670062_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

type of visit: cdc.ompuance inspection V operation meview V structure evaluation V iecnmcal assistance
Reason for Visit: Qo9outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: County:
Farm Name: '✓ 4'' S Owner Email:
Owner Name:
"Mailing Address:
Physical Address:
Facility Contact:
Phone:
J -,, (� Title: Phone:
Onsite Representative: vr� v� ,%�,i{ TGW'—a � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Certification Number:
Certification Number;
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design ogrent
Wet Poultry Oopacity Pop.
La er
Design Current
Cattle C►►opacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, Poult F Ca acit P■o P.
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qthe.r
Other
Turke s
Turke Poults
Other
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes PrNo
❑ Yes 0 No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: all - Date of Inspection: a r I
q[
Waste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j2No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
.ETNo
❑ Yes ZNo
❑ 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 2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes TZNo
❑ 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 j2yNo [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J;3'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 'E2'1clo ❑ 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?
Reauired Records & Documents
❑ Yes ;2'No ❑ NA ❑ NE
❑ Yes 1211Qo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes'121*4o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ''No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes J2'0'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 'a o
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Fj"No
❑ NA
[] NE
Page 2 of 3 21412015 Continued

.-;:7
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes '[2-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 'L2'1Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No _[:�nNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Plsio ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E7f`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 ❑,Ai3 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑.1do [DNA ❑ NE
33. Did the ReviewerlInspector 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 12 "o ❑ NA ❑ NE
Reviewer/Inspector Signatui
Date: 4 l
21412015

'Type of visit: U Co fiance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: n Arrival Time: ® Departure Time: © County: Q/(,(f[ Cif/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: f tk Nt (03-.-(C H F G " - Integrator:
Certified Operator:
Phone:
Certification Number: i 1 4 1 y y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current Design Current
Pop. Wet Poultry Capacity Pop.
I JLayer
Design Current
Cattle Capacity Pop.
Dair Cow
yC
Wean to Feeder
Non -La er
I
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, P,oultrf Ca acit P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Eacillit Number: Date of Ins ection:
Waste Collection & Treatment
I. 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
StructureStructure 2 Structure 3 Structure 4
Structure 5
Structure 6
`I
Identifier: (A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No ❑ 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
2/No ❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes D/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
j(N o
❑ NA
❑ NE
acres determination?
No
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
6IN/0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ es
E o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
17 Yes
❑ No
❑ NA
❑ NE
the appropriate b
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
ONE
❑ 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
V
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

�} Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
5. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
YIN, o
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
P40
❑ NA
0 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.
0 Yes
CZ/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
21"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
jNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to,question #):. Explain any YES,answers andlor;any additional recommendations or any;other comments
Use draw,ings;of facility,to;hetter;ez'_laln situations (use_additlonal� ages:as,necessary).,
11 Q, _r_1NF6-V i"Iv OF, N 6>J �pER�3G , ��6 0 >��w WUP AU�,
Kd,0 3104 0 C� PJ 1-6lD lJ k Td V� � krq
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
21412015

Type of Visit: - &CoTpliance Inspection U Operation Review Q 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: ftV Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: "' Iv 4=T(_RGUL.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultry Capacity
Wean to Finish I JLayer
Current
Pop.
Cattle
Dairy Cow
Design :Current
Capacity Pop.
g
IM
`'-,
}� Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La er I
Design
D , P,oultr. Ca aeit
I II-ayers
Non -Layers
Current
P,o
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults'
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �No ❑ NA ❑ NE
❑ 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
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4.1s 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1ZNo ❑ 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
Z/Xo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes �� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes No D 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes g>o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes �fNo ❑ NA ❑ NE
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes
the appropriate box.
EP
4o ❑ NA ❑ NE
�o ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
4
❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F cili Number: - Date of ins ection:
24y Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2No
t� ❑ NA ❑ NE
A5 is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q<o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Plo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
� _ . _
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
11.E "o
❑ 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
PGo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&Xo
❑ NA ❑ NE
Comments,(refer to question, #): Explain any,YES answers and/or any additional recommendations or any other comments..
Usedrawings "of facility "to better explain situations (use additional pages -as�necessary). _
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
WE
Phone:01-11
`f
Date: ip 1
2/4/201

Type of Visit: O Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: *VJLW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Z 6>±/L Ma;a ca, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C►urrent
Gattie Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Drr P■oultr�
Design
Ca aci
Current
P,o P.
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes jNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FA o [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 7 - 4,3
Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 J
Identifier: C61vJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 21'No ❑ NA ❑ NE
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 ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
FNo
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesfN
❑ NA
❑ NE
Required Records & Documents
ZNVNo
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
[3 Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
No
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o ❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility, Number: - Date of Ins ection: /Q
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L'J No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CZJ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
the CAWMP?
Yes
NA NE
32. Were any additional problems noted which cause non-compliance of permit or
❑
❑ ❑
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
NA ❑ NE
FN
34. Does the facility require a follow-up visit by the same agency?
❑ Yes❑
NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
aW
Phone:( f 17 J
Date: I� f
2/4 014

(Type of Visit: Q 7Routine
Hance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: /'Lo Departure Time: County: QNS Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: i3aitd i'p (, Ra- - 1, Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Design Current
Capacity Pop.
Q
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Cattle
DairyCow
DairyCalf
DairyHeifer
Design Current
Capacity Pop.
Farrow to Wean
Dr. P.oult .
Layers
Design
Ca acit
C►urrent
P.o
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2 /No ❑ NA ❑ NE
[:]Yes [:]No
[—]Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes , ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: -& Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA 7.60
Spillway?:
No ❑ NA ❑ NE
❑ No [DNA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): 3 b
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
Z�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 environm;No
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[To
❑ 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
[DNA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E?<'o ❑ 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 fNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VN
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes U40
❑ Yes No
❑ Yes No
[—]Yes No
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
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
CKC ❑ NA ❑ NE
01
r❑ NA ❑ NE
Nr'�o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations ovany other comments:
Use drawings of facility to better explain situations (use additional ages'as necessary)
Reviewer/Inspector Name:
Reviewerllnspector Signature
Page 3 of 3
Phone:
Date: a
1214,4011

(Type of Visit: O Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access II
ir�w�nrirr�w�r�wr-� uru
Date of Visit: Arrival Time: Departure Timc:® County: gAAXRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Ra z,ca Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design
Swine C*apacity Pop. Wet Poultry Capacity
Wean to Finish La er
C►urrent
Pop.
Design
Cattle Capacity
DairyCow
Current
Pop.
X
Wean to Feeder 6
0
Non -La er
DairyCalf
Feeder to Finish
Design
Dr. P,oultr. Ca aci
CEl
urrent
Po .
DairyHeifer
D Cow
Non-Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
[Lavers
Beef Stocker
Gilts
Non -La er
I Beef Feeder
Boars
Pullets
L
jBeef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes E1No
❑ Yes <0
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facilit Number: jDate of Inspection:
Waste Collection & Treatment
4As storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
`°�j
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?
10 ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 ARRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ZNo ❑ NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ��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 ❑ N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ 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 FNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes To
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 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

(Facility Number: - Date of Ins ection: j'7 2,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes in No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Z/N o ❑ 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 Cnr 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 M No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ] o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Wo
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ❑
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better ex lain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: ()-7b � W
Date: 4
/1 -7
4120 1

Type of Visit: Q) Co liance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time:© Departure Time: County: 4 ,/5(_ i.2 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (-'_'1iLA;n3T MZfT04F_ L,k , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design C*urrent
Swine Capacity Pop.
Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Feeder
b
Non -La er
Dai Calf
o Finish
r
Dai Heifer
o Wean
Design Current D Cow
Dr, PNult , Ca aci Pn . Non-Daio
o Feeder
Finish
ILave,s
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke s
ITurkeyPouets
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 [ o ❑ 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 g5No
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ElYes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 6,181h
Waste Collection & Treatment
4. Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? E 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 M/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 environments 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 gNo ❑ 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 ElYes YNo ❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
[3 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does facility lack for land
Yes
N
NA
NE
the adequate acreage application?
❑
❑
❑
❑
I& is there a lack of properly operating waste application equipment?
❑ Yes
o,
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fNo
❑ 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 dNo ❑ 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 ' No, ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6/0 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of Inspection:
C
24. Did the facility fail to calibrate waste application equipment as required by the permi ?
❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ICJ 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 ❑ 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
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑/ ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Rio ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes C] No ❑ NA ❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ey ' o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionale recommendations or any other comments � k
Use'drawin2s of facility to better explain situations (use additionalpages as necessary):;
6;L/, ) rk.- C4'PY d C a��C rd QWd V,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone /b 723
Date:
21412011

Type of Visit ;Routine
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: K ' 3 0 1 Departure Time: County: OAI SC012 Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Phone No:
Onsite Representative: Z_L—� SWAL)_____ _,_ Integrator:
Title:
Certified Operator: I Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = = I{ Longitude: = ° = ` =
Design Current Design Current
Design Current
Swine @apYcity Population Wet Poultry Gapaty Population Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
ElWean to Feeder 6
t1t�CS
❑Non -La er
❑ DairyCalf
El Feeder to Finish
❑ DairyHeifer
Dry Poultry El Da Cow
ElNon-Dairy
❑ Layers ❑ Beef Stocker
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
Gilts
ElBeef Feeder
EBoars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other.
ElTurkey Puuets
❑Other Number of Structures:
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
/
[INA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes []No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J �i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��2 ,..,�
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes LI 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 D 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 environmental1threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 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) .f
9. Does any part of the waste management system other than the waste structures require El Yes L�J 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/improvement? �(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence 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
[ZNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[& ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[YNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
; I ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo ❑ NA
❑ NE
Comments (refer to question #) *Explain any YES answers and/or any recommendations or any other comments
Use d`rarvings offacility.to'be`tter;exlain situafiions.(use additional pagesasnecessary):
ta0rr-K w_rT14
w
Reviewer/Inspector Name , � - :�' it l Phone: g`-
1 � 'Ez
k ,:,.,,:f-�Ki��"�
Reviewer/Inspector Signature: Date: `1 30 !0
Page 2 of 3 1 12128104 Continued

i
Facility Number: — a Date of Inspection
Reduired Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2�'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [! No ❑ NA ❑ NE
the appropriate box. ❑ ❑ ❑ ❑ ❑
WUP hecklists DM esLgn aps Oh t Cer
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PJ 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2<0
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
v
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
IJ 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
if 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
ElNA
❑.NE
33.
Does facility require a follow-up visit by same agency?
ElYes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings; � s
Page 3 of 3 12128104

Type of Visit Qf C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: f 6 Arrival Time: Departure Time: County: 0AVSLd*%1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: LCwTS S N A w
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: = o = & = 16
Design Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
® Wean to Feeder
Z d b
❑Nan-Ga er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
a ers❑
❑Non-Dai
❑ Farrow to Finish
on -La ers
BeefStocker❑
Gi[ts
❑Beef FeederBoars
ullets
r
Beef Brood Cow
urke sher
urke Puults
❑ Other
Number of Structures:
❑ Other
Discharees & Stream Impacts
dNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
[INE
2. Is there evidence of a past discharge from any part of the operation?
ElYesVN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facillity Number: — a
Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E2N0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: G-WIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
UNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental t reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[;�/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
jNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [7
❑ NA
❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes [ �
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[ -]Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
3VU `��Jt`3hr.lc4
.)Ub better ait` a�y
ki"
e drawig,ations(use aidtt�o�i'al'p uVgee s cas ned#eye$5.s�usa'rY')VExlannyYCommentsrefer to Sanswers andtor anyreDommendattoin:s pXtjoi Arny 16
`
.
Reviewer/inspector Name
---
U
Phone:( -
� pp
o u
Reviewer/inspector Signature:
Date:
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desibn ❑Maps ❑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 ❑ 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 rl'�Vo
� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Ld o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes [Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes Ll No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP'? ❑ Yes ,.._, ZCJINNI
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes LAN ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately ,�,�
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [INA ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ElYes
7NOEl NA El NE
33, Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
❑ Yes E N ElNA ElNE
❑ Yes No ❑ NA NE
Additional Comments and/or Drawings:
A
Page 3 of 3 12128104

Type of Visit c pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Z7 Arrival Time: Departure Time: County: d4 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: L(sWI—U� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of )Farm: Latitude: = o = I = Longitude: 0 ° = t = 1i
ntDesign
Desigu Mul
Swine Capacity Popation
Wet Poultry
Current
Capacity Population Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ Wean to Finish
❑ Layer
Wean to Feeder
rj �
❑ Non -Layer
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
Number of Structures:
❑ Farrow to Feeder
❑ La ers
rs
❑ Farrow to Finish
Gilts
PE313oars
❑ Pullets
Other
❑ Other
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
y
[INA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 6 7 -- 69, Date of Inspection Z as
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:
Spillway?:
Designed Freeboard (in):(j�7
Observed Freeboard (in): 3 a
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 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E, No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo
NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
I.-,, KoEl NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Z�01 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):
g J) vJ2d9/97� C" k Eva
Reviewer/Inspector Name p %, Phone: �y
Reviewer/Inspector Signature: Date: Q
12128104 Continued

Facility Number: — Date of Inspection
Iliquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L/J N El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [3Yes No ❑ NA ❑ NE
the a ro irate box
I'll p ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee Freeboard ❑ Waste Analysis ❑ Soil Analysis [I 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
La'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Id NA
❑ NE
Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 9 Yes o ❑ NA "❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EKo ❑ 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
a<0 ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,.,e0O
,L�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
2No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
04o ❑ NA
❑ NE
Additional Cominents,apd/or, DraW1 fts: -
Page 3 of 3 12128104

i ype or visa t7;om fiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time: // d
Departure Time: County: 4tNst/0 hi Region:
Farm Name:
Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: LEWD S'MANA,) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 ' 0 „ Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C►attle Capacity Population
❑ Wean to Finish
QS
❑ La er
❑ Dairy Cow
® Wean to Feeder Eo d
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ElNon-Dairy
❑ Farrow to Finish El Layers
El Beef Stocker
El Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars ElBeef Brood Cow
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VN.0
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 6 7 — 6"L Date of Inspection
WCollection & 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: LAG�
Spillway?:
Designed Freeboard (in): 3 2—
Observed Freeboard (in): 3
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 Ej No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalt7hat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2f]No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L'J No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ElNNo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
E; o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Comments (refer to question ft 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):
Fb� COPY QsC. LICCOIA6 1401 •
•
UAL,F gfARIC I" X0.trT-tALkP AL4JAY S 00 r 6 44ZM �'�
eat i►nvrc�E .
a s� c� ba7�l q Yn- oc.r� n-cw_PxoG us& i4 swocc G E r
wzL N s,�- -Do.
yFr v.<Xrat , DXGCLk-�K-&- RTN&!3 e.. IMA NE
FZ.ow T
Reviewer/Inspector Name o
it Phone: Sid
Reviewer/Inspector Signature:
Date: a
Page 2 of 3 f 12128104 ' Continued

Facility Number: &"i ,Z Date of Inspection
1teuuired Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IJ 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. ❑ W­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other ,__/
21. Does record keeping need improvement? If yes, check the appropriate box below. 2 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
ElRainfall ElStocking ❑ Crop Yield ❑ 120 Minute Inspections 04onthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,ON
'LI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
�'No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,❑,Yes
L� Yes
El No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphos loss assessment (PLAT) certification?
❑ Yes
❑ No
dNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
N/
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,_,,,
No
Lfo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
"No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El
❑ 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
LJ No
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/] n spector fail to discuss review/inspection with an on -site representative?
❑ Yes
a�
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %rp Arrival Time: Departure Time: i� County: JNaRegion:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L450,rs SNAP) - integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 = Longitude: = o = 1
Design Current
Design Current
Design
C, ent
Swine
CapacityPopulation
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I 1
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
Population
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Stocker
❑ Gilts
El Non-LayNetsers
ElBeef Feeder
El
❑ Boars
El Pullets
El Beef Brood Coyj
Turke
❑ s
Other
❑ Turkey PouIts-
JE1 Other
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
El Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

FTacility Number: 6 i — 6 2- 1 Date of Inspection � +�
i!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structurei Structure 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier: (A % ODN)
Spillway?:
Designed Freeboard (in): 3Z
Observed Freeboard (in): (�'?
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes
,�/
L7 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ffNo ❑ 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
dNo ❑ 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
[;io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[fio ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
��, //
Ei 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 Area
12. Crop type(s) CWi (3 W S60.
13. Soil type(s) FaA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
eNo
❑ 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
EI/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ 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):
2A) UP04rE t i2otp Y-rQP M. 0WAh6r,1 gqS Sots, SArw1U4e
)UA9 V -40,SEN70 *FF. A44f
JAO S" Sara, CAMPG� . PEA-Y a7* /ZEQLC9ES
SGVL ANALYS,S ANNI4 LL,"
Reviewer/inspector Name lLIU� T
Phone: �!� �-
Reviewer/Inspector Signature:
Date: S� D
Page 2 of 3 121281104 - Continued

�fr Facility Number: Date of Inspection �!
Required 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
Ind No
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box Blow.
,�,/
L�J Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking L! 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
d-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�N
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
LI NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
j9 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tJXo
❑ 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
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�
U No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ek o
❑ NA
❑ NE
Additional Comments 'and/or Drawings:
Page 3 of 3 12128104

Type of Visit ;Routine
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'fime: SSo Departure Time: County: ONSLA Q Region:
Farm Name:
Owner Name:
Mailing Address: ,
Physical Address:
Facility Contact:
Onsite Representative: l:Eo:rs 59W
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
'? (JO 171bQ ID Non -Layer -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 4 ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
Cl Yes
UZo ❑ NA
❑ NE
❑ Yes
Zo ❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jACook) 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
d� ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
7No
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYesVN9
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes❑
NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require El Yes
No [I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
f
[rJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1a No ❑ NA Cl NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Leavy 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 Drifl ❑ Application Outside of Area
12. Crop type(s) &R,wwDA (G) S 6=0 C5W
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
VNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
eNN ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�NQ,[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
ter ea p aln'situattans (use,.s
G
Reviewer/Inspector Name �7� } t./A Gw . �;' Phone: is of L
Reviewer/Inspector Signature: Date: 4' 7-os-
12/28/04 Continued

F cility Number: Date of Inspection ii f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Id No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,�No [I NA ❑ NE
❑ Yes (� No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
dNo
❑NA
❑ NE
ElYes
❑ No
EfNA
❑ NE
❑ Yes
❑ No
YNA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes ❑ No [(NA ❑ NE
❑ Yes U_ No El NA El NE
❑ Yes [? No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
Lf No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
i n 1 oirimer is"andLor�Diawin'pps
Addat a a C
�t' �" "I fi
�+ia-a�'d.n�i
12128104

(Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint gS Follow up O Emergency Notification O 0ther ❑ Denied Access
Facility Number Date of Visit:
J3 Permitted 13 Certified [3 Conditionally Certified © Registered
FarmName: .............. ..f19.W.........,,%..1................................................
OwnerName:.............1 s.......... 1.....................................
Q /C Time:
T
Not Operational O Below Threshold
Date Last OperatV"A.Z'a.C')
r Above Threshold: .........................
County: .....,.......................................................
Phone No:
MailingAddress: ..................................................................................................................... .....................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative: r�-/✓
............................................................................. Integrator: f..r....�..............................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
RJ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 '° Longitude • d «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )WfNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier: .............................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Facility Number: — ',� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. 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 ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified'Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? [3 Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below j] yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
-- �NSpECTzo r,I Qo�r F /�S Fbc c dur u,a �j G S //4�
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�
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❑ Field Copy ❑ Final Notes
C6AfV,- •l_ ��,� ZAv
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e4RD Ak7* A✓Stoc'/ .51pzG
.y ua- i £?F sit ,v„ N _ .y /' b
Reviewer peCtOr Name ." �'-that. .�".a�:F..a� =u'..,.r'TU",1aa i�u,.,?�a,r�0� t:;.t _SFt;.",
Reviewer/Inspector Signature: Date:
12112103 Continued

i�
Facility Number: Z
Date of Inspection /
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Z4o
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

of Visit Z Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 30 Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: 3/ Time:
O Not Operational Q Below Threshold
Permitted [3 Certified © Conditionally Certified © Registered Date Last Operateed� or Above Threshold: .........................
FarmName: ...... .......zz4—"' .......................................................... County:..... `1..rlV> ifr G1C1...............................................
OwnerName : ............. 1'.'elt)L .......... .f. 1lrY.............................................. Phone Na:.......................................................................................
MailingAddress: ..................................................................................................................... ............................................ :....................................... ..........................
FacilityContact: .............................................................................. Title:.......................................................... Phone No:.......... .......... ...................
Onsite Representative. ...0W410J< ......................................................................... Integrator: ... 644AL...�...
CertifiedOperator: ............................................... . .. ... .... . .. ........ ....................................... Operator Certification Number:..........................................
Location of Farm:
O5wine ❑ Poultry 0 Cattle ❑ Horse Latitude • 6 64 Longitude • 4 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes Z 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 yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes Ja'No
❑ Yes )9 No
❑ Yes ONo
Structure 6
Identifier: ...................................................................................................................................................................................................................
Freeboard (inches): Mt S�
12112103 Ud" Continued

i
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
ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
0No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
Rl No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Aaolication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
XNo
❑ Excessive Ponding ❑ PAN verload ❑ Frozen Ground Copper a d/or 7a'n�
/rHydraulic
12. Crop type Z� ✓� ( C� /!�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (A )?
0 Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Z No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
,TNo
16. Is there a lack of adequate waste application equipment?
❑ Yes 10 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
0 Yes
PjNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
3dNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
CA'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
XNo
Air Quality representative immediately.
E,use ttrawtngs ot,t tycxarn,sttuat�ons (uuonat
a es asmecessa , ::d't❑ PY ❑ ,f l,ri
e aeto`tdetter;
plj S]{ 1f+ yP errf se auNp{� 6 p ( (J) y rj3'�15jp #,1 ) Field Co Final Notes t
ad_.l-.`":'.�:if'tiPSil.'•0.ga 11°=1^.s��.,fil:°>9.5 ��gaYA 3111 °hPl6�]i.`�. 51?P..f�•;be P43.'3#YfPtl@EiliiaY'elElO°c'?.4b1.t.Vif.,d?PIliE1,rf:CSZi�'!-.��Ri..3ii.11 r�i .,��".•Mqp�.� �.�a 3 {'�j'ff'
ufl. eS ¢f r`. Rex Y>!i . .. fl- N..,75 ?a:.? P?ti t NM.1��.•., ,:�. i v'i i':'Jf�i �:. . S..lf .d �it�i
/ Jam) ak1N�� L � W OR K znl � �.v ICz�-C_ z.�c. CO � GTo ��' g fir✓ /c�-�G p5, .
'', CON � rNu� Cp GtJaRf; o� I��c a
—
DF E3 6 0. " W Te_
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G,4nJ0 �uM P Orj w1
-r7�+0L► � U-r- _rz_znJa IMFrz- �
r
ReviewerAnspector Name !1f'
Reviewer/Inspector Signature:
Date:
12112103
Continued

Facility Number: — ,Z Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [Z No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 31rNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 9No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes '0 No
28. Does facility require a follow-up visit by same agency? ❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
;INo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit o Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visitt O Routine 9 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Numbcr
Permitted OCertifled 0 C)onditionally Certified [3Registered
Farm Name: \_ 7sla / rt� �r
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Time:
Date Last Operated or Above Threshold:
County:iSLOGc%
v^
Phone No:
Phone No:
rD
Integrator:=-_! 'qe+ ,,� !
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C ` �46 Longitude a 4
Design . Current
Swine
Feeder to Finish I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
u
❑ Boars
Design: . Current Design Current
P ultry Ca aci ' Population Cattle Capacity Population
❑ La er ❑ Dai
I
ry
❑ Non -La er ❑ Non-Dai
❑ Other
-Total Design Capacity
Total SSLW
Q Number of Lagoons.__� ❑Subsurface Brains Present ❑ La oon Area ❑ Spray Field Area
w_... _.....
4Holding Ponds 1 d 'T
rap ❑ No Liquid Waste Management System
I
Di5charges & 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 yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collectign & Trgatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spiliwav ❑ Yes �No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 .ASP€C>Lo.rJ �/J /D/7!f �03, t!'�(�* Continued

Facility Number: Date of Inspection O Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [I No
(If any of questions 4-6 was answered yes, and the situation poses an .
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Poyes ❑ No
I2. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional D'N'Q 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 ONO
24. Does facility require a follow-up visit by same agency? Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Ciimaients'(refe�'to gneWt i #,7: '•E plain' any YFS s&Wiiii�and/o atiy�ieccnim ndattions 6Fany"otlier coriiments.�y> ' la � a S
Use drawings of facility. to better explaln stttinttaus .(use addttlonal pages as necessary) g, �� r r
s �a E� ❑ Field Copv ❑ Final Notes
r� g ie
/�����zo�
x:r s ! k'Nh �1 �."E'
Reviewer/Inspector Name J.f "' , f" 1�- r, .. w ,lk Lam n 1
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 6 Date of Inspection ► l
or I,,,Lsues
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 p'ermanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
G a w �Q E /o,� sz�� D� ��
SPr y/
60a) MOZ-4T,
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i
649 _lea AVID
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NCR A L L e,,, o Srf APE / i ' y.tl G!c> S4me
&U'/ /41c'!5_5 /1/'Z 49,645,
/if P ski✓>�7� l�f5 ST/,I2r�.� !" �irlOzr✓�
05103101
i ok�r5.q"`���
Z u > 174,c-

f 'CE.•,'
DEvEsioa of Water Qi�$iEa-T
,3d r $ a s
j•„ E Y °p � 1 €' ; �(i C
� 1 f f .kaFi �° 7 it d .➢ y€3..95
w> * _
O DEvIsEOst of,Soil'aad Water ConservatEtltl
,
bf a.
jMt I
O,Other:,Aency9`:!6 f .egg IAA
%l��3.flfi
I ;�
F,
;!f;.
t,;#
. r:#:.a_ Pend. `as: ..Y .•�-? I au. .3 t.. �1 .. �>_..:.
.�` �"' ., .�� ,,.,E_„ k. E� .. r. � 3..,> �_ s. _..
:,. r�.a ".�,:
� �. a.. t .�.,..,� f..., I_,.�. ... � ..
Type of Visit 9' Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine O Complaint (Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: / ime: QTnal Q Below Threshold
P Permitted ❑ CertEtled E3 Conditionallr
fied © Registered Date Last Operated or Above Threshold:
Farm Name: _ _„ County
Owner Name: - ..� Phone No:
Mailing Address:
Facilitv Contact:
Title:
Onsite Representative: G�tre � .�/`iA L _
Certified Operator:
Location of Farm:
Phone No:
Integrator: L20_a
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
: Desi : :ICurrent .: .. :.i,_ ...
D_Current
Swine Ca aci . Population Poultry Cattle Population
Wean to Feeder a@2 JE1 La er ❑ Da'
❑ Feeder to Finish ❑ Non -Layer " ❑ Non-Dai -'
_ ❑ Farrow to Wean
Other ❑ Farrow to Feeder ❑ her `
❑ Farrow to Finish �4 E `Total Design CapaGty
❑ GiltSI;,
❑Boars
Total SSLW
.. .:..,. .. .... _, ._ ._.. -. . .34;� ,' -�.:'I S . ,� 1 � ���. Etl i Lk •E f _';4 �3.0
f (',P i.'•3.1 `1 f tl�`r _j�',r,
Number of: Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ S ray Fietd Area ,
�Holdta'Pands�l�Snlid Traps #' °� �Ir;' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste llecti n & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Frceboard (inches):
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 ❑ No
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 ❑ Yes ❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15, Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;Z'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� ,, E 13�
Comments'(refer to"quest<an.#) Explain any,1YES,{answers:;and/or anyirecamutebastions ar anv other comments. '
y 2
Use drawing's of=facility ro'f;etter explstn sitviattans. {use additional pages as necessary) ` ; El Field Corsv ❑Final Notes
1 �.
.:
i� ..hj.fe.,t...1i.,':S#i:.�.-�,,.w.r+.-,w.+n.-rt.,.nfa«r.-+r�...--,-.f,....--.s•�+rr.-.-rn•....-wry :.. ..
w'se�cT��,.� ,Oa�✓� 45 ��e oc✓ uo G5z 7- � .� �Pe.�z,✓�
-- do %mac fir✓ `jvGF35,
YJ�i✓/✓/J- C-��2�4 �/`JQ �LL �i%�P �P�j /��jrt �NS�t'ttJ �, �O�G g, LLJ��
m.
Reviewer/Inspector Name ` ae.'6-' 3 1 E�. ..i. t i
Reviewer/Inspector Signature: Date: /0
05103101 Continued
r

Facility Number: Z-62 Elate of Inspcctinn
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional.Comments,andbr Drawings:.
❑ Yes ❑ No
❑ Yes [:)No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
/Q i�} D �i/ Obi✓ i9 �f��2 �i✓CO.P2�c rG� �i✓ l� z713
05103101

Type of Visit Ocompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: l2 OZ Time: 3 . 34
ri
N t O eration [ Belo Thr hold
O Permitted D Certified O Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ,J k"'`� rrV s County: j0 „
Owner Name: Le w; S^ S h-ty Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
L et.v ; r .Shaw
Title:
Phone No:
Zr,
Integrator: �J _ ew a e,94
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 0 GG Longitude • 4 ii
❑ 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?
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
St7cture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Frecboard (inches): 3
05103101
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [3'No
❑ Yes ONo
❑ Yes ANo
Structure 6
Continued

's
Facility Number: 7— 2
Date of Inspection Q 7-
5. Arc 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 '�INo
❑ Yes �No
❑ Yes ZNo
❑ Yes VNo
❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes � No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulics _O�verloaadf ❑ Yes'P'No
12. Crop type Bo—L,,44 4LS4-v V rhik !1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP) 11 ? ❑ Yes JzNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ;RrNo
b) Does the facility need a wettable acre determination? ❑ Yes J'No
c) This facility is pended for a wettable acre determination? ❑ Yes 7No
15. Does the receiving crop need improvement? ❑ Yes ;;�No
16, Is there a lack of adequate waste application equipment? ❑ Yes ERINo
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ;2'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 ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes.0No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes'P'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 10No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ff No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes Z No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes I'No
[3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cottizitents (r`cfer !n' question;#) a `Explain �y+YES.answers awdfor any rek6mme talons tir any er cpmmen., ts'�
xie drawings of facility to better explain Mrtnatiii- (Use additional;pagesas necessary) .f ❑Field Cony ❑Final Notes
-rt.;S Taer-p, ij' >fer7 well kpjoa. -7_�e lleco,'dS Gee vef7. well )kaf) and
well ve--yq 111 zeal t o,, i t via. e lelo is well a4et bl Sti ��,� S­tt
Mqy need 4o .fie seeded eA9R.ih -,,, rijer-f; Al., . Skct,.,.1,01 seed otloo
6V41q!v�✓. t't iS Sat✓ in 5c'f'''lp elrecls, Tke [i,�,aop, and .sw;�P hot.LSe
av�ea s ape toelI IrQomed . A9A:,N , 4� e Affirm ;.S Ver � well kc)94.
wank ou Q. our eF�a✓�f �d wla�� -�-1�e *r1 in o�d order.Hy
�iyt
Reviewer/Inspector Name�rr!,E, �� 1 -? ,rR E, 6 E
ew ,S i,
Reviewer/Inspector Signature: Date: Z
05103101 Continued

Facility Number: -- 2, Date of inspection Z �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 'JZivo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'WNo
28. Is there any evidence of wind drift during land application? (i,e. residue on neighboring vegetation, asphalt, ❑ Yes JO'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 ZNo
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 qo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes , Z'O'Vo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Dr2wingsi
05103101

�DiV191Qr1 0[ Writer Quality
s fix �-
"I Q Division O[ Sall and Water CORSerV8tioR 7 1i tj fir �,r 4
� r
its
� + 4
Type of Visit IRCompiiance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Uatc of ViSil: �-� —lJ 'rime: 0Q0 Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or ``Above Threshold:
FarmName:......................................................................... County: .... G..................................... .......................
OwnerName:........................................................................................................................... Phone No:.......,..............................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No: ...............................
MailingAddress: ....................2,....................,......................................................................................`...�..C........................................ ..........................
Onsite Representative:,,............................................... ........ Integrator:.`-!,,... &„
.....................
Certified Operator: ................................................... ................... ................... Operator Certification Number: ...................
Location of Farm:
❑ $wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 it Longitude • 4 "
Design Current Design Current Design Current
Swine Capacity Population Poultry_ Capacity Population Cattle Capacity Population
Wean to Feeder T-Jg d ❑ Layer JEI Dairy
❑ Feeder to Finish JE3 Non -Layer JE1 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 ❑ Lagnnn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischare£s & 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 malt -made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. II' discharge is observed. what is the estimated flog;` in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
❑ Yes
[(No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes kNo
❑ Yes )4No
❑ Yes )<No
Structure 6
Identifier:......................................................................... ....................... .
Freehoard (inches):
5100
Continued on back

s` L
Facility Number: — a- Date of Inspection a G Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes t4No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes tj�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes &No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ `Hydraulic
/Overload []Yes ONo
�
12. Crop type �� !! 2; S \ Q ��trt' �e� I c.i 1.5��/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yi41afl0iis'o[r• dtrjcie d s -*Oro 00(je$- d((Wijjg �his'visitf - Y:o0 wiii •ti 00iye 06 fut�-tht� .
cor'resoondence: abo' itf
❑ Yes ,KNo
❑ Yes [R No
❑ Yes No
❑ Yes [?(No
❑ Yes P�No
❑ Yes XNo
❑ Yes No
❑ Yes KNo
]Yes ❑ No
❑ Yes 9No
❑ Yes 9No
❑ Yes &No
❑ Yes XNo
❑ Yes 2�No
❑ Yes XNo
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):
`(���e s� s�►�l�srJ p
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

Facility Number:, 9 Date of Inspection G` Printed on: 1/9/2001
Odor Issues �No
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes qNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes I�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 �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONO
ortal L'ornments,andlor
-ra ngs
5/00

Divh
JVP
lilts �`.�,� ¢, �F P-,-� ¢�y � ', E�� , it •.I
"• �D1V15
3r3 r 'ifLt ... �3 ISM i Othe
4er, Conservatjon ,Operatii
,ter Conservation Complig
aacr �u:ui�y vuuatnauauc aciupc�uun�
Operation Review„ t P Po ',,,I,
,Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Y IYii •Ii�Y�YlI IIYYIIi II I III
Facility Number Date of Inspection 'kGG
Time of Inspection 24 hr. (hh:mm)
© Permitted Certified © Conditionally Certified 13 Registered Not O erational DateLastOperated:
Farm Name: '..... \s � �. ..... County:.... .^`j"'io�+..................................................
OwnerName : ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: .............. ... Title: .................................................. Phone No:................................................................................................................ ..............
MailingAddress: .......................................................................................................................................................................................................... ..........................
Onsite Representative: ,'r............................................................ .... Integrator:....`..... .....................................
Certified Operator;,,,,,,,,,,,,,,,,,,,,, .. Operator Certification Number:
Location of Farm:
................................. ............................................. ........................ ...................... ............................................. :...............................................................................................
...................... ........ .......... ......... ....
Latitude ' 4 " Longitude 0 ' 16
eSIg1°CUrentDesign CUrreptDei,urrent' `
''Poultry:Swine Ca'acit ',Poeltion Caacit o`ulaon;'Catl?o"ulatioi
,.
Wean to Feeder <j ❑Layer ❑ Dairy
❑Feeder to Finish ❑ Non -Layer 10 Non -Dairy �r
❑ Farrow to Wean '
❑ Farrow to Feeder JEIOther
❑ Farrow to Finish
'Tota! D'esign'Capactty
❑ Gilts
❑ Boars "Total'SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area i
'7 II
Holding Porids'1'SolidTraps ❑ No Liquid Waste Management System 3 :, �� ,' •.,`
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 ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes WNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
TNo
❑ Yes
JgNo
❑ Yes Q(No
Structure 6
Identi tier:
Freeboard(inches): ................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes xNo
seepage, etc.)
3/23/99 Continued on back

r
Facility Number: ! — a Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops dieer 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?
Rec wired Records & Document,,;
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ 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?
NO •yioiaii¢ris;ot• ftficiendes -were noted• 00thig �his:visit: • Y;ojk;wil1-tOOiye do #'ui-t. ;
cor'res' oiidence. about: this :visit
❑ Yes KNo
❑ Yes 'gNo
❑ Yes ET No
❑ Yes 9No
❑ Yes bjfNo
❑ Yes XNo
❑ Yes KNo
❑ Yes 9No
❑ Yes ' No
❑ Yes C; No
❑ Yes O(No
❑ Yes 9No
❑ Yes KNo
❑ Yes ® No
El Yes /X\ No
❑ Yes [9No
❑ Yes VNo
❑ Yes O'No
❑ Yes J�No
❑ Yes 9No
❑ Yes ;dNo
•. i j t: <.ix�t
Comments:(refe'r� w4bestiori ;•Explaan'any„YES answeirs and7or�a y recominendatrons,oriany other comments +
Use draw�rigs of facrl,ty to better_explam situations (use,,addittonal pages!as necessary)
�] �3 :,sue uey � c--� 1 r ��. ��•-. � e SZ,
't ( ' 40,
Reviewer/Inspector Name
Reviewer/Inspector Signature: n Date: 14, a.•-ci

Facility Number: — ' '} Date of Inspection GQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 ENo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional. ..o,m.- m_:.e.. nts;an,.....o,ra,,.rayin-,,. .:,..,... _, 1 j
?,l,t �viG•�,r7rr...-3, a>}1., nt ._i%',i.i. -N ,: 3�i.

.. f DiVlslon of Soil and Water'Conse'rvii<tion Coln lianceE nS W µ
1 0 Division of Soil and ai ter Conservation Up"eration Revi r; r= ,, r
i p I peetion �, ° vt 1� i
__(Division of Water QAahty CUtllphanee Inspection' 'i ' �, ° e:, � •ir et ct i , r 3 s ,
�. QI.Ot]leP Agency:- OpOeAtioh ReVtew,, t 3 r r rry' r r
Q Routine Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection a
Time of Inspection 6 24 hr. (hh:mm)
0 Permitted Q Certified 0 Conditionally Certified © Registered JE3 Not O perational Date Last Operated:
..........................
Farm Name:....... L.1� ��✓I2 County:........i...,...............................................
..................................
OwnerName: ....•................................................................................ Phone No:.......................................................................................
Facility Contact: ............................................................•................. Title:.................. ['hone No:
.................................................................................................
Mailing; Address: ...........•.•...•.•.•...•.........................I......I...................................... ................................................... I ....... ....... ...... .....1,.............
Onsite Representative: ..............................................................• -Integrator:....` K �....................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number ...........................................
Location of Farm:
.............. * ...... """" ................................................ * ................................................................. ............ * ........ ............. * ............. ........... .................. * .............
Latitude a & •6 Longitude �• IJ4 64
Design Current Design-- Current Design Current
Swine 7 C I apacik Population' Poultryr Capacity Population, .. ,Cattle. Capacity Population,
Wean to Feeder E,06 ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
`, ❑ Farrow to Feeder 1,❑Other
❑t'1
Farrow to Finish Total Design Capacity
❑ Orltslwr
rn,
❑ Boars :: 4:` 1 :r1 Tota1,SSLW
Number of Lagoons- ❑ Subsurface Drains Present I ❑ Lagoon Area ❑ Spray Field Area `.
4„
.•HoldkigEPonds / 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. I1' discharge is observed, what is the estimated flow in gal/min?
d. Dries discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? gYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): .....{... 11 .................................................................................................................................................. ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
Continued on back
3/23/99

1{acilitg Number: 0 — Date eel' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? VYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level w
elevation markings? ❑ Yes EXNo
Waste Application
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
V
13. Do the receiving crops differ with dose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
Cl Yes
kNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0: 1a violirisodficiencies wri¢td• (Wing tis Y64 Will lid fu�thO ' e dhieatg:r g;
' • 'comes• onriei�ce, a�atit: this visit.: • •
Co" ,
mments�(refer to, question #) Explam any Ykk answers and/or any;recoit�mendatians or any other comments
Usedrawrn s of factht ta' betterex lam situations use' " g y p ( addetronal pages as necessary), ,' +
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r r».arr nee¢- . �� �E 1 1{ t ,�'�' rl-
Reviewer/Inspector Name , € „-" ,.>�� t..��s .G ¢�' g's'' 0 r' r
Reviewer/Inspector Signature: Q_ fl Date: — �a --C '
3/23/99

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
2T 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional.Uomments and/or l)rawings:.. ; z' .t•.3. E "t. < :! 3, , �° i .: ,,. .F ,� I
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` ❑ Division of Soil and Water Conservation ❑ Other Agency
ivision of Water Quality '
�.
outine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
- __ ___ ] Time of Inspection d 24 hr. (hh:mm)
Registered D Certified ©Applied for Permit ©Permitted Not Operational I Date Last
Operated:
Farm Name:........ �..✓.� ......... ,j .� �.'`1. ....... . �t�2 w►............................ County:............?. S.)...................................
Owner Name: ......... (.%�Ir.:5................ ........hl.KTr .............................. Phone No: ...... ....................................
Facilit Contact: �� Title: U ti
f'f%,. ...�..F�.................. Phone No:
Mailing Address: ..g. ..., rf hL�i z... u f? . z.w �. ° ` . .:.5........................... ..........................
......... ........................ ...............................
Onsite Representative:..... ................ �. 1 ..3c{................................ Integrator:....... tj�:....... . ........................
Certified Operator:..........................Z...`..................................G..."................................ Operator Certification Number ..........................................
Location of Farm:
C
ME
Latitude • 4 �66 Longitude • 6 46
Design Current
Design Current
Design:Current
Swine
Capactty Population
a',
Poultry Capacity ,Population Cattle
CapacttykPoplation
s ❑ Wean to Feeder
A❑ Layer ❑ Dairy
❑ Feeder to Finish
10 Non -Layer 1 JEI Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other
>
:
Farrow to Finish
Total Design Capacity:'
Gilts
❑ Boarsr
; s Total SSL,W
Na>iber of Lsgootts /Holding Ponds , �;.
❑ Subsurface Drains Present
❑Lagoon Area
❑Spray Field Area
_ .
x
❑ No Liquid Waste Management System.
„
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. 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
ZNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
5LNo
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
EffNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
MNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
Q No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Oyes
❑ No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
W1 No
7/25/97

Facility Number: —
8.*e there lagoons or storage ponds on site which need to be properly clotted? Yes ❑ No
y Y �
Structures (Lagoons,liolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ,Pr No
te
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft): ............... .?..?. ............ .. ........................ .. ....................................................................................
10. 1s seepage observed from any of the structures? @^Yes 0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[t-Ia
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type..........................................................................:..........................................................................................................................................................
lb.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ONo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
9No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
W No
20.
Does facility require a follow-up visit by same agency?
O Yes
[] No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
4�rNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Ut No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes A�f No
0 No.vio'Ntioits-or deficienkie's.werenoted•iltiririg' this:visit.- You:tvill rece veito•further ,
. corresphndehO dlioW this:visit:' :. .
1014 PAq_O_?_OTrete9 ,moo
e Cu
7/25/97
Reviewer/Inspector Name z
r.
Reviewer/Inspector Signature: Date: ski

L
❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
10 Routine O Complaint O Ftrllom,-upfEl' I)IV(2 inspection 0 Follow-up of DSWC; review 0 Other
Z Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered [3 Certified [3 Applied for Permit 0 Permitted [3 Not Opera Date Last Operated:
Farm Name: .jq. f,4-,e�5 County: ��1..%^....... . ......... ........... I..........
Owner Name:. .. f % . .......................................................................................... Phone No: ....
. 2.....,.............,.............................
f
Facility Contact: t.,vn............. -55.�..4. .� ........ Title: .. ... Phone No: ....................................................
iN•lailing Address:..,.. . ...... .......�.:.1C-'_5.............................................
t Onsite Representative:.. Z.ezvz..............:5...1`Ti..! .............. lntei;razor: ..�...: f],C�J. 1G ............................
QQ
' Certified Operator—
. .............................................................................. Operator Certification Ntunbc.r,........�(,l. .............,...
Location of Farm -
Latitude Longitude �• ��t
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Mc
C
Poultry Capacity Population Cattle Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity,
Number of Lagoons/ Holding Ponds 0
Total SSLW
Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
No Liquid Waste Management System
General
1. Are there any buffers that need niainten:tnce/improvement'? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? Yes ❑ No
DECCItafze oi'r,inatcd at: agoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes R No
c. ]f discharge is observed, what is the estimated flow in gal/min? o Q
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes EZNo
3. Is there evidence of past discharge from any part of the operation? RYes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge'? ❑ Yes J4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ,t� Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge'? ❑ Yes No
7/25/97 Continued on back

Facility Number: �, —67
8. Are there lagoons or storage ponds on site which need to be properly closed?
Yes
❑ No
Structures (Lagoons.11olding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
RYes
❑ No
StrUC[Ure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft) ......`1...:.................r.,.....,..,.......,,......,.1...!.............. ............................. ........ ............................
....................................
10. Is seepage observed from any of the structures?
M Yes
❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
91 Yes
[] No
12. Do any of the structures need maintenance/improvement?
,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
VNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
ONO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................f.........................................: [................................ .........
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
No
18. Does the receiving crop need improvement?
[9Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
E� No
20. Does facility require a follow-up visit by same agency?
KYes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes]
No
22. Does record keeping need improvement?
fqYes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Ye
No
25. Were any additional problems noted which cause noncompliance of the Permit?
Yes
o
0°No.violationsor d'iciencies.were'noted-during this:visit.-.You'Will receive no,further
. corre!90hdeb6e about this'. visit.,'-
' attonsgror�any otter cont ents. ' .
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Reviewer/Inspector Name{J" :- Y '
Reviewer/Inspector Signature: Date:

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