670043_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

Type of Visit: (F Cogtfpliance Inspection V 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: tt I Arrival Timed® Departure Time: Z= County: OU L4Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Lr[—SIM �=—j`�� , � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 J6
Certification Number:
Longitude:
Design
Swine Capacity
Current Design Current
Pop. Vet Pouli t_V= Pop.
Cattle
Design C+urrent
Capacity P.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I INon-Layer
I
lf
Feeder to Finish tip
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , Poultry Ca a_city P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E(No
❑ NA
❑ NE
❑ Yes
640,
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: jDate of inspection: 11
Waste Collection & Treatment
4. N 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: Al ,LACiaw&11T.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g
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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Noo ❑ 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 `t' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [;3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
11No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
- ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
u o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
DNA
❑ NE
20. Does the"facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
2/No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑�Ye
h r:
21. Does record keeping need improvement? If yes, check the appropriate box below. s ❑ 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 Zo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F21<0 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Wnility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes /No ❑ NA ❑ NE
25. N the facility out of compliance with permit conditions related to sludge? If yes, check FYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes I ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes E N ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes ( o ❑ NA ❑ NE
❑ Yes P - ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Comments (refer<to uestidif,#i) rEb;ipplain an „YES:a.nsw'ers,,and/or:any additional.re,
commendations or, any other cmts
Use drawings"offncihy o bette,ezlainstuations(useadditional a esas"necesarY).
J
PA
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C, jevti r 04
(L-It) CCK /
PhoneCgly
Date: S I
21412015

Type of Visit: E) 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 O Denied Access
Date of Visit: Y Arrival Time: Departure Time: t3 o County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: 'Z Z.. Y 3 r'>
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
11
Wet Poultry
Layer
Design Current
C*apacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
INon-Layer
I
Dairy Calf
Feeder to Finish
1 ZOO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Pl -Ultl�
Layers
Design Current
C►a aeit PILa ,
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
E the_r[Turkey
Other
Turke s
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ 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
J�r`No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: 7 - L4 Date of Inspection:
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'1 o-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El"'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 El 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,
No
notify DWR
7. Do any of the structures need maintenance or improvement? Yes Z
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ED<
❑ 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 E3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [!] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? E Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNc,Yes
❑ NA ❑ NE
DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
6 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ f 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
01<0
❑ 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
�N0
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Fecili Number: (1- V Date of Inspection: ty 1z S-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check GrYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [ailure 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 ESNo ❑ 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
[�3No
❑ 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
EINo
❑ 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
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[]�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any; other cgmments.
Use drawings of facility to better explain situations (use additional pages as necessary). ..
j 15-, I,...c.c I ( on j r- ( o rl ! ` i(s
2� �f-[— Irvi•���e1�h �fr0Yk ()nS�oL.. 5,�.� W
P '
CDIn Try G 73 ek-
Reviewer/Inspector Name: Ja v,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [ l � 7 � t 17.30 y
Date: l z_yL�
21412015

Type of Visit: UCo liance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L_tS7 C-P_ �J�-Iry/►Iq�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: Z L q;)
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity Pop.
Wean to Finish Layer
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
DairyCalf
Wean to Feeder
I
jNon-Layer
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P■ouit�, Ca aci P.o ,
Layers
Non -Layers
Pry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharees 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 0 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 ❑ N ,❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued.

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: coif
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 130
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
❑ Yes
Structure 5
[(No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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 N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes L Q 1` o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [al�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: '
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �i�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g/No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

\y
Facility Number: - Date of Inspection: i
24. Did the facility fail to calibrate waste application equipment as required by the permi ? I ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fait 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 Z240
❑ 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 C3 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Rio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional napes as necessarv).
PA
Reviewer/InspectorName: Jo�IgJ �%�� Phone:
-4
Reviewer/Inspector Signature: Date: t
Page 3 of 3 21412011

Type of Visit: QrCo pliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y )3 Arrival Time: DO Departure Time: ® County: o4h4u✓ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L,STQL_ 2='r4MAly
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 22.14 3 o
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I JNon-Layer
I
EE
Calf
}(
Feeder to Finish ;240-0
Design Current
Dry P,oul C•_a aci P,o
Layers
—Dairy
Daig Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
MLj2ther
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)?
[:]Yes [Frio ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 3<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes F(No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Faciliiy Number: - jDate of Inspection: Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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: }A" [ LA GOaJ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-3 `C
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 No ❑ NA ❑ NE
❑ Yes YNo ❑ NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [�J/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [/] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F]/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C2 o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
io
❑ 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.
64�es
[] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield Ell 20 Minute Inspections ❑ Monthly and 1" Rainfall Inspectii Opsitudge
Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3rl�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[JIIfo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: L7 - Date of inspection:
,�4. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑/ NNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [; Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
114
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6111qo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q "o ❑ 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 [3/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
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes Q No ❑ NA ❑ NE
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
2/No ❑ NA
❑ NE
NA
❑ NE
r❑
No ❑ NA
❑ NE
30 ❑ 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).
ZZWWA v
L5 7LANPJErD
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 14 13
21412011

Type of Visit: UZoutine
ance Inspection Q Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: dWIZU Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: L r_- 5L &y��ma Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Poultry Capacity Pop.
La er
Design C►urrent
Cattle Capacity Pop.
airy Cow
Wean to Feeder
EWet
Nan -La er
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
(p(
Design Current
1)r. P,oultrr C_a aci P,o
Layers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
/No
1" Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑ ❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
o ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

J
Facili Number: - Date of Inspection: i2=
!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
Identifier:
Spillway?:
Structure 4 Structure 5 Structure 6
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?
_:� 7�
❑ Yes2No
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes INo ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
❑ V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E349'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes go
❑ 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 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 VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Ficility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 2rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 2ryes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ F lure to complete annual sludge survey El 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: -7/11
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E2 N/o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes O'No ❑ NA [D NE
❑ Yes JE]No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
N1:W'0
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).'
fl � b � �OA
Fob- S �J oC� ��.1Mov��-- c ,�-
Reviewer/Inspector Name: Ili 0
Reviewer/Inspector Signature:
Page 3 of 3
Phora v I ✓
Date:
21412011

(Type of Visit: O Compliance Inspection V Operation Review U Structure Evaluation Q technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Other 0 Denied Access
Date of Visit: Arrival Time: lv b Departure Time: 6 - County: atjSLot,J
Farm Name: KC-D IP r T M A FA0,A/i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
iC
Feeder to Finish 3$2o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P,ouI Ca aci P,a .
Layers
Non -Layers
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Beef Feeder
Boars
Pullets
Turkeys
Turkex Poults
Other
Beef Brood Cow
EL10ther
Other
Discharges and Stream Impact
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 (2/ o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No
[:]Yes dNo
❑ Yes FJ'INO
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FILcility Number: (ol - +43 Date —ofinsgectionTtI311ts
Waste Collection & Treatment
Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[2
❑ o
El
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lfl (Y-00 1 l q( yd
Spillway?:
Designed Freeboard (in): Z-G 'LO
Observed Freeboard (in): 1.1 22
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
Ei No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2f/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ 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
[2*/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
Ej"NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[] NA
dNE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA EKE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Serve
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA C:(NE
Page 2 of 3 21412011 Continued

F cili Number: 1 - 42 Date of Inspection: 8 3 t o
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA rNE
4
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes [:]No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA N
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes El"No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes dN0
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 eNo
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 dNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Y33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes
34. Does the facility require a follow-up visit by the same agency? [] Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments,.'
Use drawings of facility to better explain situations (use additional pages as necessary).
'i_,) ^rrJS96C:-ct.Et$op,." LkV(L. SW60 C9 I? 3►J�-W[ 5 LA&,.ro►-� B`{'
ip,,it—AL, —5u-v 6tj, l 1.1Ss as- ASS -mntj t,4E 1_CQLL%jR-_J Fa_CEQoARD a
Zo S.NctAGS JETCar,aNC� 1Y 1ACrro t J oCs t:90,
311,) PAZL-Co 7o 0 o frf '� r&C-e B.A(0,
Reviewer/Inspector Name: 'J o[40 k anti Foil t_ALm
ReviewerAnspector Signature:
Page 3 of 3
Phone: 010) 7g& - i37V,
Date: Ck1 ? JI t
2/4a011

�; Fac�ltty Number (P
r'+
t
vw'sion-orwater
C 3 0"Dtvtsion of S6iFa6
D:;Other�Agency
Type of Visit ,Gomm liance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
( Reason for Visit utine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 3 3 I Arrival Time: it b b Departure Time: County: at-35LOW� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: " Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: a c 0 ' = Longitude: = °
Swine Capacity Pi
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish ji
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
rent
lation Wet 1'©ultry _.
Non-
ign Currents : f
is ty, Population.
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
TurkPoints
❑
Other
Cow
Calf
Heifer
Non -Dairy
Beef Stocke
Beef Feeder
Beef Brood
Discharges & Stream Im acts
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 2 I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA El NE
El Yes :No
N ElNA El NE
El Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: (,,I — 4,3 I Date of Inspection 3 1
'i Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ��� I LAGvt*l 7,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o d
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 Z 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 environmentalth
Eleat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes �No ❑ El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IJ 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 � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
]I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
El No [I NA ❑NE
EIN"o ❑ NA ❑ NE
Ej,,'Ko ❑ NA ❑ NE
LZo[__1
El NA ❑ NE
NA ❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or4ny other comments m
Use drawings of facility to better explain situations. (use. additional pages as necessary):
r ReviewerlInspector Name —jog t l 4 A Phone.n1 rb 74C — 7.3
Reviewer/Inspector Signature: Date: i
Page 2 of 3
12128104 Continued

Facility Number: — 3 Date of Inspection 3 t.
Regnired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box. ❑ �p ❑ Ch kl' ❑ D . ❑ ?A❑ O h
ec �sts es�gn aps t er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ 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
,310
❑ 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
E?�o
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
l�/No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,�/
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately 1
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,, //
Ck<O
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Id No
❑ NA
❑ NE
Additibnal Comments apolor
r AL
Page 3 of 3 12128104

0 M. y3
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: qO0 Departure Time: County: ONSL�� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: l E TEn- Q �T -r(nA_d Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Oc
Operator Certification Number:
Back-up Certification Number:
a Longitude: E=] ° = ' =
MMgg-r—rent
Design Currntopulation
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
43TIO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
ElLayersers
El Stocker
❑ Gilts
❑on -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey 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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
7(N
❑ NA
❑ NE
❑ Yes
L No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of inspection
Waste Collection &Treatment
4 � Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[3 Yes o El NA El 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: iACy-ouu L LA4.00" L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
,�(
ElLl 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 ENo ❑ 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
eat, notify DWQ
environmentaZo
7. Do any of the structures need maintenance or improvement?
El Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pemut?
❑ Yes 6 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [;(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,,,/
10. Are there any required buffers, setbacks, or compliance alternatives that need El[2 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 10 lbs ❑ Total Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Lf No
❑ NA
❑ NE
d No
[INA
❑ NE
E No
❑ NA
❑ NE
6 No
❑ NA
❑ NE
[;�No
❑ NA
❑ NE
( q ) p y y
ments refer, to ueshon # : Ex lain ' w mend..ations,or a Com� :an .YES answers,andfor an .<teram nyvther comments e`
Use drawings of facility to better explain situations. (use additional pages: as necessary)
.V,) 6 F r S L U OG E OCAX 3o DABS . GALA— jOw Q Da.JE , . •.
Reviewer/Inspector Name j
Reviewer/Inspector Signature:
Page 2 of 3
�ta�tN6L•� °„
) Phone,1, `j lb 3-
Date: S -t ho
12128104 Continued

Facility Number: -- Date of Inspection
R�auired 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. ❑ nrr Tp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
LdYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EAo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E�Ao ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJ t 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,/
LIN
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Tonal Coi
12128104

Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 OGI Arrival Time: 0 Departure Time: County: dN3t,al.•� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: U�k-tZ-iz �'S-rWAO
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = Longitude: = ° 0 d = «
Design Current
urrent
Design CfI
Design
Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
91 Feeder to Finish ?jb
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Layers
❑ Non -Dairy
El Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑Turke Points
❑ 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 'LI No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
❑ NE
❑ Yes
El Yes
o ❑ NA
El NE
[]Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

.t
Facility Number: Date of Inspection 3 0?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
g P P g P q
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: LA GIN 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;Z3
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 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environment71teat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes a No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [ o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El YesVNo
❑ 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 rNo
❑ NA
❑ NE
V-RKS• f .ak.' K - A ' �+-.df �' .-srvE'' iaf' -�`'�' � � �i_.�i�^4 ("""'
;Comments (refer„totqueshon°#) �Explatn-any YESyanswers�andIor any recom�endations nr�any��other comments.,
Use dtawtngs o(facthty to bet#er explain situations: (use additional -pages,asstiec_essarr,):� _
Reviewer/Inspector Name
p _ i� —� Phone: 9l -
Reviewer/Inspector Signature:
Date: 3 A-U
Page 2 of 3 i 12128104 Continued

Facility Number: 7 — 3 Date of Inspection L tg
Required Records & Documents ,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 1% J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [(No ❑ 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
VNo
❑ 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
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
0 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
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElICJ Yes
�ONo
NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B 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
QrNo
❑ 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
LEI 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
2No
❑ 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
DIN
❑ 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

Type of Visit Q C mpliance Inspection Q 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: 195 6 Arrival Time: ® Departure Time: County: S2AJ5t4 L4 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Us'f(, rL _1Z"l`fN lqt ') Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ n =1 Longitude: = o = , 0 «
Design Current
Design
Current Design Curren#
Swine Capacity Population Wet Poultry
Capacity
Population Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ We to Finish
❑ Layer
❑ We to Feeder
❑ Non -Layer
Feeder to Finish 5 'L4 o Q
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
ElNon-La ers❑
❑Beef Feeder
poGilts
Pullets
Boars
❑ Beef Brood Co
❑ Turke s
otl urkey Poults
❑ Other j 10 Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Yes
El No [I NA
❑NE
El NA
❑rN
❑ NE
❑ Yes
❑ Yes
EJ ❑ NA
❑ NE
El Yes
L7 No ❑ NA
El NE
12128104 Continued

Facility Number: (p� — ?j Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: lA(stroj I (Q (tVtJ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 171-7 28
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes D'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 iNo ❑ 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 E�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [J 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 U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [2/No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [n 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
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
(No
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
Yes
[IJ
L� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
2d.) VPOArC- rj of u sT44
COPY
Reviewer/Inspector Name
-fge A& w F-b S r'✓C.
L q to
k— I Phone:
71 C.
Reviewer/Inspector Signature: Lodi ' Date: jo4'W09
Page 2 of 3 112/28/04 Continued

Facility Number: (�'� — 3 Date of Inspection K012SiOg
t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have 11 components of the CAWMP readily available? If yes, check ❑ yes El No El NA El NE
the appropriate box. ;1 ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�To
❑ 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 El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
L� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑' Vo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
VYes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Lrf 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
[JrNo
❑ 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
0No
❑ 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
�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
VN(o
❑ NA
❑ NE
Additioaal:'Commetts'andlor Drawings
Page 3 of 3 12128104

Division of water Quality
Facility Number '] 3 O Division of Soil and Water Conservation
- - — 0 Other Agency
Type of Visit
co fiance Inspection
0 Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine O Complaint
0 Follow up 0 Referral O Emergency
O Other ❑ Denied Access
Date of Visit: / C! n 7 Arrival Time: A U Departure Time: County: dAIP041 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: i'_t=5tC2. EtIrMAtJ _ _ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f ❑ Longitude: ❑ ° = A ❑ u
r.Swine
llesign Current Design Current Design Curren.f
Capacity Population Wet Poultry , Capacity Population Cattle Capacity Population,x:
❑ Wean to Finish �_I _J' LJ Layer
❑ Wean to Feeder ❑ Non -Layer I IY
® Feeder to Finish -7- D 3 Ov
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars .
Other:.
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 l of 3
❑ Yes 21 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ' EJ'No ElNA ElNE
ElYes LJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: 7 — 3 Date of Inspection eL a
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 Cl NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tA &w n/ / ,(A (r>ZZ_
Spillway?:
Designed Freeboard (in): ?�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rj 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 dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes l( 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V 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 Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes D No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [1q'o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [2oNo ❑ 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):
JToacv-J& OV /(
Reviewer/InspectorName R Phone:Q9j0 % —73?T
Reviewer/Inspector Signature: Date: 6 7
Pase 2 of t 12128104 Continued

Facility Number: — y3 Date of Inspection
Re uired Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 12'�4o ❑ NA ❑ NE
the appropriate box.
❑ W1JP El Checklists El Design El Maps El Other ,,,,����
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes ER No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
BIN'
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑'N10
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-&o
[:1 NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El"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
ET -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
ET -No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[]'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2rNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
El"No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number J O Division of Soil and Water Conservation
- M_�-- Q Other Agency
Type of Visit Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 0(/ Arrival Time: Departure Time: County: dNl44W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ll Title:
Onsite Representative: S1i+n-?TTY`nflN
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = 1 Longitude: = ° =
Design ".Current Design; Current.::Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity. Po ulation:°...
_E
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 1351-10
1 �-A"
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Cow
FDai
Dair Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
v- -- --- 1__I 1 urxe S
Other ❑ Turkey Poults -
❑ Other k,.
❑ 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?
Page I of 3
❑ Yes [X10 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: 6'j — Date of inspection l oil.
!Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (A %'d 1 cadj A! -"
Spillway?:
Designed Freeboard (in): 'Vb
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures 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 in No [3 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E;r/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L/ I 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) ti3 (,((� s(22
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 V6 ElNA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ YesVNO
o ❑ 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 ❑ 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):
,14) Upor+-rE wup w=M
,sCW c v^ &DJ<:i Fs4_t_ CT vJ ,:,�T64 0h qf, RE wa Jrc �'��► j b
AoC- 'Co 6AS t.XKV—.
GPDA% SrDUC. V(r
; oft, GEr ANNvAt- AV6"&E �t,�y� ZNTEfy2AT6t..
w4) 66m:w Cs.Rr -Fov-
V*W PuwtP .zC ( *L- "r4A.t.? tALX6AATZC t j Ag:_� toum.0.
Reviewer/Inspector Name
Phone: Phone: ?10
Reviewer/Inspector Signature:
Date: o b
Page 2 of 3 $ 12128104 Continued

F-

• Facility Number: Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have al components of the CAWMP readily available? If yes, check
the appropriate box. p ❑Checklists
❑ Design Li maps ❑ Other
❑ Yes L✓1 No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applic on El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
❑ Annual Certification
El 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
ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Ej 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?
❑ Yes
O No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
EI/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q No ❑ NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Ld No ❑ NA ❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

G1 H LA
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: g o Departure Time: County: ops St--nn-, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ? AT'c MAO
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = o = i
Swine
Design Current Design Current `. Design Current
Capacity Population Wet Poultry Capacity jg�opulatton Cattle CatyA Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La ei
❑ Dairy Calf
© Feeder to Finish
35 Z
s do
Dray Poultr.}
❑ Dairy Heifej
❑ Farrow to Wean
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ La ers
❑ Beef Stocker
❑ N ers
❑Beef Feeder
Nets
El Pullets
❑ Boars
❑ Beef Brood Co
Qther
❑ Turkeys
Number of Structures:
❑ Turkey Poults
❑ 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?
❑ Yes [dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [No. ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued

- Facility Number: — t 3 I Date of Inspection Lt 14 o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes CfNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA boa d I 423Gaa,,1 Z
Spillway?:
Designed Freeboard (in): 20 20
Observed Freeboard (in): a a S`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ZNo
❑ 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 2�114o ❑ 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 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) aCR',%-V*A t (,
13. Soil type(s) AJQ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CleZ
El 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
Ed� o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
E No
❑ NA
❑ NE
Eueshon#.) Erpla�n.:any, .YESf,
�?J-) KEEP C.WY. of At0QUAc- CE-9--r. w-uru (ZC,c.ot- m, Op, r Tar ra". R.h'Tj-JCAL�L_ L> sEW�2Ar�_
aq,) w rTj1 pew AZp-xJAte NC-.D CAL—USRA-r4,),J Oob-ts= .. A5AP
Reviewer/Inspector Name a W ;j rbn 06_L_.. .:. Phone: 010) _jY 3206 x z
Reviewer/Inspector Signature: 6E, Date: qjjctlo $"
12128104 Continued

Facithy Number: (,7 — L4 -� I Date of inspection � iGloS
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 11f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
MYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
EdAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElL� Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes
9No
ElNA
ElNE
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
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
dNo
[:]'NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,(
[} No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑'No
❑ NA
❑ NE
(Additional Comments and/or Drawings:
12128104

IType of Visit oeFCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason For Visit oRoutine 0 Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified © Conditionally Certified [3 Registered
Farm Name:
Owner Name: LJ�.S�.�%L &w'T,��__
Mailing Address:
Facility Contact: Titie: Onsite Representative: I�JT�ie �T7,-TAA/
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold:
County:
Phone No:
Phone No:
Integrator: '6qozalv�'
Operator Certification Number:
Swine []Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ` 6 0
Wean to Feeder
I"i
l__I Layer
Feeder to Finish
-3S'20
_y
❑ Non -I.
Farrow to Wean
❑Other
Farrow to Feeder
Gilts
Boars
Subsurface Drains Present
No Liuuid Waste Manoeen
Discharges & Stream Imoacts
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 & Treatmant
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Stricture I Stripre 2 Structure 3 Structure 4 Structure 5
Identifier_ r� 2—
Freeboard (inches): 2w
iSpray Field Area
❑ Yes
A No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
5rNo
❑ Yes
ZNo
❑ Yes XNo
Structure 6
05103101 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes YNo
immediate public healtb or environmental threat, notih• DWQ)
7. Do anv of the structures need maintenance/improvement?
9Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes PrNo
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
ElYes ANo
Waste A�olication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes �No
11_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Ilyd ulie Overload
❑ Yes )ZN0
12_ Crop type MA.4 laE4
13. Do the receiving crops differ with those designated in & Certified Animal Waste Management Plan (CAS )?
V
❑ Yes 1XNo
14- a) Does the facility lack adequate acreage for land application?
❑ Yes RrNo
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 2fN0
16. Is there a lack of adequate waste application equipment?
❑ Yes 'ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes fi�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
19. Does record keeping- need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes �No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notifi, regional D' � Q of emergency situations as required by General Permit?
(it! discharge. freeboard problems. over application)
,�f
❑ Yes �LJ No
23. Did Reviewer,'lnspector fail to discuss re,.zew•linspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
© No violations or deficiencies were noted during this visit. ' You will receive no furiher correspondence about this visit.
CnmmeatS;(refer fo gnesboti ..Exp11a]:n.any YM. answersrandfor any recomumendazzons sir any other•.cammiii s �
Use of of facfiity to better explain situations,; use ad"aliai page as necessary) �
x� ❑ Field Copy ❑ Final Notes
lq) NEEo /4 �� ,ter. arrr9�g
r 2 pa 3 SOzC- 7F15r /;�ZPoa-r ; / r� 14 CaL F_ ✓macs �%i✓o / o,9,g p r. F2
�OL! S, P✓FL /7r�L�O 4
J J
Revieweranspector Name .
Reviewer/Inspector Signature: Date: O
05103101 v� T Continued

Facility Number: —7 2 Date of inspection D 1?
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes /!A No
❑ Yes �ONo
❑ Yes Y�10
❑ Yes O'No
❑ Yes No
ElYes /❑ No
Additional C6&62ents aod/,or_Drawings:.
i
E�0 �0 �Q t�r✓ � T.e�c»itl ,� ��
J7h�- L/1 vovs. ley- Ss d,�s��OGau�
L/���,� �i4,�} 7G4� clir) I� C/w/�5S�T�2/✓� �D /c/i�2�v
/y 5
)5�;'e540-5
05103101

Aeck o Oliva R cc'L-se W/ Psi `/ ram, 1
Type of Visit -0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f-Vboutine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: 3 1 % D3 Time: 7 = 75,7
IQ Not Operational 0 Below Threshold
0 Permitted [3 Certified /�[3 Conditionally Certified [3 Registered Date Last Operated orAboveThreshold:
Farm Name: ked J` 'il yVkA"t l'Gt f' County'
Owner Name: t_e'54e'r Phone No.
Mailing Address:
Facility Contact: Title:
Onsite Representative: L.es4er IPAgA.,
Certified Operator:
Location of Farm:
Phone No:
integrator: M U� R/'DlnlYT
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 °
Design
Current Design Current Design Current
Swine Ca aci
P,o ulation Ploultr.,y Ca aci P,a ulation Cattle Ca aci P,o ulatson
❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Non —Layer I I I JE1 Non -Dairy
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ goy
Total SSLW
Number of LagoonsWiFff—T
Subsurface Drains Present ❑ Lagoon Area -1 Spray Field Area
Holding Ponds 1 Solid TrapsNo
Liquid Waste Management S stem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ 1 2—
Freeboard. (inches): 2-1
05103101
❑ Yes .1ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes 13'No
❑ Yes I"No
Structure 6
Continued

Facility Number: 7 — 3
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stucrures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes VNo
❑ Yes ,) No
❑ Yes .ElNo
❑ Yes IzNo
❑ Yes O'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes %6 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )ZfNo
12. Crop type _Se �' VJ LJ�& Ove,'-ze"91
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14" a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a -,venable acre determination? El Yes �,(No
c) This facility is pended for a wettable acre determination? El,L�,! Yes No
15. Does the receiving crop need improvement? ❑ Yes 6o
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Reguired Records S Documents
17. Nail to have Certificate of Coverage &: General Permit or other Permit readily available? ❑ Yes AzNo
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 0 No
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes /ZNo
20. is facility not in compliance with any applicable setback criteria in effect at the time of desiem? ❑ Yes'ONo
21. Did the facility- fail to have a actively certified operator in charge? ❑ Yes ONo
22. Fail to notifir regional DWQ of emergency siruations as required by General Permit?
(ie.3 discharge. freeboard problems. over application) ❑Yes XNo
23. Did Reviewer(lnspector fail to discuss reviewiinspection with on -site representative? ❑ Yes 01`10
24. Does facility require a follow-up visit by same agency? ❑ Yes JZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about tliis visit.
r -.�::... ."..A'��•"' ,�-^ .� �w _. �.. : - �`' �`% -� s� -iw�C+�£Y.
Comments {refer fA"gnestgon .-Eip]am:atey YFS Saswera.and/or a' yreeommetadattoas or any -der camme�tss S T 4 ?
a
_
Use drawings of facility io better explain situations. (nse nddnttaaat'pages as necessary) Field CTovv El Final Notes
�2.x-i
IV ell r►' 4740;'}e4- ate reGei ✓ ;�� ce2p s qre Gt/e��
5-�a�b[ S�leGf• 7_4e _<Ltfl-ie howe ArCAJ �p0ry stre L✓e��sue✓?��G���.
Ivt,%,4
►secordS qre neaqly kef+. A t�a�s��ile ae✓eS i4r` 11 vvl.A-;ck/n�S
vlq p a-Y)d wa r-le pl�r, s a�vld 6P doge F�� - e �a�'W,, �'I� � ►^ �J
e r^� �r�s, 7ht•r k bout � >r'
��
�T"a �-�-��, �"*� �
4c � � '�"-�"� e`�2 "1'
Reviewer/Ins ector Namel
c �.- ._ p
Reviewer/Inspector Signature: Date:
05103101
Continued

Facility Number: — 3 Date of Inspection Q
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? ❑ YesNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes ) No
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or f
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �J No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /1Vo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /❑ No
Additional Comments and/or Drawings.:
05103101

i
Type of Visit Ocompiiance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 hate of Visit: 1.0 62- Time: I Z D
Not O erational Below Threshold
O Permitted O Certified 0 Conditionally Certified O Registered Date Last Operated or Above Threshold:
Farm Name: �ed E , ^--1 County: D n sip w
Owner Name: L es4er 1;Frl_tc� h Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Les4e,- I,0 j!jj
Certified Operator:
Location of Farm:
Phone No:
Integrator: MV r d OLD/ j­
Operator Certification umber:
[:]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • OK Longitude 0'
Des�go C�rretet Design Current. ;'
Design Cnrr+�ut
Swine Ca achy Po Mahon _ ' .. Pouhry =Ca 'acity _ Po `elation Cattle ~— Ce achy Po ulabnn
? -a
`o-� 5
❑ La er-: Dairy
❑ Non -Layer ❑ Non -Dairy!
=.
i_ ,_-_ __, _
❑
_ Other
Total Des>Egn Capaclt
d:
is
Irt Totaf L%
Y
- _ ...
umber of Lagt�ons ( " ;; ❑ Subsurface Drains Present La oon Ares
❑ S rav Field Area
Hold�4g Panels 15ottd'Traps' = tl = ❑ No Li uid Waste Management 5vstem
w
- Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑Farrow to Finish
❑ Gilts
❑Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes.' No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -2—
Freeboard (inches): g z
05103101 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes.' No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -2—
Freeboard (inches): g z
05103101 Continued

r
t
Facility Number: 47 — 3
Date of Inspection !a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 'gNo
❑ Yes E!fNo
❑ Yes )No
❑ Yes �No
❑ Yes ONo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
,�No
It.
Is there evidence of over application? ❑ Excessive Ponding XPAN ❑ Hydraulic
❑ No
12.
jOverload
Crop type �ev�"� ✓01 �q S Ivies S►�ct<< G/ar/1 40y Br'�0[,
'PlYes
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ZrNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
,RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
Z' No
15.
Does the receiving crop need improvement?
❑ Yes
O'No
16.
is there a lack of adequate waste application equipment?
❑ Yes
ONo
Reouired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,EfNo
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 ONo
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 0,No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 2!rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes A No
24. Does facility require a follow-up visit by same agency? ❑ Yes �ZfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 'ZNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.Cornmenis (refer to questiirn #}. vkxplatn any YES answers and/or urs or any outer comm" ents❑.
0gessds1" aPMss�tio�
L15e'drawiR g5 of facilttv;to better a loop situa#toa`s. (usc aiidtaan}.iecinmen _NotesField Copv
Final
QL/Ceq 6e)'#'L) VVIq fned rn qPL excellehf
cdnd�� io=-1. -i,ere rs qn exccflehl Graf or eke"--1v'qcq ;n 4ke
Lt atA-Se grey q.,d 1419ean l a.-e 1.+•�1/ mGtn t ufed .
� ✓era It � -��,e r-e cd-d s Gt r-e well ke f� _
i I. Th cry was less-��qr.� Z �atingrs rsF �vc,����1: r_a� �o �i �l �-lA0 rn
o n - Lle Grey Pki BHA �' c -r ,'eld s,
Reviewer/Inspector Name -- ng c ✓
fa
Reviewer/Inspector Signature: Date: W4
05103101 Continued

4L .
Facility lumber: 47-431 Date of inspection iLt O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes -010
❑ Yes XNo
❑ Yes Ua'No
❑ Yes O-No
❑ Yes io
El Yes /❑ No
Additional Gomrnents:andler-Drawings:; ' q.
I1 •t%Con��'� v[��� Tyt�',I W�1� a'�'7 G .i'El�-�r`✓cG� sLtic�� pu�� a ►'iaj
we 151111S"55ed vU; 11�9 wlo�'e egCL4 el 1�. .
g, sure �e use a &,,iqs�e e7nalrs,'s- d-f�ed k/,44,ti &o zt�y
a-p JLe ei)pyI cA416;1 evens -lo cale- illa�e �tP hio: e&-i
a pp !lea( 4L,e I-eno d sl!y. 4 44e
G v r reh -� -�rC�e 6 0 � � Gt' i1'teG a �d S� � r . �,77 ►^-z c, ., S`G�q rG k �� � /'
,ese and S�tys 4k4� 1?e does he, ve Aee-%
�`T rvjr, f i Y`1olYL SR,1S 4ji�qT DO,thCt �t lam,! Or �t'�JlO1nJ SDtI -�i
�R��� 11 Lvor�rrz4 A4 q-i VIG�47 t
- � � � -�L►� ,dew ��! cnd d es �.� �e�'Ie�� A-9 r.✓P � 61 e acrns
Q►rl� !�"%i a�tior� ,�aC--��'ccs -far ��� �ct�rl-, ,�P .fUr� Ella
4he t,ir,g�e Ptah is w r►' en qae,-d :•-,51 y a od e alvfa
) 0
reG A�dg Ale -4e1 GtGGOrd��L
�5 •'h 4tizs 44 -� is well n�� �'n-la,'tied . 1 4e � r� �'s ►�Pa��i
��c�� P��o S 4o Ae ►-.^� ,h
41,der are qfp ec,,g1e4 .
J
05103101

D►visioa of Water Quality
Division of Soil and Water Conservation
=flther Agency _
Type of Visit vCompliance 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 r] 1')ate of Visit: = a8—U Titne: 3 Printed on: 10/26/2000
li Not Operational Q Below Threshold
Permitted 0 Certified [3 Conditionally Certified Cj Registered Date bast Operated or Above Threshold: .........................
FarmName: ........................................ County•!.. ......................... ......................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact...............................................................................Title:................................................................ Phone No:....................................
,'Mailing Address: ............... ...................................................................................................... ..........................
.�...................................................................................
Onsite Representative: . ......................................................................... Integrator: ��-7 4741J.................................................
...................
Certified Operator; ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 0.4 Longitude • 4 66
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
Feeder to Finish
S15' 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes t<No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identi ficr:
y............... ...........a.................................I..........................
❑ Yes N( No
Structure 5 Structure 6
.................................................................
Freeboard (inches)
5/00
Continued on back

1-- Facf rty Number: br — Lj 3 _ Date of .Inspection ag Printed on: 1 /9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �TNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
k'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? _ _ _
❑ Yes
ZNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
C�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Hydraulic Overload
❑ Yes
ZNo
12. Crop type 1 � VQ" -zr- jQ 2
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONo
b) Does the facility need a wettable acre determination?
❑ Yes
2'No
c) This facility is pended for a wettable acre determination?
❑ Yes
WNo
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
JRfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
lr�'No
19. Does record keeping need improvement? (ie/ 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
b`No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
14No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
X�No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
qNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
fmNo
Q fib a1�iQ11S'fly 0001 knvig,4 -W�rE' pQte�• di1• W thi V�.slt. • Y,o0 wjJ j -;eeei*� ill) f111�'t11gt'
. • eorrespoti�eilce: about this :visit: ' : - : - . - . • ..... - :. • : • ..... - .: • :......... - . • . - :.. .
natmeats''(refer:to'question #): Explain any'YES answers antllor any recornmendatiotns oi�
se drawings of facility to better ezplain situations. (use additional pages as necessary)
050y�s k I X -V
Reviewer/Inspector Name �- n
Reviewer/Inspector Signature: Date: 5/00

FaM ity Number: -1 { 3 Date of Inspection S C1 j Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes NO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes k No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes bk No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
Additional Comments and/or rawrngs:
trt c;-`Ve- Gam_ L-it
\-L,-., "P-" `,
ye-
944 51\1
5100

urv�sion o� you ano-warert onservauou vperduun xeview M=~-
��,D Dston oiSoil and Water Conservagon Compliance Lispect.ontz-
;r'
�s-x. '� "'$ Diveston of Water t�iality-.Compliance Inspection
Other Agency p _
� �� �,. � - O eradon Renew . � °-�� � �..a .�A{--j •R:
Routine 0 Complaint 0 Follow-up of DW ins ection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection 0
Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified 0 Registered 10 Not O erationa! Date Last Operated:
Farm Name: ��5 Fi&ti`^o. ........ County:......C,� 5!.(^?.............................. .......................
OwnerName :...................................................
Facility Contact: ...:...I........ ........ Title:
MailingAddress: ............... ......................... ' ..... ­­­ .....................
ddress:..........................................................................
Onsite Representative: „_ `r
PhoneNo:......................................................................................
.................................... Phone No: ......................... ..........................
..................................................................................... ..........................
Integrator: ....... G.. � —...b.................................................
CertifiedOperator:.........................................................................................I...................... Operator Certification Number:..........................................
Location of Farm:
w'
....... .... ......
Latitude Longitude
Design:Current: Design Cpi=rent Design Curr'e'nt .:
:Swine - -Capacity Population Poultry Capacity -;Population` ,: Cattle .-.;Ca —Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish d ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity:
❑ Gilts
❑ Boars Total SSLW=..
Number of Lagoons ;' . ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds] Solid -Traps ' ❑ No Liquid Waste Management System . -.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes NrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ................................ .............. ............. .............................. ....... I .......... I ................. .................................... ....... ...............
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
3/23/99 Continued on back

aciW7 Number: <r — 3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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
12. Crop type
❑ Excessive Ponding ❑ PAN
ff No
❑ Yes
❑ Yes
WNo
❑ Yes
NtNo
kYes
❑ No
❑ Yes
J�(No
❑ Yes
ONO
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?
Renuired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. 'Does the facility fail to have all. components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20-- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yio�aW, ris :oe- dgf ciencips wiere ngted 00fiitg ihis:vlsiL - Yoir . eeeiye Rio further
orresponden ' about: this visit_
❑ Yes 5rNo
❑ Yes ff No
❑ Yes 19 No
❑ Yes gNo
❑ Yes CR*
❑ Yes )d No
❑ Yes } Po
❑ Yes 0No
A(Yes ❑ No
❑ Yes D'�lo
❑ Yes q No
❑ Yes 9No
❑ Yes gNo
❑ Yes ONo
❑ Yes 0 No
`3q
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -<— Ir--Qd

i .
'Faeilly Number: Date of Iuspeetion 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 VNo
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ikNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes AM-)
Additional Comments an or _ awings:'
-._.� -
P
003 �t'6-5 s� , }�)a'
3/23/99

'Division of Soil and -Water Cons6vation -Operation Review.
© Division of Solt aril Water Conservation `Compliance InSpei flop
` ®,Division of Water Quality :Compliance Inspection
©°Other Agency'- Operation i2eview.:
1O Routine O C omglain t_0 Follow-up of DW2inspection O Follow-up of DSWC review O Other
Facility NumberDate of Inspection J
Time of Inspection 24 hr. (hh:mm)
® Permitted ® Certified E3 Conditionally Certified © Registered 10 Not O erational Date Last Operated:
Farm Name:..........REl)....... R.1._'T'm.. .N.... R( M................................................... County: • NSC131iV.................. r. e 7....
Owner Name:....-.. . r R.........Q..1.RMAIN............................................... ...... Phone No: ?4...
...............................
Facility Contact: ............••--............................................................. Title:...........
Mailing Address: ..1 k.5......RE.......%%.............................................
Onsite Representative: ........................
Certified Operator: ....LEST.R.........Pl.�!!114
Location of Farm:
:............................... Phone No:............................. ...................
...............................&....
I n to a ra to r:..... Cl f4 lz f~d-t '.........................
....................... Operator Certification Number:, ..........
EN.I?.... or.._RJ� ?...Lftc .,. lH� C,.-. o�.75.-ra.i:... s:...or.s�z. tz ..f.. a p.. kxm� ..l . P! ...... . M ......5Aq.dF./N,?7 �,.... RF...
A,
z o4 a nett t 2 f
Latitude Longitude '� • ®° �«
- - ,. .
Design Current D`esigii Current Desi
Swine Capacity Population'. Poultry Capacity Population- Cattle Capa
❑ Wean to Feeder
Feeder to Finish,3,52p
J �OC7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer I❑Non-Dail
❑ Other
Total Design Capacity
. Total -SSL W
Current:
'opulahon . �..
: 0
Z/7 5-"2- as
Numbei'bf Lagoons Subsurface Drains Present ❑Lagoon Area aSpray Field Area
Holding.Ponds /Solid Traps �' ❑ No Liquid Waste Management System
Discharires & Stream Impacts
1- Is any discharge observed from any part of the operation? ❑ Yes ';"No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other `
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYes zzo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard(inches)..........°�......................................................... .................................... ................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back

.t 0

Facility Number: (e q— Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes WNO
(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 9-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �<No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZNo
Waste Auulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes )� No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes )�'No
12. Crop type a Uj_� (,� WL !:! _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: 10 yiblatticjns:or deficiencies were ngtec� ditrtng �his;visit; Yolk w' r eeeiye Rio; further ; ;
.6i respoiidence. about" this .visit. ..... _ . .
W.questian #):.Explain any YES answers
al pages;as necessary) a
❑ Yes ❑ No
❑ Yes gNo
❑ Yes XNo
❑ Yes G
,,'Yes NrNo
❑ Yes 1);2 No
❑ Yes b4 No
❑ Yes 0 No
❑ Yes No
❑ Yes ('Y�LNo
❑ Yes N No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 1113 d
3/23199

Facility Number' Date of Inspection �� D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes UN-1
liquid level of iagoon 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 S,No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
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 QrNo
3/23/99

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - _^
Farm Name: -
On -Site Representative:
inspectorlReviewees Name:
Date of site visit: �<— kg--«Q
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility iterrr(s) F1 F2 F3 F4
�! Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Date of most recent WUP: Operation pended for wettable acre
determination based on P1 P2 P3
Annual fans PAN deficit:�eg pounds .
Irrigation 5ystem(s).- circle #i0hard-hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wipermanent pipe; 5_ stationary sprinkler system w/portable pipe;
6, stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and Dz D3 irrigation operating parameter sleets, including snap
depicting wettable acres, is complete and signed by an I or PE.
T E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
V E4 75% rule exemption as verified in Part Ill. (NO T EE:75 % exemption cannot be
applied to farms that rail the eligibility checklist in Part It. Complete efigibili y
checklist, Part 11 - F9 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required. because -operation fails. -one of the .eligibi4ty
requirements listed below:
F1 Lack .oj acreage:whichTesultedjnnver�pplicauonmf_wastewater_(PAN) on:spray-
feid(s):accordingzo-iarm'sip-sttwoyears:oi.iti gauonTecords..
2 Unclear, illegible,-nr lack of information/map.
F3 Obvious --field iimitations -(numerous jjitches-;-:fgi]Lrre:io:deduct7equired.-..--.
bufferlsetbacklcreage;ir25%:Dffotal:.acreageidentinadan CAWMP.,:.iricludes _
small; irregularly -shaped melds=fields-less -than 5�cres-for.-iravelers=or.lessihan
2 acres-for-stationarymprinklers).
F4 WA determination required because CAWMP creditsfield(s)'s acreage -in excess
of 75% of the respective Yield's total acreage as noted in table in Part Ill.

Revised April 20, logo
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER' IRRIGATION ACRES ACRES %11
SYSTEM
1 914 I
I
�.vc IL4—
�
`�
I Iloal
to
I
�II
I
I
I—T
I
FT=LD NUMBER'- hydrant, pull, zone, or:pointnumbersmay be used in place of field numbers depending on CAWMP -
a+md type of irrigation system_- if pulls, etc. crossTnore-than-one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMB—ERZ - must be clearly delineated on7nap.
COMMENTS'- back-up fields with CAWMP acreage=exceading75% of its total -acres and havingTecalved lass than 50%
of i*z annual PAN as-docunmented in,;fhefamz's-Dreviaus�wo years' (1997 & 1998) of irriaationTecords,-canna;serve-as-the
sole basis -for requiring a WA Determinabon_hack-up3maldsznust-be noted inthe -comment zeciion.and must by accessible
by irrigation zystem.
Part IV. Pending WA'Determinations -
D1
P2
Plan -lacks _following information:
Plan Tevision,may:satisy75% rule based on adequate overall PAN deficit -and by
adjusting -all fieldacreaga:to-below 75% use rate
P3 Other (ielin process of installing new irrigation system):

Lagoon Dike inspection Report
Name of Farm / Facility
Location of Farm 1 Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
{ Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Pittman -Le of 67 - 43 A
_SR 1204
9 / 27/ 99 Names of Inspectors Patrick GTogan
ant Paith
<10 Freeboard, Feet 0.5 - 0.8
< I 0 Top Width, Feet 8
_ 210 1 Downstream Slope, aH:1v 3 to 1
Yes X No
Yes X No
Yes X No
VerLp-o�grass _ .
Yes X No If Yes, Depth of
. Overtopping,. Feet
Follow -Up Inspection Needed? Yes X_ No
Engineering Study Needed?
Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments May w= to cgntact Qwner aboulpm=ing agon
- 8-99 r n ht 12ipe both lagoons t o el s to bringhe liquid levels
down iQ 12 inches of fr=ebumd. after reaching I7—indhes continuo to pump through spriwklers or a
r v fin thg l v to 19 inches of fretboard

:s
Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion`.'
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Pittman. Lester ( Caarrrols ) 67 - 43 B
SR 1204
9 / 27/ 99 Names of Inspectors Patrick gr4&an
Janet Paith
<10 Freeboard, Feet 0.5 - 0.8
< LO - Top Width, Feet 8
2 to 1 Downstream Slope, xH:1v 3 to 1
Yes X No
Yes X _ No
Yes X_ No
Very good grass-- -- --
Yes X No
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed?
Yes _X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
If Yes, Depth of
Overtopping, Feet
Yes _ XNo
Other Comments _ May want to contact owner abg t umnin soon
9-28-92 Owner needs to strahablipe botlLlggoQn5 to the fields to bring the liquid
gvels dower to 12 inches �f freeboard_ after reaching 12, inches continua to Puma through
sprinklers or a taveiing gmio king the ley -el IQ 19 inches of freeboard _ - -

'NOW
Division of Soil and Water Conservation [3 Other Agency
F g Division of Water Quality_
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection /O Z
Facility Number 7
Time of Inspection 24 hr. (hh:mm)
[3 Registered Certified Applied for Permit [3 Permitted © Not Operational Date Last Operated:
Farm Namc: .,.�`j� 41, ?1 r � �. County QN� o
......................... ...................... ..... ...................... ... .....
Owner Name: ,•E L ��D ... 1..!11. ! Phone No:.... `a afI `f ......................7
8
Facility Contact: ..................P�3M.,E.................................... Title: .... aLdlJv?......................................
Phone No: s3.a.. 57��..
MailingAddress:....................................................................... ....... ..........................
Onsite Representative:...- 7L[ :... �,Y..I.......................................... Integrator:.............................................................................
Certified Operator......... ..... Operator Certification Number;.--------------
.............................................. ..........................
Location of Farm:
Latitude •.0 a �� Longitude ©• 3 5� bb
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0
'o
❑ Yes V No
❑ Yes - 'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �qNo
❑ Yes XNo
Continued on back

Facility \umber; 7 —
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (La oons Iloldin Ponds Flus1h Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard(ft):........... ...........................................
10. is seepage observed from any of the structures?
❑ Yes )91No
❑ Yes ❑ No
Structure 3 Structure 4 Structure 5 Structure 6
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)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Wastg Application
14. Is there physical evidence of over application?
(If in excess of WVIP,, or runoff entering waters of the State, notify DWQ)
15. Crop type .... .!!`'`'`�- �....�.rC1c G- .........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
0 No.violations or deficieneie's.were-noted-during this.visit. Voumlll receive no further
correspondence about this'. A sit'.,
❑ Yes allo
❑ Yes tj No
❑ Yes ❑ No
❑ Yes WN0
❑ Yes /qNo
.........................................
❑ Yes
JKNo
❑ Yes
kNo
❑ Yes
kN0
Cl Yes
).No
❑ Yes
kN0
❑ Yes
(KNb
Yes
❑ No
❑ Yes �'1T 0
❑ Yes !K1No
❑ Yes K.1111
0
Comments' (refei to,question #): =Explain any YES answers and/or'any reconmendatiorts or:any tither comments ,
tJ drawn 4 facibiv to better ex lain situati6ns:'(t se additional a es as necessary
�1�
Ln 7t 0 J 177Ae
ire.
7/25/97
Reviewer/Inspector Name A
Reviewer/Inspector Signature:A:t Date: D

® Routine O Complaint O Follow-up of DWQ inspection O Follow-ug of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
7Wertified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:...?II. r'....1LV! ,(9 tl.� .... l� �....._...... County: __..?S�t .....__... _ .....__...._ .
Land Owner Name:� ....... Phone No:
Facility Conctact: L1. ± Title: Phone No: 3Z`L.. 7b�7
Mailing Address: l 4 �. ... ...., f3 .�.. _....__ .:..�_. ... � G6 L�1 N 7 .
Onsite Representative: ..sir..riU.�............_._.... __. _.--- _ integrator: _Q �� S ...._....... ......
_ .
p �f
Certified Operator: Li'S �£f� 1 +fir`= �'�-1 _ Operator Certification Number:
Location of Farm:
Latitude �•�� �u Longitude �• �'•
Type of Operation and Design Capacity
,y as 3 o
il
Design-.,7eut a Des gnoC'uarrent s ack Daesxi�gn=
CuCCatlPoulyaulatio'n Pa "rriednit
ia acn
❑ Wean to Feeder ❑ La er ❑ Dairy
Feeder to Finish U * SVO ❑ Non -La er f] Non -Dairy
Farrow to Wean
rl Farrow to FeederTotal Dt'stgzt Capacity
Farrow to Finish SLW
❑ other ` Tatai Szl-
Numbefr�of`L go n / H ding PoQds� ❑ Subsnr#ace Drams PresentA�
s 3 ❑ Lago ❑Spray Field Area on Area
Genera
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
maintenance/improvement?
4/30/97
❑ Yes El-N-o
❑ Yes [;-NO
❑ Yes O No
❑ Yes 03,No
❑ Yes
93'No
❑ Yes
GWo—
❑ Yes
F�Wo
❑ Yes
❑ --
Continued on back

Factility Number: ... ....._ —..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
EA4o
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
9190
Structures a.,adoons and/or Holding Ponds]
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
QNo"
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.... _ .. ......�?...._...... ............................ .... —...... ........ _.... ......... __.............
_ .....
10. Is seepage observed from any of the structures?
❑ Yes
Um
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
gdZo-_
12. - Do any of the structures need maintenance/improvement?
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Waste Aplication
14. Is there physical evidence of over application?
❑ Yes
[;�do"
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _..... ..... .............................................................................................................._.............._.................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[ -NO
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ISY1vo
18.
Does the receiving crop need improvement?
❑ Yes
U'N
19.
Is there a lack of available waste application equipment?
❑ Yes
Q-90
20.
Does facility require a follow-up visit by same agency?
❑ Yes
G[ <o
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑-3o
For
fi ac' 'tie 1
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
WC
0�90
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
[T o
24.
Does record keeping need improvement?
&(Yes
JPNo
Continents (refer to queshoti #i} Explain any YES answers`and/or any reconunendahons or any other comments
Use drawings of facility to better ezplarn situations' (use additionaY pages as necessary) x
1 "g P.--�-•an r s 1C f- V / NCelel `L 5 _V01 P—E V " 5 `L.
'3e--
i
Reviewer/Inspector Name 1XIM7 Z,�.� ...
ReviewerAnspector Signature: Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

•
Site Requires Immediate Attention: N6
Facility No. (o -7 -!4 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 81.3 , 1995
Time: 4 : 00
Farm Name/Owner: R En P t 1T N I'A r4 / 4�5LUJo(Db 'KC-Z P r TT M A1A
Mailing Address: _ 2 (o5 7' C-D C.AtIj -Z.1 cN t_N0j) 5 _l-i C Z8 5 -74
County: O M 5 LOV,/
Integrator: C a rlga z Phone:
On Site Representative: -Va-
Physical /� AddressiLocnati`on: /
� 0IIsw r,4 _ 0 W_ - i Pj La.,, Y�'V kL w!tX hA.�c /ro_u S.e �oxy
Swine ✓ Poultry Cattle
Type of Operation
Design Capacity: / 7 (0O
641\ Phone: 910 3 2.4E - 31 / 6
lit -ro ClRE,-To.wb�e ea �%n .ems rr�« .rv1uri 1l s-640nr
5e I2of) Te er rc2 t, 3 rYrnEfore, 44), 5te-r•
Number of Animals on Site: i �rjy
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 Y ' '�7 --' .�, 7_ ' Longitude: 77 • 3(1 oAf0 "' Elevation: Zb Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No ' Actual Freeboard: 5 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray es r No Is the cover crop adequate? Ye or No
Crop(s) bein., utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings: or No
100 Feet from Wells? or 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 -trade ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes No
Additional
- �!s IZA bk
• -r-)0R2EiT
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] J'A 24 •'95 18:19 P. 15l18
Site Requires Immediate Attention AO
•
D
Facility Number:
SITE VISITATION RE ORD
�1, L
DATE: Sul
G�
Owner. .Clv4gg Farm Name:
County: _ylyrieo w
Agent Visiting Site: -V� e-, Phone:
Operator. -v �ti r -4" Iq .v Phone: _ &,#v ,r •� sl��
On Site Representative: .t'e' .mot r�.,.v.•? - Phone: _
Physical Address: ary Se-,71/ zg-t /l r o &A. Z "Xy
Mailing Address:
Type of Operation: j7[ p c Poultry Cattle /-7.00l e-t
Design Capacity: 4 4,40A, 2 - Number of Animals on Site:
Latitude: ° _� Longitude:
Type of Inspection: Ground �- Aerial
Circle Ycs or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event .
(approximately 1 Foot +8 inches) �5 or No Actual Freeboard: �, Z Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o&Was there erosion of the darn?: Yes orvp�
Is adequate land available for land application? Ye r No Is the cover crop adequate? <feDr No
Additional Comments: _ .? Zo419ao•w_ •�.f,!- ri. 3' i=- •=- xo�.�
�i4eep. W,� Xlei . �t�� , Y,ir!n4
Fax to [phone]
5 i�,. atur
c cif A�,�nt

1 Site Requires Immediate Attention: CJ
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: — F3 3 _, 1995
Time:
FarmName/Owner:_ RCD PcTTMRN RCb Pr7mA^i
Mailing Address: Z (-S t2C D t_AraE _P_tCH+->aN_D5, h1G Z 57i{
County: 0A5t_ov,1
Integrator: C&AA4q-& , _ Phone:
On Site Representative: &j Phone: q 16 - 3a 4_= 311
Physical Address/Location: sue- aeoQ ,�,,P--Ff..�.,�- to Q-r- Gki-
. - ^ c -4
Type of Operation: Swine 1/ Poultry Cattle
Design Capacity: l —7(,0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 3 ` ./O Longitude: 7 7 Elevation: 2,D Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)�or No Actual Freeboard: ? Ft. Inches
iWas any seepage observed from the lagoon(s)? Yes or(95Was any erosion observed? Yes o No
Is adequate land available for spray? i es r No Is the cover crop adequate?<�aDor No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinasl!gpor No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oCa
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oo If Yes, Please Explain.
Does the facility maintain adequate waste.management records (volumes of manure, land applied,
spray irrigated on spec acreage with cover crop)? Yes oo
Additional Comments:
• `Du i2R 6-Ti
Inspector Name
'� &W_Z�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OFERRTIONS BRPNCH - WO Fax:'919-715-6048 6 ,,
Sul %.. _i1:1`a F.1,f1._:
•
0-
0
Site Requires Immediate Attention 'PO
Facility Number: $
SITE VISITATION REgOR) ,
DATE: s'az,�
Owner-. _--Z,�veea w6E&! ��{ : �A.+� Farm Natne: 4.r'.a ��r.-.�ra.r1 f�4•r ••7
County: Uivtd Pw _
Agent Visiting Site: e i Phone: (p/a/,.Yrj sues-,— L
Operator. ,a rt: •- •*� •v Phone: 6r.,L/
On Site Representative: A- .ew ,rt: r ,.a _ Phone: ,
Physical Address: _ aiv so-w7jy y,'= S/z �ZAKe
Mailing Address:
Type of Operation: Swine c Poultry Cattle
/7CD ea /7GO���
Design Capacity: ZZce& Number of Animals on Site:
Latitude: 0 " Longitude: o "
Type of Inspection: Ground c Aerial
Circle Ycs or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foat s9 inches)e' or No Actual Freeboard: ---,? - Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon{s)? Y'es of 1Was there erosion of the dam?: Yes o�
Is adequate land available for land application? Ye r No Is the cover crop adequate? e r No
Additional Comments:
Fax to [phone]
Sias �ttutc of A�,c tit