[DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facial Number: jDate of Inspection h CT
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W,,?�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑Yes
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
6yo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N ❑ 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
ZNj❑ 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
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes WN(o
g❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments'(refer to question #): Explaiwany,YES:.answers and/or anv,additional recommendations or. any other comments
Use drawings of facility to better explain situations (use additional. a es as necessa
g ty p p g rJ'}.� --
Reviewer/Inspector Name: Phonk-1
Fit
11
Reviewer/Inspector Signature: Date: I
Page 3 of 3 21412014

(Type of Visit: Q) Cgdtpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: C Routine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: 3 Arrival Time: Departure Time: ® County: U�S"tom, L Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: _ fl"i 9114 Q1k'S Integrator: hh
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poaltry Capacity Pop.
Layer I
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Oc7
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , $o_ultr. C•_a aci P,o
Dry Cow
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
F-TOther
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
[:]Yes ❑
[—]YesCJN
❑ Yes [ 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 43 - N I Date of inspection: tti
Waste Collection & Treatment
- 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA D NE
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes IE] No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA C] 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) T
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 S"���"""-------"''�/o
�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [ o ❑ NA ❑ NE
❑ Yes No ❑ NA D NE
❑ Yes wo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes�Zo ❑ NA ❑ NE
❑ Yes /K o D NA ❑ NE
❑ Yes ][NNlo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 InspectioW_1�
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: la
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Vo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 [3/No
❑ Yes ,�No
❑ Yes No
[—]Yes Z/No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
EZ No ❑ NA ❑ NE
Ism Av ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exulain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
hC
Phone:
Date: l�
21412011

Fh
Type of Visit: Q Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: &Routine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: $ D Departure Time: County: UMSZAw Region: �w
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J bD Y &LXZC5'A N 0 S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: oiq q lb
Certification Number:
Longitude:
Design Current
Swine C•apaeity Pop.
Wean to Finish
Design C►urrent Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
I ILayer I Da!a Cow
Wean to Feeder
I
INon-Layer
I Dairy Calf
E]
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
po
Dairy Heifer
Design Current Dry Cow
Dr. P.ouItr Ga aci tYVIMMP.o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood CowF I
Other
Other
LLIter
Turke s
Turke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
. of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes F(N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 7 - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA 660n1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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?
E No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
El Yes No ❑ NA ❑ NE
❑ Yes M NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [?,/Yes ❑ No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:J'�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E! f No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [3/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
a
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CJ '�0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
aI o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
r3/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
dNo
❑ 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 [31 o ❑ NA D 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 ENo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1Facili Number: 2 - ILI jDate of Inspection: 3
24.' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ] qo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes YNo ❑ 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 [Zr�4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes F(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 [ KNo ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
❑ Yes uZo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ej�o ❑ NA ❑ NE
[:]Yes [-]No ❑ NA ❑ NE
❑ Yes [�] No ❑ NA 0 NE
Comments (refer to question #): Explain any YES answers andlor any.additional recommendations or any other, comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewertInspector Signature:
Page 3 of 3
Phone:
Date: �l •Z� f 13
21412011

(Type of Visit: Q 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance '
Reason for Visit: 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: b L Arrival Time: Departure Time: 2, County: QIOX C4 .J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
� � r
Onsite Representative: a tT t%2-[r U $ Integrator:
Certified Operator: Certification Number: dot T lb
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Is
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
}C
Feeder to Finish
i)D
Dr. P,ouItr, C►_a aci P,o ,
I Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
I
113eef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [] NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
[—]Yes [( o
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili amber: --3qDate of Ins ection:
Was Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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:JN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/I�
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ 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?
❑ YesVNo
❑ 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 No
❑ NA
❑ NE
IS. 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 ["Zo
❑ 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 belo [/] 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilityumber: -LqDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [� o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 20
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo [DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes E�No ❑ NA ❑ NE
❑ Yes
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
d'No ❑ NA ❑ NE
No [DNA ❑ NE
TN�o ❑NA ❑NE
o ❑ NA ❑ NE
FNo ❑ 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).
�, SoZL R ST TA 1L6� LA T BUT QUAD f Y/Url, CA 64 L. fAXT gym(
Reviewer/Inspector Name: Phone: !'a 1%
Reviewer/Inspector Signature: Date: y 0
Page 3 of 3 21412011

�DEvisio of Water Q�uahty
Ttiacth Numberb (q`2 QDivis�on of Soil and %Water Conservation 8 .
t3' I Q;Other4Agency" -
Type of Visit CC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ll Arrival Time: © Departure Time: County: OA)Q_4 rJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title: Phone No:
Onsite Representative: JO DY G-UaLAAL.)S Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o Longitude: = o ❑ A 0 u
" Design Currents Desi n CurrentDesi
t
rim Currerit
gg,..
Swme� �CapacttyPa�ul°ation _- aWet Poultry :-Capacity,`Population Cattle y _..0 P Y
. P cityopu IaEion
�.__. y _
�d . ., _� map=
❑Wean to Finish
: ❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I 1
❑ Dairy Calf
Feeder to Finish �1 S
w ❑
❑ Farrow to Wean
'I) Poiilt . '" r
N ❑ D Cow
�" ❑ Farrow to Feeder
T` '"�"°` ❑Non-Dai
❑ Farrow to Finish
El Layers
„ ❑ Beef Stocker
❑Gilts
❑ Beef Feeder
❑Boars
❑ Beef Brood Co
:-
Other ��
❑ Other
of 5tructu
"N mbar es:
�— - .-- .:�•
❑ Non -Lavers
El Pullets
❑ Turke s
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes hIo ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ io ❑ 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: L- od
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
l4 No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El9 Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
f5"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
EJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Ayolicatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or I0 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
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Y o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
.Comments (refer to questaon #} Explarn any YES answers and/or any recommendations or any`otherRcomments.
'Use`drawuigs`offaeiiity to better'explaen'situatidns (use-additeoual-pages as: necessary)
Reviewer/Inspector Name p/�(L� ,: �- Phone:
Reviewer/Inspector Signature L '4L,„Iazfl Date: Z
Page 2 of 3

Facility Number: — Date of Inspection �_Sj Jai 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 appropriate box. ❑ Urf Tp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑Yes ;/No
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U40
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EXo
ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
Yes
El0
- o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Vo
❑ NA .
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E:�1Vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
-CJ No
[]NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L! No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C 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
L IN'o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q"No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

(0 -1 H 31-k
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: [ 2R In Arrival Time: Departure Time: County: StJa,J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: '50flle GUfzCrRNV5
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 a ❑ d = Longitude: ❑ o = 6 ❑
r
esign Current Design Current
Design Current M.a0acit
Swine
Capacity Population Wet Poultry Population C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
Feeder to Finish
$
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkev Poults
❑ Other
❑ Other
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?
❑ Yes �No ❑ NA ❑ NE
❑Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
Page] of 3 12128104 Continued

4 Facility Number: 6') — y Date of Inspection I Izq �p I
t.
j 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: LPI%&-�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 �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 Ld No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement? DI
11. is there evidence of incorrect application? If yes, check the appropriate box below. ElLJ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[JPAN ❑ PAN > 10% or ] O 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
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
NNo El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�LJ
3/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El"No ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
EI No ❑ NA
❑ NE
Comments,(refer,to question #) Explain any YES answers and/or any recommendationsVor any;other comments
g ty.s p situations. (use addrtia.nal pages as necessary},�.��.
Use drawings of facili to better explain s�tuat�o_ e
Reviewer/Inspector Name ; w = �(; - eI Phone: No f PC C — l5g9
Reviewer/Inspector Signature: Date: It
r 1nAmll

r Facility Number: — Date of Inspection 1 2A
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
jNo
❑ 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
ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
6No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[`No
❑ 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
[:f 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
, �(
CJ 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
dNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
12128104

F
f Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistancen for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 13 D ej Arrival Time: Departure Time: County: ONYL-4 „/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
OnsiteRepresentative: c 1 oOq GUA6MY0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
❑ o
Operator Certification Number:
Back-up Certification Number:
i u ❑O =
Longitude:
Design
Swine C•apa�city
Current
Popnlation Wet Poultry
Design
Capacity
Current
Popnlation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
U Feeder to Finish y
Dry POuItry
❑ Layers
❑ Non -Layers
❑El
Pullets
❑ Turkeys
❑ Turkey Poults
❑Other
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Co
Number of Structures:
Other
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ElNA
❑ NE
❑ Yes
❑ Yes
L N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: T —
Date of Inspection I U
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA &OA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 139
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 21/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
o
❑ NA
ElNE
ElYes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [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 d/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �WN
o ❑ NA El NE
15. ' Does the receiving crop and/or land application site need improvement? El Yes Ed]
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes ZZ.,o ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #) Explatnpanv YES answers and/or any commendations or�any,othhe co m nts
Use drawtn s:'of.faeih to better-expla�n:situatrons. (use;addittonal pages as necessary): *°
RCcpMei,);i a3rNG- Tow fn TLrk f,el UCV­T CAL'rg(ZA Ttr�}
Reviewer/inspector Name 1 (j6W I Phone:IT
Reviewer/Inspector Signature: Date:
Pane 2 of _3 12128104 9Continued

Facility Number: — Date of Inspection a
Re uired 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 ,
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes (J 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes ICJ No ❑ NA ❑ NE
❑ Yes L/I No ❑ NA ❑ NE
❑ Yes E:rNo ❑ NA ❑ NE
❑ Yes
/iJ No
❑ NA
❑ NE
❑ Yes
[2"*No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes LEI No ❑ NA ❑ NE
❑ Yes [:Ko ❑ NA ❑ NE
❑ Yes
Qo
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes
[]�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: gLfS Departure Time: County: W11-okJ Region:
Owner Email:
Facility Contact: / Title:
Onsite Representative:yT ° Dq t;!/Z 6 AhJUS
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 c = . = Longitude: = ° a � = «
Design Current
ine Capacity Population
Design Current
�VetEoultry Capacity Population
Design
Cattle Capacity
Current
Population
Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
d1 419
4ob
Dry Poultry
La ers
❑ Non -La ers
❑Pullets❑
s
❑Turke Poults
❑ Other
❑ DairyHeifer
❑ D Cow
❑ Non-DaiFarrow
❑ Beef Stocker
❑ Beef Feeder
Beef Brood CoTurke
Number of Structures:
to Finish
Gilts
Boars
I[OE3
er
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E4No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
l No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 6 — L{
Date of Inspection 5 t S J
ti Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
03 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
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qo
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 property 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
environmental notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
treat,
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Lam! 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
Ll No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
UINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
IdNWNo
❑ 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 acre determination?[] Yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Name I ToV A (A-- ]Phone: 6 M —_1 In
Reviewer/Inspector Signature: Date: 1,S 0
ru5c c. v_/ ...........T ._..�........o..

I
Facility Number: 1 —
Date of Inspection S So
i.Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
K�
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design :❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E 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 lnspections P
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
—
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
?No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
Elf 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
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[� Yes
,�o
CI 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?
El Yes
,,.�,!!
ER' o
❑ 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
C l No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�fo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
L
EJ No
❑ NA
❑ NE
Additional Comments .and/or Drawings::.
Page 3 of 3 12128104

Facility Number
Division of Water Quality
O Division of Soil and Water Conservation V
0 Other Agency
Type of Visit 0 CC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CY1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z.g o Arrival Time: Departure Time: County: — . C1P&4A!1 _ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Pt( &d1LGArjL�5
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f [= Longitude: [� ° = ,
Design Current Design Current: Desigu, Current.
Swine Capacity Population Wet Poultry Capacity Population Cattle.. Capacity Population
10 Wean to Finish
❑ Wean to Feeder
® Feeder to Finish a� ,:rob
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
i Number of Structures`-
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
El NE
❑ Yes
Zo
❑ NA
❑ NE
12128104 Continued

FG�Fac'_ Number:
—�^_ Date of Inspection
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;P<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _(AQr207i
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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
u(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
M/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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[' No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[)/No
❑ NA
❑ NE
Comments (refer to question #)r 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.):
tvjbI/ &P SaZi. SAW"
Reviewer/Inspector Name �r jQ,✓ a^/(� r L Phone: �L'110% ��g b —i 3
Reviewer/InspectorSignature: Date: 1�2'Lf �7

4
I.Facility Number: hj— Date of Inspection D7
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 all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. C2rYes ❑ No ❑ NA ❑ NE
❑ Waste ApYstocking
tion ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ElWaste Transfers ElAnnual Certification
❑ Rainfall ❑ 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
dNo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&o
❑ 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
[�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[)/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
2/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

f' _
Division of Water Quality
Facility Number 3 L 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (YCo liance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S Z Arrival Time: Departure Time: County: _0iVIALo _ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 622GUy*.G 01
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude: = o
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: = ° = d
Design Current Design Current Design Current�k
Swine:Capacity Population Wet Poultry Capacity Population Cattle Capacity PQpulatioi
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
2.
%
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
61 Other
' El Layer
❑Dai Cow
❑ Non -Layer ❑ Da'X Calf
- -- - - " ❑ Dairy Heifer
DryPoultry ;: El Da Cow
i ❑
ElLayers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
N
on- Dairy
❑ Beef Stocker
❑ Beef Feeder
n Reef Rrnnrl Cn
Number:of Structures- f '=
-
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2No ❑ NA ❑ NE
❑ Yes DIKo ❑ NA ❑ NE
12128104 Continued

1
r
Facility Number: — 3 Date of Inspection Z �G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z 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: 1. &ct:, lJ
Spillway?:
Designed Freeboard (in): ?i0
Observed Freeboard (in):�
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 ETN/o
❑ 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) thrr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I o ❑ 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 El Yes E3 o ❑ NA ❑ NE
maintenance or improvement?,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [�/No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 01N0 ❑ 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) g"' S ('-0
13.
Soil type(s) G GIl LW
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
'['N�o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ef'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Q<o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
EI o
Cl NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or-any'other comments. '•>
Use drawings of facility to better explain situations. (use additional pages as necessary):
LAG aaN L—xk&4 WALL- Loa K2Wt,-
13(=> 5 - G E `t AK1u Ug L- 1 Ca -A (r, #4A vv% ,.jv TE(sT'oR-
Reviewer/Inspector Name Phone: 9i V % 54
I
Reviewer/Inspector Signature: Date:
Page l oj_f r12128104 Continued

�r
Facility Number: 7 —{ 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
El Yes VNo
El NA El NE
El Yes ❑ 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 V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
L"l"NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
[INo
[3 NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ej4o
❑ 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
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L" 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�/
IJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�
El
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

.3
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D 3 D Arrival Time: 1'-iD Departure Time: County: 015 w & _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
dy
D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
J& V1 1rug- CrA d o
Owner Email:
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' [-] ' =" Longitude: = ° [—] ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
r
❑Yes [nNo El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
❑No
❑ Yes ENo ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
12128104 Continued

Facility Number-0 3 i. f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ 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 666A/ f
Spillway?:
Designed Freeboard (in): 2.6
Observed Freeboard (in): 441
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
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?
dyes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
[2(No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) Ga� L-l3
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,_,(
Ef o
El NA El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
�
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
at.)
090ATE CAA79
`?XC LO
r,a r4-hAS .
C3E r Lv L-T(a r_.tJT6 rt.A11)TL- ��a�, 3ToCtcZkjC
Reviewer/Inspector Name �� f r Phone: �rG� S 3S r 39 0 a k ZZ,j
Reviewer/Inspector Signature: Date: S s v
12128104 Continued

Facility Number: �, — Date of Inspection 3 bJ
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other ,_..,1/
21. Does record keeping need improvement? If yes, check the appropriate box below. LTYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall LVJ 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 d4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 2NA
NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NE
❑ Yes
D<
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes D<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No [?KA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
ICJ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
2 o
❑ NA
❑ NE
❑ Yes
Ei o
❑ NA
❑ NE
❑Yes
L?
El NA
❑NE
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: < . .. .
12128104

IType of Visit P Compliance Inspection 0 Operation Review () Lagoon Evaluation
Reason for Visit Q Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
id Permitted E3 Certified Q Conditionally Certified [3 Registered
Farm Name: L �' Z.4�
�%l�.�. . .Owner Name: �rfl � } l�S
Mailing Address:
Facility Contact: Title:
OnsiteRepresentative: yu rvK�
Certified Operator:
Location of Farm:
Time:
Date Last Operat r Above Threshold:
County:
Phone No:
Phone No:
Integrator: Z/WA4/ _ &'6zC42'n)_
--
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude r_�a � K Longitude ' 6 u
Swine
Design Current Design C*urrent Design Current
Ga aci P,o ulation Cattle Ca aci P,o ulation
Ca aci P,o ulation,LEt
❑ Wean to Feeder
❑ Dairy
rIII[j Non -Dairy
Total Design Capacity
Total SSLW
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ soars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
- - -
Holding Ponds 1 Solid Traps ' ❑ No Li uid Waste Mana ement System
❑ Spray Field Area
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
Identifier:
Freeboard (inches):
05103101
❑ Yes 'le No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
A No
❑ Yes
ZVNo
❑ Yes
ONO
Structure 6
Continued

Facility Number: P— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
'Waste Application
10. Are there any buffers that need maintenanceiimprovement?
11. is there evidence of over application?
12 _ Crop type
13. Do the receiving crops differ with those desi4 ated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Covera e & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively cet-tified operator in charge?
22. Fail to notifti- regional DWQ of emergency situations as required by General Permit?
(it! discharge, freeboard problems. over application)
23. Did Reviewer,Inspector fail to discuss reviewrinspection 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 No
t
❑ Yes /� No
❑ Yes No
❑ Yes No
❑ Yes /� No
❑ Yes No
le Yes ❑ No
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;ZNo
❑ Yes Z21No
❑ Yes zo No
❑ Yes 9, No
El Yes No
❑ Yes No
ElYes gNo
❑ Yes X.No
❑ Yes XNo
❑ Yes )6No
❑ Yes XNO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about tk4is visit.
._'( & '' ' " .E' lai>ian i'FS gas viers ndlaf�ui treetitnmen[1at ns"or aav otitmmeax Gornments"{refer to
Uieraw dings of facility to better explain sitnations (use addittonai pages as nece�a,ry) — �-
- Field Copv ❑ Final Notes
... s_
�.iA"y3
llw #� �/✓�A� F Z�D.� � �� uvq
Z/(,70,�Z
ljkV/�
Reviewer/Inspector Name°~ - , s
t
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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?
/49
PrA6 1h J! 5: -
AV 4
LasT �YJV
6V00
❑ Yes V I No
❑ Yes f� No
❑ Yes �No
❑ Yes ONO
❑ Yes A No
❑ Yes ONO
❑ Yes ❑ No
0510.3101

Facility Number
Date of Visit: 1 43 Time:
:3
10 Not O erational Below Threshold
0 Permitted O Certified 0 C/onditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: QyNt: tl'' c'�I c,'^ t� S �<-+'�''`�. County:
Lin ii
Owner Name: ��d O� �+ (, U t�4 ✓1 L S C L! 'e;a hv$ - F0'r "' F-Le No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: �� d '� eA y\ V
Certified Operator:
Location of Farm:
Phone No:
Integrator: I"I v✓]plly r� rE'�+J"1
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 " Longitude '
Design Current
Swine Ca achy P,o elation
ElWean to Feeder
Design Current Design Current
Poultr, Ca achy P,o elation Cattle Ca achy P,o elation
Layer ❑ Dairy
FEII]Non-Layer
El Feeder to Finish
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagaons ❑Subsurface Drains Present ❑ l a oon Area
— —
Holding Ponds 1 Solid Traps ❑ No Li uid Waste Management System
❑ S ra Field Area
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
Identifier: I
Freeboard (inches): 40
05103101
❑ Yes 2!rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JffNo
❑ Yes �No
❑ Yes 2fNo
Structure 6
Continued

i�
Facility Number: ( r? — 2 4- Date of Inspection 30 b 3
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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? ❑ Excessivef Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type e r w.,r,� cL .SL+�ct i i -a ,rr, i' �, !� v
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?
Re uired 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 WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel 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 ONO
❑ Yes ,0 No
❑ Yes E]"No
❑ Yes ONO
❑ Yes Z No
[I Yes ,JNo
❑ Yes _2]rNo
❑ Yes JZNo
❑ Yes ONO
❑ Yes �No
❑ Yes PNo
❑ Yes No
❑ Yes /� No
❑ Yes )21 No
❑ Yes ,fNo
❑ Yes gNo
❑ Yes PNo
❑ Yes ONO
❑ Yes ZfNo
❑ Yes ,FfNo
Cl Yes J�`No
❑ Yes gNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer to.question: #i) Eaplam auy YES answers aii llor any recomuinend tionslor ady.ofher comments ; 4
Use drawmgs"af facile to better ex "lam sitgahonsse . naddibonaagesvas necessary) } a
ty l�p° ❑Field Cogv ❑Final Notes
. :- t
7hc {c C,'1 s L_jew.a,'+-,_el }r)Flei hGI .Stw 1-,P
Ti. C � c r+..-. ✓ ��. � Grc�� q rt d
S✓�-�a�l q r-q;+-. C ror � ')Cod
iS lG G(�` ).6+-� A►�1 f
a t '0 ✓ ye Ll �' E {i a
1j,n 5cerd o�d� �•
w
Reviewer/InspectorName.41
Reviewer/Inspector Signature: - Date: 1 3 O d
05103101 Continued

Facility Number: — 3 4- Date of Inspection / 30 03
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 Commehts and/or. Drawings:`
❑ Yes ❑ No
❑ Yes AffNo
❑ Yes ,4ffNo
❑ Yes 'FeKo
❑ Yes J2rNo
❑ Yes J�rNo
❑ Yes ❑ No
05103101

1
� Dif
i n of.Wa er Qualit}
0 ton of So
and WateriGonseryahon
b
Other Agency
Type of Visit f Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
16 Not O erational 12 Below Threshold
Permitted ©Certified Q Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: D� f/�L fyZee, County.It%�,�G
Owner Name: (,. �rA_AAIIZ< Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No -
Integrator:
Operator Certification Number:
Swine ❑ Poultry , ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 C «
Design Current
awtne Capacity Yo utanon
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ (aits
Design Current Design Current
Poultry Ca acitq Population Cattle Ca acity Po ulation
❑ Layer I I JEJ Dairy
[E]Non-Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes IZNo
Discharge originated at: ❑ Lal400n ❑ Spray Field ❑ Other
a. 1f discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
o
❑ Yes
.,/N'
!!! L� No
❑ Yes
XNo
Structure 6
Continued

Facility _Nu mber: Date of Inspection EgEP9-
I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
r] Yes
JCJ No
seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
�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
)ZNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over applicatio ❑ Excessive Ponding ElPAN ❑ draulic Overlo d❑Yes
XNO
12. Crop type �/�
13. Do the receiving crops differ with those desegna(ed in the Certified Animal Waste N46agement Plan (CAWMP)?
❑ Yes
No
A
l4. a) Does the facility lack adequate acreage for land application?
❑ Yes
X No
b) Does the facility need a wettable acre determination?
❑ Yes
X_'No
c) This facility is pended for a wettable acre determination?
ElYes
No
15. Does the receiving crop need improvement?
❑ Yes
ANo
16. Is there a lack of adequate waste application equipment?
ElYes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ YesN0
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
A No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
PTNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
eoNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to questtott,#): lExplasn any YES"answers:'and/or!iiny recommendations or"anyut eucomments.- v
Use. drawings of foci ity to better explain situations: {use additioaal'pages as nec`esssary) w{°
Field Copy ❑Final Notes
�m g �;
PN�l�r,
1�� (;o�✓���Y G✓o AV m�lAfl �z �S
ReviewerlIns ector Name
P � p
Reviewer/lnspector Signature: Date:
05103101 Continued

s
Facility Dumber: ' — Date of Inspection 2 O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ONO
❑ Yes &No
❑ Yes ?o
❑ Yes A' No
❑ Yes XNO
❑ Yes ❑ No
Additional Comments and/or Drawings:
05103101
05103101

qs.�"''.t Y�
Devrsion of Soil and' Water Conservation "S"
F ,' ;. Other Agency
of Visit V Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Bate of Visit: rune: � Printed on: 7/21/2000
Facility Number 3
Q Not 02
erational Q Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold- -----------------------
Farm Name: ( . •....1GU..................................................
...
Farm •!-!- r................................................... County.
OwnerName: ........................... ....................... ........................................................................ Phone No:
Facility Contact:..............................................................................Title: ... Phone No:
.............................................................
Mailing Address: ..... ................................................
Onsite Representative:,,,,1-?`^cTh--!r'-1,----------•-,•---,----,--- Integrator:-,l"�'y,
Certified Operator:,,,••,,,•,,,• ............................ Operator -Certification Number:••,,,,,,,
Location of Farm:
❑ 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 I ❑ Dairy
eeder to Finish GqLt6 JE1 Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon .Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; wits the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min`!
d. Does discharge bypass a lagoon system:? (if yes, notify 13WQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes DdNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes b�No
Structure I Structure 2 Structure 5 Structure 4 Structure 5 Structure 6
Identifier: .................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: `7 —3q Date 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, ❑YesNo
seepage, etc.)
O
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
14No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�f No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes[
No
12. Crop type _ "� S�"�G-`� c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
tj'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
allo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
)ZNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
W�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
XNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss reviewlinspection 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
KNo
:: o viaiatigris o. deficiencies were Hated during �his:visit:... . ..receive Rio #'uTther
.. correspondence: about, the visit.:...
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional
©pages as necessary):
A,
►A�O
tA
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

e
Facility Number: — 32UI Date of inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 14 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes kfNo
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 )] 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
Additional omments an or rawtngs:-
--
Y�
�fS� �c�-ems-. ��t,�►a r� � �Y- (�f��; � ��/ � � 11��! 1��
5100

Division of Water Quality
: 0 Division of Soil and Water Conservation
0 Other
Agency 9
Type of Visit Rcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number [late of Visit: Tiine: ® Printed on. 7/21/2000
0 Not O erational 0 Below Threshold
0(Permitted © Certified Q Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: \.... Count}': .... Q!'..i h�....................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ............................................................ .................. Title:................................................................ Phone No:...................................................
MailingAddress: .........................................�............................................._................................................................................................................... ..........................
Onsite Representative: ..c..J.4c.` ... ...... .......................... Integrator:.....................
y..............................
I.................
Certified Operator:. ................. Operator Certification Number: ..........................................
Location of Farm:
w.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• �� �«
Design Current
Swine C'anacity Ponulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 1 fj Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagn-n Area I0 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impac_
I. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. 11' discharge is observed. what is the estimated flow in gal/tnin?
d_ Does discharge bypass a lagoon system'? (If yeti, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [:]Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 91No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFier: .......................................................................................................................................................................................................................
Freeboard (inches): " 1q
5100 Continued on back

Facili*, Number: 91 —'3C47 Date of Jnspection I�I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
DNo
(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
)4 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
DdNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
gNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
j dNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
g(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
fXNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
9Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Re uired 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?
Yes
gNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NINo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
NNo
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 IgNo
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
:. No •violations:or deiieiencies •were notes• durring this:visit; - ;Y:ou witl •receive tio: further
.. correspondence. about this vesit. ...... ..... . .... . ..
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):
tj
Reviewer/Inspector Name Ue ►-, ► k-Q� Q _ _ _ _ �_ o) 3_ 9S_-37G_o �.'�
Reviewer/Inspector Signature: (—k. 1-�� Date: Y —9!--f--C;q 5100

FacRity Number: Fn -- 3 Date of Inspection I��
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes`] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) 1
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes qNo
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 �Wo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes L No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JffNo

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 4-
Farm Name:s
On -Site Representative:
�J�-T , i�
Inspector/Reviewer's Name:
Date of site visit: �1 �]
Date of most recent WUP: 5-bL6
LCL6—.—
Annual farm PAN deficit: d pounds
N/Operation is flagged for a wettable
acre determination due to failure of
Part B eligibility item(s) Ft e F3
Operation not required to secure WA
determination at this time based on
exemption E9 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -Dose traveler, 2. center. -pivot system; 3. linear -move system;
®stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. 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 D21D3 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 Ili. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part Ill).
PART H. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required .because -operation fails nne of the .eligibility - -
requirements listedbelow:
_ F1 Lack of acreage=which Tesultedinnver-applicationzfwastewater_(PAN) on:spray_
field(s):accordingtofarm'sdasttwoyearsmfiniczation7ecords.
F2 Unclearjllegible,-or lack of informabonlmap.
F3 Obviousfield-limitations -(numerous=ditches ;failureto:deductTequired
bufferlsetback acreage;-or25%:of#otal:acreageidentifiedin�CAWMP.=iincludes
small; irregulady-shaped felds=fields-less thanazcresfor.travelers-or_1ess-than : -
2 acres -for stationary- sprinklers).
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 111.

Revised April 20, I999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER
NUMBEW-2
IRRIGATION
ACRES
ACRES
%
SYSTEM
r-ICL.LJ ItlLJIYIaGIC - IIYU1GlIL, gull,J-UIIC, Vl .PVIIIL IIUIIIUCI.I IIJOY LJU U=U III E IC" VI LIUJU IIUIIILA; Ib Ut::PU11U11IU UII Lr.-MIVIT
and type of irrigation system. If pulls, etc. cross -more -than one field, inspectorfreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBERZ - must be clearly delineated on map.
COMMENT53 - back-up fields with CAWMP acreage_exceeding75% of its total:acres and havingreceived 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 Determ_inabonrack-upfields -must -be noted in the -comment section -and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
Pi Plan -lacks -following -information: _
P2 Plan revision may.-satisfy-75% rule based on adequate overall PAN deficit -and by
adjusting all field acreage -to below 75% use rate
P3 Other (ie/in process of installing new irrigation system):

r.
A I Sion o -Soil andW. Water'Conservation f at b
fS'
.T[]-DiVisiono oil hfid Water Conservation - Coinl;liancelngpectlon,
lVivision of Water Quality -Compliance Inspection'
Other-Agency'-,OperationRe view
JaRoutine OCornplaint 0Follow-up ofDWQinspection OFollow-up ofl)SWCreview 00ther I
Facilitv Number
[3 Permitted 0 Certified E3 Conditionally Certified 13 Registered
Farm Name: . . ... "4,.S
Date of Inspection
'rime. of Inspection 6 24 hr. (hh:mm)
113 Not Operational Date Last Operated: ...............
Countv: ..134cl-i
.... ...................................... I..... ..........
Owner Name: Phone
N 0:
......................... ..... ...... * ....... * ............... ------- * ............. * ...... * ............... * .............. ­* ............... * ........
Facilit Contact: ......
y 6 Title: Phone No:
.. ....... L;A ..............
........... ­­ * ............. * .... ­ ..... ­*­ ........
MailingAddress . ................................. ...... ­.... ......... ..................................................... ................. ................................................................... ..........................
f
Onsite Representativ .........T y ...1....... . ............. Integrator:.....} �
ntegrator......(v..
Certified Operator:.. ...................... . ......................... ... .... 11 .................................................... Operator Certification Number:..........................................
Latitude 0 .4 Longitude a 4 69
Design Current
Swine Capacity Population
E] Wean to Feeder
gFeeder [oFinish
E] Farrow to Wean
E] Farrow to Feeder
El Farrow to Finish
[:] Gilts
El Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
JE] Layer I I JE] Dairy
JE] Non -Layer I I --- JE1 Non -Dairy
ID Other I I I
Total Design Capacity
Total SSLW
Number of Lagoons . I I FEI—Subsurface Drains Present 11E] Lagoon Area 10 Spray Field
Holding Ponds / Solid Traps I I JE] No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: E] Lagoon [] Spray Field E] Other
C
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed. did it reach: [] Surface Waters E] Waters'of the State
c. li'discharve is observed. what is the estimated flow In aalhnin?
d. Does discharge bypass a lagoon system?
1 Is there evidence of past discharge from any part of the operation?
4-1
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?
C, Cr
Structure I
Identifier: e3�
Freeboard (inches); .................................... .......
Structure 2 Structure 3 Structure 4 Structure 5
El Yes
KNo
0 Yes
0 No
El Yes
E:1 No
E] Yes
E] No
EI Yes
5? No
El Yes
r'17r No
E] Yes
XNo
Structure 6
1/6/99 Continued on back

acility Number:, — '3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes LX 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 Wo
(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 main ten ancelimprovement? 0Yes ❑ No
S. Does any patt of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [5kNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes (�No
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes allo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes No
12. Crop type ...�.. --1.. �..��'...............................................................................................................................................................................
t.. I....
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
UNo
15.
Does the receiving crop need improvement?
❑ Yes
EfNo
16.
Is there a lack of adequate waste application equipment?
[:]Yes
t4No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
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
D<No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
D<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 certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23,
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
W No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
0: No:violations -or. deticienci es :were noted during :Niis:visii.. You will:receive no further ::: :
eorresbiHidence:tibout:this visit.......:•:•:•.•.•.•.•:•:•:•:•::•:•.•:•.•.•:•: ..::.: ::. .
Comments. (refer to question #): Explain any YES answers and/or any recommendations or,any.. other comments.-
Use drawings of facility to better explain situations. (use additional pages as necessary)
�� ��,.�� lrG►� �' f � � � `� !�� '.1-�H�_�-dam. �� `G���
tpP2 (Qwet Q
IcO Ne (Ak A4,�v-g� IQQ_�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 1& 1116/99

Lagoon Dike Inspection Report
Name of Farm / Facility _ Gurganus, ONeaI (Murphy) 67-34
Location of Farm / Facility _ Sr 1209, 2215, 3579
Owner's Name, Address
and Telephone Number
Date of Inspection
9 / 28/ 99
Names of Inspectors Patrick Grogan
Janet Paith
Structural Height, Feet
- 1 j'
Freeboard, Feet
Lagoon Surface Area, Acres
L0
Top Width, Feet 8
Upstream Slope, xH:1V
2 to 1
Downstream Slope, aH:1v 3 to I -
Embankment Sliding?
Yes
X No
( Check One, Describe if Yes )
Seepage?
Yes
r
X No
( Check One, Describe if Yes )
Erosion?
Yes
X No
( Check One, Describe if Yes )
Condition of
Excellent=eass
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Yes
X No If Yes, Depth of
Overtopping Feet
Follow Up Inspection Needed? Yes X No
Engineering Study Needed? T Yes X No
1
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes 9_ No
Other Comments

F '(
t
s' 13 Division of Soil and Water Conservation ❑ Other Agency �=
N,Division of Water Quality K
Routine O Complaint O Follow-up of DW inspection O Follow-up of I?SWC review 0 Other
Date of Inspection I
Facility Number
Time of Inspection 24 hr. (hh:mm)
J�lRegistered [Scertified E] Applied for Permit 13 Permitted 113 Not Operational Date Last Operated: ...................
Farm Name: ....... V _�.�...0 4j ../.6County:...........DNs&Z,CI
.................. ........... .......................
Owner Name:.... .. (i�u-C... .... / � J. ..WF..................... Phone No:..... .. .:..'.......................................
Facility ContaI t: ...1±' J� G,/ ......6..VA.6' 41U ..... Title: 9 7� ,. .... ...... Phone No:. `j.'a la..V.......
MailingAddress:.... ......... u..r.. 4-.....................................................................................................................................................................
Onsite Representative%./NA,(--z :..... a ��%N . � .. Integratdr:.......1;U"1,9
...................................................................................
Certified Operator;....... ?r— ........:................................. Operator Certification Number,......................................
Latitude — 61 3D ff
Design- 'r.Current
&v ine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
2. Is any discharge observed from any part of the operation? ❑ Yes qNo
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
maintenance/improvement?
5. 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
kYNo
❑ Yes
YINo
❑ Yes
No
❑ Yes
No
❑ Yes
No
Continued on back

i .L
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (l.aQoons.Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
❑ Yes I�No
Structure 5 Structure 6
Identifier:
................................ ............................. ...... ........................
Freeboard (ft): ........3 ......................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes �gNo
12. Do any of the structures need maintenance/improvement? ❑ Yes kNo
(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
9No
Waste Annlicatlon
14. Is there physical evidence of over application?
❑ Yes
�No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typeGtT!9.�....+�,�>sc� t ..I..SQuc.".........................................................................................
.. ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
140
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
Cl Yes
�No
19. Is there a lack of available waste application equipment?
❑ Yes
XNo
20, Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`?
❑ Yes
No
22. Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9-No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
�No
No.violations or deficiencies.were noted-dwring this,visit.• .Y,ou.will receive -no further
correspondence about -this.Visit:-
Cocrmatents'(refertq question #) :yExpla�n any Y>✓S answers -and/or iinv recommendattons;or eny other conv eats
T3se drawings of facthty tii better;explam situations Oise additional'pag6 as°necessary) x
fv;y
f
7/25/97
_
S r , i
Reviewer/Inspector Name i "
a
Reviewer/Inspector Signature: -� Date: Q

0 Routine O Com faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:m'm)
Total Time (in fraction of hours ^
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
53 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _ .. _ .._ _.. _..... ..... .... ..,. _...._ .... _.......
Farm Name: � � .... i ' �1 �. �T$. 2.P-5...,.....��....��..� � �.._. county:
.5 ��� ...._ ...._ ..., .. � _.
Land Owner Name:.. �r.!�—� G'�.�vS.. Phone No:.
Facility Conctact: aft C, 14" "=3 Title: _X.j9 Phone Flo:
Mailing Address: _. /-✓ r CC4 G X c/ ..........
Onsite Representative:/!,., ... _.....z.... Integrator: V
Certified Operator: . . ..... Operator Certification Number: ................... . . .... . . .....
Location of Farm:
Latitude Longitude * 6 64
Type of Operation and Design Capacity
�&
Design Current Design; Current Des�goSG rent
. �; ''
Swine ,:; ;Ca aci P..o tilation Poultry �r Ca aci .k-Po elation Cattle _Ca acePa ulatron ::.,:.3,
❑ Wean to Feeder ❑ La A [] Dairy I
Feeder to Finish 7�4`>! ~4 ❑ Non -Layer ❑ Non Da
x
171 Farrow to Wean
171 Farrow to Feeder otal Design C4ac� y
Farrow to Finish �;
.,. M- w�..........._ Totals LW�
Other �a �� 3 SSSIX
Number ofLagoons J HoldmgPopds ❑ Subsurface Drains Present
.F
Lagoon Area ❑ Spray Field A ea
Gene
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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?
❑ Yes
O No
❑ Yes
[9'No
❑ Yes
❑ /No
❑ Yes
F-KNo
❑ Yes
a No
❑ Yes
U44o
❑ Yes
B No
❑ Yes
JINo
[
Continued on back

Facility Number:..
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
truc u s (Laugoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ii): Structure 1 Structure 2 Structure 3 Structure 4
Z
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Cl Yes
2090
❑ Yes
G 1 io
❑ Yes
OK.
❑ Yes
[ENO
Structure 5 Structure 6
❑ Yes
M No
&rfees
❑ No
ges
❑ No
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, r runoff entering waters of the State, notify DWQ)
15. Crop type ................._...
- .................. _ ....................... __........._ ................... ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
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?
For Certified ,F'acilitie5 QnIX
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes G_f4o
❑ Yes [moo
❑ Yes E31,10
❑ Yes ['Vo
❑ Yes ONo
❑ Yes ,Eg No
El Yes ,M o
❑ Yes l -Ko
❑ Yes ONo
[a Yes ❑ No
❑ Yes ONO
Cornments (refer to question 40 kExplatn any YES'answers andlor.any recommcndations'or any other comments`
Use,drawings; of facility to;better explain §ituations �(use`addrtional pages as necessary}`
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Reviewer/Inspector Name
Reviewer/Inspector Signatu : Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIO ,nS, SITE VISITATION RECORD
DATE: K6 , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
1/V/ /f
Integrator. [J PH Phone:
On Site Representative: zi667145 e Phone: �L
Physical Address/Location: .6 mil. 40d se 11?e .,' CO
Type of Operation: Swine Poultry Cattle
Design Capacity: drNumber of Animals on Site: dq�y -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 27 _°'y r , u " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have icient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 incheK YejA No Actual Freeboard:n-a—Ft. _�p Inches
• Was any seepage observed from e agoon(s)? Yes Na as any erosion observed? Yes No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: 1,5 4eR --5 2�10�rQ L % Ar-4-0—S or�_aSr_�Jg'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es No
100 Feet from Wells9 es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes q0 If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific a cage with cover crop)? Yes r No
Additional Comments:
Inspector Name _ ignature
rg
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 195 18:16 P.09/18
Site Requires h=ediate. Atientxon
. Facility Number. - s
SITE VISITATION RECORDR
DATE: , 1995
T±c i
Owner:
Farm Narne:
County: 41/L-s4rw
Agent Visiting Site: _VAS
-
—�„ _ - _ Phone: ff!b
ysr"- f a
Operator:
Phone: felP
.� •_ �� ��__
On Site Representative:
a AvCc x l- d u
A a r;v o 4 z_ _. Phone:
Physical Address: 7-4.C6
Ate &,,
�icP
Agir 0,,,fC
w L'i. L4irC a� %NAw.�LiCN! ►..� X�C_�fXAr
PC (r�0
0
Mailing Address:
Type of Operation: Swine c Poultry Cattle
Design Capacity: W s Number of Animals on Site: y
Latitude: o Longitude: a "
Type of Inspection: Ground Acriai
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of, I Foot + 25 year 24 hour storm event
(approximately I Foot +$ inches) (9 or No Actual Freeboard_ _ z Feet Inches
For facilities with more than one iagoon, please address the other lagoons' freeboard under the
conunents section.
Was any seepage observed from the lagoon(s)? Yes or Was there erosion of the dam?: Cajr- No
Is adequate land available for land application? �Pr No Is the cover crop adequate7 e ar No
Additional, Comments:
Fax to [phone]
/,4 i i 1L
J x aturc 4 A-ent