670076_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental dual

Type of Visit: (a 70utine
liance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: a/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: G iu (- MWj 0,S9&)tZt } Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: _ �„ g7i,-7
Certification Number:
Longitude:
Design Current Design Current Design
Swine C►apacity Pop. Wet Poultry l►apacity Pop. Cattle Capacity
Wean to Finish iLayer Dairy Cow
Current
Pqp.
Wean to Feeder
p Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
Di. l;0ultr. C•a acit ,op.Non-Dairy
ILayers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fj No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
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 yN
❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

iFacility Number: Date of Inspection:
wja to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesWNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ONE
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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 a�N�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [2/No
❑ Yes dNo
❑ Yes EfNo
❑ Yes E No
❑ Other:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 ❑ 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 permi ? ❑ YesZNo
D NA ❑ NE
25..Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �rNo NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
To
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
dNo,
/No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
❑ Yes FN
Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer toiquesNon'#) Expliim�any, YES' answers and/0kny additidnal;.recommendations or, any other'commentS.'
a:. eG R f Yv= ? { $'+. ? ; fir.. t. a ys`an �
Use drawings of facelityao better.explam situations.(use�addltlon, pages'as°necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:

Type of Visit: (D Co pliance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency , 0 Other 0 Denied Access
Date of Visit: Arrival Time: -�111wf l Departure Time: [77= County: tJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �[~ 9_6k AACS1414'W
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: i b U 2
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet M. a c I t07V__V3MMFop. Cattle
ILayer I Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
OI
INon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
ltr. Ca aci P,o P. Non -Dairy
ILayers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey 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 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 ENo ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes ❑ No
[:]Yes Z�o'
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: 1 j
Waste -Collection & Treatment
4. I storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ 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: CA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ' o ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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
IyNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[,] Yes
D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�N0
❑ NA
❑ NE
18. 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
�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rN
❑ 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 7,.- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes/No
❑ NA ❑ NE
2;''Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes t
D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
(3
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O/No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesVNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES. answers. any additional rec6mmendations,.6C y othe'ri c mrnenfs:
Use drawings of facility to better explain situations (use additional pages as necessar )
ow fia,
vT /Jt- W Put W-aT �� as s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone( t2�,q
Date: I & f j,s
14

Itype of visit: W U finance inspection V uperation meview u structure ;valuation U 'i echnical Assistance I
Reason for Visit: Routine Q Complaint O Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 4WSt,*J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: {�` YYh�i i'Z.� �7U 12�1! Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design C►urrent Design Current
Sw€ne Capacity Pop. Wet PouItay Capacity Pop. Cattle Capac€ty Pop.
Wean to Finish La er DairyCow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design C►urrent Dry Cow
Farrow to Feeder
Farrow to Finish
1)r, P,oultr, Ca aci Pao Non-Dai
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharses 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 ZNo ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4.,I9 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 I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5
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?
[fNo [3 NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
o
❑ YesVNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes 7/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2(No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN M PAN > 10% or 10 lbs. ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
;�o
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE.
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2XNol❑ NA
XNo
❑ 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 YNo ❑ 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 Z/E]
❑ 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: - r5 71 jDate of Inspection: 1
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?
❑ Yes ONo ❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
N
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile. drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ri627
❑ 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 drawinss of facility to better explain situations (use additional vases as necessarv).
Reviewer/Inspector Name:
' "dw N
Phone: (MV-1 5 4
Reviewer/Inspector Signature:
Date: 213 / i
Page 3 of 3 1 214Y2011

(Type of Visit: O Co Hance Q O O Hance inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine Complaint Follow-up Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GP—C-G- MA aJ1j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
ILnn,2-!La
Wean to Feeder
"WL
N
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Gilts
eNon-La
Boars
Poults
Other
Phone:
Certification Number: 1(e22'"
Certification Number:
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes d No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Ef'�VNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Insection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [. A &-oo J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
/No ❑ NA ❑ NE
[]No [DNA ONE
Structure 6
Yes ENo ❑ NA ❑ NE
[—]Yes Z No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 21"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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes allo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 91a
❑ Yes 5Ta
❑ Yes Vo
❑ Yes '
/o
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements []Other: 1-1
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 YNq ❑ 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 21412011 Continued

Facili 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Flo ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 2No ❑ 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 ICJ 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 210'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑ NA ❑ NE
rNo
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 anya,other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary). "
Reviewer/]nspector Name:
Reviewerhnspector Signature:
Page 3 of 3
Phone 3
Date:
/4 QII

Nrl
Type of Visit: 0 Cagx�Hance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Z Arrival Timed P r-] Departure Time: County: � Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: "R.S U Integrator: Certification Number: a 16 Op
'2
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Wean to Finish
La er
I
Dairy Cow
Wean to Feeder
sm
1 3506
1
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
ID , P,oult , Ga aci P■o
Layers
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:)Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ 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
ElYes
��No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility, Number: 07-
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U "'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IdNo ❑ 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 environments hreat, 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
[ Na ❑ 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 [3 N ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No ❑ NA
[] NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
NZD
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3 ❑ 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:
l
21. Does record keeping need improvement? If yes, check the appropriate box b�ZAnalysis
Yes
[:]No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste 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
e o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
g3 No ❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: (p'J - 'j (0 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit U ❑ Yes 2(No ❑ NA ❑ NE
ti
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0<0
❑ 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
[J No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storagc Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up by the
❑Yes
Yes
1V
�00
❑ NA
NA
❑ NE
NE
the require a visit same agency?
❑
❑
❑
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).
L-C--AA) F�JC-Lj( G4--Lo SE_Foj�L� fcjyvjiRDJ6—
S dzL, PMA 0,1-TF Nod- fwojo ongs 10 G(--T OiJ(-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:! �0 o D
Date: L,
2 4 11

e71,
Faciltt;yNumb'er:
')
5 i� ;
ater9uality:
it and' Water,Conservahor
Type of Visit Corppliance 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: Arrival Time. I Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative:M. G�6Gs l ` IfltLSdG11AA1 __ _ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` = " Longitude: 0 °
.. i a �.�.i ,�..xs= !'.� t� '' y,.3 •`,� s 42.,E g.. �e
D.C31 rat a ';I11lCC"ellt x r. '� 1 k Y t.,z'is Cs'
x t 17 YCurrentg::;';`wl` Design4gCurrent
111C' i. �&'i�. }zs"�� s 1� '.f � V�
`Capaeity Populuho'n i,'Wet Poulto'y":C, ity #Populateon Cs>f31e; � f ,f t Capacityg Populahon '
�.. ns ..as.€ "fit. _ r i1.t ka � flli€Y Ott vl f .,.r s�a.crosasM£�m"'.e
❑ Wean to Finish ❑ Layer
+ ❑ Wean to Feeder 3 4 u D 14 6D ❑ Non -Layer
El Feeder to Finisha��sz `'t t` ,a'?
❑ Farrow to Wean,�t.
Dry Poultryt E
❑ Farrow to Feeder
s, ❑ Layers < ❑Farrow to Finish k
Gilts
❑ Non -La ers r
❑ Pullets
❑ Boars r
's" ❑ Turkeys a
Other" I t to a}} �a., s w
� a=:Z, x % ,2,�'1 .x `ci'S s s+=x ❑ Turkey POUItS �,�
i���{ 3
❑ Other " ❑ Other, Number of Structures tyy
ei aa=4'.1.. T&. fro`;-'.' i'a,rc64;r:a3.;;;��&-4sa.C.'«. ,:: a-aC .�s,-n, i.'SW ei.;! w=k:°�2� �i«�iik-43-�'a£�a,.:,�„af
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Doi
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
24
❑ 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
❑rNo
❑ NA
❑ NE.
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CJ
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge`?
Page I of 3
12128104
Continued

Facility Number: 6 — 7 Date of Inspection
Waste Collection & Treatment
4.�ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z<o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): P ,. /
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes I2'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, 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 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 [INA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
El 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 o ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E!(No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes rNo
� ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
m any YES°answers and/or any
n. situahons:;(nse additron'ala
I Reviewer/Ins ector Name1111,2114M ��ti~.-p `;Q, '> ® } Phone I
p���.,� 3
Reviewer/Inspector Signature �n. ^� Date:
Page 2 of 3 / 12128104 Continued

Facility Number: —7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N ❑ NA [--IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'V ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [ /No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA [INE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 7No ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 7No
El NA ❑ NE
El Yes ❑ NA El NE
❑ Yes
r KNo ❑ NA
❑ NE
Cl Yes
CfNo NA
❑ NE
❑ Yes
N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings: F;r .
Page 3 of 3 12128104

r
Type of Visit 0 pliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Co7Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:MA E Arrival Time: = Departure Time: County: f�b� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
%
Onsite Representative: C� �' �/J
Certified Operator:
Back-up Operator:
Location of Farm:
0
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
i = Longitude: = 0 0 ` 0 11
Design Current Design Current
wine Capacity PopuonENtry t«apacity Population
Design Current
Cattle Capacity Population
❑Dai Cow
❑ Wean to Finish
Wean to Feeder
r
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dr. Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
11
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated ac ❑ 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
24o
❑ NA
❑ 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

r
Facility Number: —
Date of Inspection s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 VNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes Zo
o ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes �No [I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNco ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WIN, o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VN
o El NA El NE
El NA El NE
No ❑ NA ❑ NE
VN
❑ NA [I NE
❑ NA ❑ NE
§ridc�'tl rzei k yy
Comments (refer to question #): Explain any YESk.answers and/or, any`recommendations�or�an9yytother{ commentsa + 3
Use drawingsof'facility to betterexplain situations. (use additional pages asnecessary) �,, �;'; ��,��, ,
Reviewer/Inspector Name I `](Jf L Phone: 7 13j
Reviewer/Inspector Signature: ' Date: S
12/2R/I1Q f'nsltinund

s _
Facility Number: — Date of Inspection
,l
r
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspectionss Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Cl Yes
,//❑
o ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EWo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;J'�4 ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Na ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CJ No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑-Ko-- ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B 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
I� 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
[3 o
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
Yes
El Yes
❑ NA
❑ NE
12128104

Type of Visit Cornpllance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Arrival Time: ® Departure Time: County: QMfIhY,J Region:
Owner Email:
G RC G m*4$UJzN
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 ❑ « Longitude: = ° [= ` = u
Design Current Design Current
Design C*urgent
Swine
capty P�op�ulatian wet Poultry Capacity Population
Cattle Capacity Population
to Finish
to Feeder
❑Non -La er
❑Dai Calf
r to Finish
❑ Dai Heifer
w to Wean Dry Poultry❑
D Cow
w to Feeder
Non-Daiw
to Finish ❑ La ers❑
FGilts
7
Beef Stocker
❑ Non -La ers❑
❑ Beef Feeder
Pullets
❑ Beef Brood Cow
❑ Turke s
❑ Turke Pouets ❑ Other I
Number of Structu►es:
DischaMes & Stream Impacts
1. 1s 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
o
❑NA
(INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L&Vyt�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
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 ZNo ❑ NA ❑ NE
El Yes ❑No El NA El NE
Structure 5 Structure 6
❑ Yes [�I'No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thxeat, 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 R 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 El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes �o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �
ElNA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
t ..�.� .".. y - `� .. i-�':. �, } 3'-3' '..@. '„ay ti§.'A i4A.4-".ki�yS4"_. .:.
Corriments (refer to question #) Explain any YES answers andlbr�anysrecommendations or anyk oother con rnents ea
s
gLlse drawingsof facility to better, exptlain s�ttiahons.' (use add�tronal pages'as necessary):: ,;x ; v w$,u4� y,,
•
Reviewer/Inspector Name
Prone: 1
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 12128104 1 Continued

A
Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [J"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
El<
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainlall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
� o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�IN o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;Jl�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
640
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Uo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
[/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VINo
[:1 NA
❑ N13
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
O/ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Cd Other ❑ Denied Access
Date of Visit:4�rAl
Arrival Time: G]Y Departure Time: C� County: 4W.2_0k1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: �e = s =4, Longitude: = e = , = 1I
No Design Current"
Design Current
Design Current
Swine " C�apacit�y Poptlon
Wet Poultry Capciy Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
Non
❑ Farrow to Feeder
El Layers
-Dairy
El Stocker
El Farrow to Finish
❑ Gilts
❑ N era
ElBeef Feeder
El
❑ Boars
Pullets
❑ets
❑ Beef Brood Cow
❑ Turkeys
Oth er
❑ Turkey Poults
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ 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?
❑ YesT
o
ElNA
ElNE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y
ElYes
CJ No
ElNA
ElNE
other than from a discharge?
Page 1 of 3
12128104
Continued

vacility Number: Date of Inspection t o
Waste Collection & Treatment �f
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E! No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LiaCIOV J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '24
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q(No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or ] 0 ]bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Effl�N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
u No
❑ NA
❑ NE
Comments (refer to question #)
ESzplain ariy YES answers ani�lvr` any recommendattons or any other co m nits
Use drawings of i'acility to better
explain situahons.'F(use':additiiinal pal;es;as necessary):
y 1 � F+ �,Jf�S ' �v►T
«�i(. 4 � 1'41a�.. W4S �awt��o� �+ � �'fLt�- c� 1/i �,
AL
Reviewer/inspector Name ��
t f 9•G
- ''' n�R °� _ Phone: —73
Reviewer/inspector Signature:
Date: o
1 12128104 Continued

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

6-7 M. 17
Type of Visit Cpliance Inspectlon 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit LJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: YSr 0 Arrival Time: � Departure Time: County: olVSbft^ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GRe-Cr I ,/�� YrA.040;"J
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = i Longitude: ❑ ° =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
Design Current
Cattle C*apacity Population
❑ Wean to Finish
❑ Dairy Cow
® Wean to Feeder
v
❑ Dairy Calf
❑ Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Stocker
Non -Layers
❑ Pullets
❑ Beef Feeder
❑Beef Brood Cow
El Turkeys
❑ Turkey Poults
❑ Other
Other
Number of Structures:
❑ Other
Discharges & 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
04o NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: &
Date of Inspection ' 0�
,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?
Structu_r% 1 Structure 2 Structure 3 Structure 4
Identifier: (ram+"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
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 L4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No [INA ❑ NE
[]Yes 22No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tthh eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �/NIN ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [:2 o ❑ NA ❑ NE
maintenance/improvement? ,�,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ClYes 2No ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Zo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes I1J ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Ej,<o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes YN o ❑ NA ❑ NE
�. �a�ti�'.
Comments refer:to,question;#): Ex lain any YES angwers and/,or an�recommendations or any other coinnients. g
�s�'4-'����'k�'i�s�:�i'a� �l"!T4'�.'`�#
Use�draw ngs,,of�facnity t)o.better expllO situa�Huns.a(usey additional p�nges s necsessary}y; +
L
7
Reviewer/Inspector Name o /�/ i �. 'j Phone: 91a —�
Reviewer/Inspector Signature: Date: 1 z5 d
Page 2 of 3 12128104 'Continued

Facility Number: fo— KI Date of Inspection u
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readiLfly available? If yes, check ❑ Yes No ❑ NA El NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Desi n '❑ Ma s ❑Other
g p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,_
O'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [I Monthly and I"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
� �E]
LdN0
❑ NA
El NE
'No
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CI
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L_1,/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L1 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ON
L7 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
In No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ 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
ETNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
�/
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
El Yes
L`'J
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I l-1 Oy Arrival Time: Departure Time: County: e&5ou/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Gwc.G- M"LSU'304.k)
Certified Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = 4 = Longitude: ❑ o = A =
il
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C& WD—a—c ifyj Population
Cattle C►apacity Population
❑ Wean to Finish
ID Layer I I
❑ Daia Cow
® Wean to Feeder g b 6
❑ Non -La er I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
ElYes
[I NA
[I NE
El Yes
VNo❑ NA
❑ NE
12128104 Continued

Facility Number: — fo Date of Inspection +ti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
d 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: LA6-&o J
Spillway?:
Designed Freeboard (in): S.6
Observed Freeboard (in): C. L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
�
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo ❑ 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
EX)❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
LQNo El NA [I 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
❑ Yes
eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�
LJ No ❑ NA [:IN I,
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
Cl Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�No
[INA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
El
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
-Comments (refer to question #): Explain any YES,answers and/or any recommendations or.any other, comments.
Use drawings of facility to better explain situations.: (use additional pages as necessary):
A6
Reviewer/inspector Name a r/ q L L-------� Phone: /d 7Q4 — 7 AP
Reviewer/Inspector Signature: Date: ) o
Page 2 of 3 1 112128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes <o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E]Xo
❑ 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
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
FNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B-,
El NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,/No
IJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus 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? ❑ Yes 0< ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ 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
u No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L'JrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Fact t:y Number 7 I
ivislottwof Water Quality
iviston of Soil and Water Conservation
ther;Agency
Type of Visit ()I7Routine
PI lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Arrival Time: Departure Time: County: U�SLO 'Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: G(Z•6G 14,44114404d Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 5 Longitude: = ° = & 0
Design Cu. rrent Design Current a Design Current
v
� Swme 'r, Capacity Population' Wet Poultry. Capacity _-Population . Cattle s Gapacity>,Population ':
❑ Wean to Finish
54 Wean to Feeder
I JI b
3z."
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .:"
�' ❑ Other
❑ Layer I I ❑ Dairy Cow
❑ Non -Layer I ❑ Dairy Calf
- — ❑ Dairy Heifer
Dry Poultry El Dry Cow
❑N D '
t
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
on- ai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
T.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes fo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
�❑
L7Zo
El NA
El NE
❑ Yes
❑ 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 0No ❑ 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: LAS-00�
Spillway?:
Designed Freeboard (in): ?_A
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Zf 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
2No
❑ 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
<
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Zo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
; 0
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
t,Xo
❑ NA ❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
��
12. Crop type(s) Fes C.f�, (1h)C'w ,S
13. Soil type(s) M xk)j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
24es
❑ No
❑ NA ON E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
e1No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
No
El NA El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,E!�I
E5,f//o
❑ 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):
CeM?UC' .T/- FC-Sw6
ANb LS 9.6AO Y ro
Reviewer/inspector Name
E Phone(
y167 (o-% � 3—
Reviewer/inspector Signature;
Date:
5 0
■ USV G Vf J 1 Z1.60/u'} UUrrrrlrueu

Facility Number: — 7P Date of Inspection
I
ifeguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [ N NA El NE
El Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard. ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dVN
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2rNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
VNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�`No❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ej No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ 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

lType of Visit A Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit grRoutine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted ❑ Certified [3 Conditionally Certified © Registered
Farm Name: eg11oFF Fi9,!/!
........................................ .....................................I.......1.............
OwnerName: ........ C�,,,9 �r�`.....................MKIZ:a,� C,,,e J..............................
Time: ID I5
1perational O Below Threshold
Date Last Opera4d`or Above Threshold: .........................
County: ... ........................
UU.0 ........ ��......................................................
PhoneNo: ... . ..................................................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
FacilityContact:.............................................................................. Title:................................................................. Phone No:............ ..............................
Onsite Representative: .... &l'�P�!�............................................................................. Integrator• .... 2zly.f A'... <..&u%/ D..............
Certified Operator:
Location of Farm:
Operator Certification Number:
❑'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & " Longitude • 4 «
6 ¢ P Design `#�Current�
Swine ; arr �.',Po ula#zo li
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
I
❑ Boars
on -Layer l I j;�XN
7 ?i [�l 'P zit
i l ill
ether
��i `fly J Yft 61W'.Des>Ign,,Ca]
ii y _ r _ i. ij,
Discharees & 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? Cl Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 116 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9110
❑ Yes ;YNo
❑ Yes Ao
Structure 5
Identifier: ......................................................................
Freeboard (inches):_
12112103
Continued

!� .It IF
.'acid 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 ;YNo
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? R(Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes o
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes "J 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 (_;4 W.. JL0.
13. Do the receiving crops Aer wish those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PeNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ;YNO
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 dNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes [ YNO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes AiNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 2 No
Air Quality representative immediately.
Reviewer/Inspector Name J,&f
ReviewerArispector Signature:
❑ Field Copy ❑ Final Notes
Date:
12112103
Continued

'" Facility Number: Date of Inspection 1 :313 1?
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes jO No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel AMP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes O No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes )"No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes XNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes P No
28.
Does facility require a follow-up visit by same agency?
❑ Yes �(No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )eNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes,eNo
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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit .Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Numher Date of Visit: S / 0 Time: �v
Not O erational 0 Below Threshold
Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: Me UGZD�'�' r County:
te.IJ Rlo-3gq
Owner Name: Gee Gt'-s1 by r-" Phone No: zS R3
Mailing Address:
Facility Contact: Title:
Ousite Representative: -1.� ' ' Idl ✓s�! �7y �"�
Certified Operator:
Location of Farm:
Phone No:
Integrator �Gt rd 1 �:�q -b a�a t.v�i Y L L e,
Operator Certification Number:
swine [:]Poultry ❑ Cattle ❑Horse Latitude ' 1 Du Longitude 0 4 1�
Design Current
swine Lapacity ro ulation
Wean to Feeder 1361,0
❑ Feeder to Finish
❑ Farrow to Wean i
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dai
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Nuitiber of Lagoons l ❑ Subsurface Drains Present ❑ La oon Area ID Spray Field Area p
nHolding;Ponds I„Solid Traps
. ❑ No Liquid Waste Management System
Discharges _ Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): 2-6
05103101
❑ Yes )16 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes ❑ No
❑ Yes L3"No
Structure 6
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,
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 ZNo
❑ Yes ZNo
.TYes ❑ No
❑ Yes ZNo
❑ Yes lzfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes •INo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ;No
12. Crop type (:Ll I W A e �� .Sou be A V)S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ETNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ETNo
b) Does the facility need a wettable acre determination? ❑ Yes JZNo
c) This facility is pended for a wettable acre determination? ❑ Yes JZ No
15. Does the receiving crop need improvement? ❑ Yes -No
16. Is there a lack of adequate waste application equipment? ❑ Yes EI'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 'PrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ es .�No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) es ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ff No
2 t. Did the facility fail to have a actively certified operator in charge? ❑ Yes _ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ff 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 _Z`No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,(r,otoetoquestiow:, .) E ptaiin any�,V,ES answorseand/ r any' recommendatio WO, any other. comments,;`
Use'" g tlrawin s of facility tolbetterex❑Field Capy ❑Final Notes
:s�:�
Ne-e d 4o hot ve pi way 41e, q n e, [ ys�'s da'&d w: [�t,, 60144
Opp I;eel � o1i eve-ri+( '4 eve is el.p w�s�eaM�[ys.'1 tr✓ik-,: ,
':;jrPi If, cal -}r'e'vt Gve L14 s W GI;,d, O CC clrrM ak7 /0IJ4•) 10/3" 1 e
J
1016 t 4 10/IB/01 on Ilse kAee'4 c faf •
IaC�
61;-V4 S n bGoV�Yd[ o� �a�oo�'1.
7, TAke vieCcsSgf`1 AL�3on�S-fa e.S4gr�,�r.,3
Nn-�t : 04ke-- itz,v, A04,Zd 016ottelo 4� )e re,,c .•'l-� Ce'vPfiRnd 2COeA-r App'Ot'- we11
Reviewer/inspector Name �-�ipn ee.�/ "� • .� ,, .!?� S �'� � 0
Reviewer/inspector Signature: Date:
05103101 Continued

Facility ldura1 � � ils.Oz of lnspecti-m
Otlor ham
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes XNo
❑ Yes ,ZNo
❑ Yes '0 No
❑ Yes 'No
❑ Yes ,3"NO
❑ Yes ,ff No
❑ Yes ❑ No
05103101

4 x
'Dlvision ofWater -Quality
Divisictin, of Soil and' Water Conservation
:O"OtherAgency,,.>
� fr
Type of Visit Acompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit R
Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: rT �—Gk Time: � Printed on: 7/21/2000
r Not Operational O Below Threshold
'Permitted ©Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
Farm Name: �r `��'"l. .. County: .\.`' ................................. ................ I ......
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ........................................................................ ......Title:................................................................ Phone No:...................................................
MailingAddress: ...................................................................................................................................................�..Q....`.`..1��..'.... ........................
• � �Integrator, Representative .......................................................................................................................................................................... Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
'Design Current Design'. Desig. Current` Design �, Carreat.
Ca a acl .Pia alas
Poultry Capacity Population Cattle C'"
K +, Swine Ca aci Po ulation lion:,
F N` Wean to Feeder U ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
i"
Farrow to Wean
Farrow to Feeder
❑ Other
i ? Farrow to Finish Total Design Ca0acity,
;; ❑ Gilts
h Boars Total.SSLW ,
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnon Area 10 Spray Field Area =,
Ht1iCiWPO`ef1.9 / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the esuhnated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: ...........................................................................................................................................................................
Freeboard (inches): j
5/00
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes D4 No
❑ Yes J�rNo
Structure 6
Continued on back

Facility Number: Date of Inspection .Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 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 4No
(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 VNo
8. Does any part of the waste management system other than waste structures require main tenancelimprove ment? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes EfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )9 No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 19 No
12. Crop type �C— 11,,,� 2�4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N(No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes J No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes ONo
16. Is there a lack of adequate waste application equipment? ❑ Yes ] TNo
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/]nspector 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?
YiQla ignjs or d�fc..... were O ed-O(Wing this;visit;- Y;oo will_t&oive do fufthO _
corres• 6fidence' abbut: this :visit: ' '
❑ Yes WNo
❑ Yes X No
❑ Yes j"N No
❑ Yes allo
❑ Yes 0 No
❑ Yes [21 No
Yes No
❑ Yes ff No
❑ Yes b'No
. , .....: , . _ , .
W question #) '' Explain any � YES answers. a n"dlor any recvim.mendations or any� other comments
acility_ to belter'exolain situations. -(use additional oaQes as necessary):
-�SC!•"2. �i�'CaQ 'r,Q b,G`�C�, ��I C�.o� ira"��\v'•� \I� b�cetw' ����, �� Ci-1--'fir-,�'� f
�1 C:1tr41 G `�k�erte
�-r c4��--�� c� � � 4 e ,e f t
Reviewer/Inspector Name ,., r f: ` i
Reviewer/Inspector Signature: Date: --lye 5100

..? Facility Number: — Date of Inspection of Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
)�No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
UrNo
IT
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
ff
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate Cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
[�tNo
Additional Comments and/orDrawings: i
JAJ
J
5100

;7
Division of Water Quality
Division of Soil and Water Conservation
Q Other Agency 4
Type of Visit X Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRouline O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted #
Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: i ` "' `Jt-�."` �" `` .... County:.... . ? 1G�a............................... ............. I .........
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ...............................................................................l'itle:...................................................... Phone No:
(Mailing Address: ..................................................................................................................... ....................................................... .
Onsite Representative: G R�ir................................................... Integrator:..... . ........i-����..............................................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
I1
r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �•° Longitude �• �� �__
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder d 10 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 10 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 ❑ Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [-]Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes ❑ No
h. If discharge is ohserved, 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? (ll' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo ..
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes *o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identificr:.......................................................................................................................................................................................................................
Freeboard (inches): d d�-
5100 Continued on back

Facility Number: Date of Inspection � Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j2rNo
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
EgNo
Waste Application
10. Are there any buffers that need maintenancelimprovement'?
❑ Yes
IgNo
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
XNo
12. Crop type k. I G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application'?
❑ Yes
ONo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination'?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
gNo
16, Is there a lack of adequate waste application equipment?
❑ Yes
NNo
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
CTNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping necd improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
I WVo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
C'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
Yes
&No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewed]nspector fail to discuss review/inspection with on -site representative?
❑ Yes
ff No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
INNo
�' i*ft>lati6ris:or d�f ci nd� 's 46re potted• &-titig this;visit; • Y04 Will•i•eclriye no further
carresporideike: about: this viset..
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): 4
�� fn�7�t (� ���c��k��-� �►�'�,'1Cr � G� [�1�5-� f..v1.��J '� �y—a+R <<t�l 1^�2eC� �
' f `
i
twz
Sat W t+-�lc j �Ne
Y fsl6m�,,� _

Facility Number: Date of latspection 1_Ll�.I� Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or helow ❑ Yes �fo
liquid level of lagoon or storage pond with no agitation? '' 11
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
IT
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes RNo
Additional Comments and/orDrawings:
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number (r)
Farm Name:
On -Site Representative: �e
Inspector/Reviewer's Name:
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3' F4
- ,Operation not required to secure WA -
determination at this time based on
Date of site visit: a exemption E1 E2 E3
1
Date of most recent WUP: f �`�� 8 Operation pended for wettable acre ..-
1 determination based on P1 P2 P3
Anneal farm PAN deficit: pounds
Irrigation Systems) -circle #hard -hose traveler; 2. center:pivot system; 3. linear -move system;'
4, stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent-pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete.
and signed by an I or PE.
E2 Adequate D, and D3/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting -
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part II1. NOTE:75 % exemption cannot be
P ( P
applied to farms that fail .the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART 11.75%'Rule.Eligibility Checklist and Documentation of WA Determination
fZequirements. WA Determination .required .because_operation .fails one of the.eligibility - --�
requirements listed below:
_'F1 Lack.of:acrea.ge:whichTesultedinmver:applicationmfwastewater(PAN) on:spray.
fields) :accordingtofarm'sdasttwo-years mfirngaWnzecorjds. .
F2 Unclear, -illegible; or lack of information/map.
F3 Obviousfield-limitations-(numerousA tches,failure:to:deduct7equired::._.
buffer/setbackmcreage;-or25%`offotal-mcreageddentfedJriLAWMP::includes ..'. .
small ;-irregularly-shapedfelds=-fields:lesslhan-5mcresfortmvelers-or_lessthan
2 acres-forstationarysprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage -in excess
of 75% of the respective field's total acreage as .noted in table in Part Ill.

Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF*
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER
NUMBER',2
IRRIGATION
ACRES
ACRES
%
SYSTEM
and type of irrigation system. if pulls, etc. cross more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise_ operation will be subject to WA determination -
FIELD NUMBER' - must be clearly delineated 66-biap."
COMMENTS' --back-up fields with CAWMP acreage-exceeding`75% of its total. -acres and having Teceived less than 50%
_,of its annual FAN as documented in the farm's-previous-.two years' (1997A 1998) of irrigationTecords,-cannot serve•as-the
sole basisforrequiring a WA Determination. -:.Back-up fields -must-be-nDted in the -comment -section -and must be accessible
by irrigation•system.
Part IV. Pending WA Determinations -
.P1 Plan Jacks.followinginformation:,
P2 Plan -revision •maysatisfy7-5%,rule based on adequate overall PAN deficit znd by
adjusting -all field -acreage. -to below 75% use rate
P3 Other (ie/in process of installing new irrigation system);

MA
w
Lagoon Dike inspection Report
Name of Farm / Facility dreg Ma hburn o0offlarms) 67- 76
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, xH: IV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Greg; Marshbum, 140� 3� Ram,Sev Road'
Jackonvilig,N-C 2854� 10-346-98842__
9 / 28/ 99 Names of Inspectors ZaNd Uan_
ViMeilt LeM_
4-5 Freeboard, Feet 22 Inches --
54_600 Top Width, Feet 3-4
2 tQ-L - Downstream Slope, xH:1v 4 to I_
Yes X_ No
Yes _ X No
Yes X No
Yes X_ No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X_ No
Engineering Study Needed? Yes _ X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments Waite was leaking, om th b1flding- ageds to ted.

13 Division of Soil and Water ,Conservation Operation Review t 3'
..[3 Division of Soil and, Water Conservation ,ComplEance Inspection * ., ,' E ,°i! E `�
�f ! .3,`-.'� t,t t
3�71v15IOn'Of Water, Quality.., COIiLpllanee Inspection
d
v= a r
�
Other Agency Operaon fRevieW ?� i
El
Routine 0 Complaint Q Follow-up of DWQ inspection O F61low-upof DSWC review Q Other
Facility Number ('� � Date of Inspection G
Time of inspection d 24 hr. (hh:mm)
© Permitted XCertified ❑ Conditionally Certified © Registered 113 Not Operational I Date Last Operated:
Farm Name: 9 ......................
OwnerName:........................................................................................................................... Phone No:......................................................................................
FacilityContact: .................................................... .......................... Title: ............................. .....:............. I............... Phone No:...................................................
MailingAddress: ....................�........................................................................................................,.......................................
Onsite Representative:.O.,"'er!..................................................................... Into rator. � G c ...................
......... K ..........
Certified Operator: ................................................... .......... I ............ I ...................................... Operator Certification Number:..........................................
Location of Farm:
................................................ ........................................................................................................... .................................... I ....................... I ............ ...........
Latitude Longitude �• ��
Design Current Design Cu'rrenf Design Current'
Poultr
Swine �r capacity Population... , y, Caacity.Po ' elation' Cattle Capacity Po ufation
Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ NonDairy
Farrow to Wean .. .. , : �.. ..:
❑ Farrow to Feeder ❑ Other
,' ❑ Farrow to Finish '
❑ Gilts
Total Design Capacity
❑ Boars ` ' . TdtarsSm
Discharges & Stream Ind
I. Is any discharge observed from any part of the operation? ❑ Yes LVNo
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 Sutte? (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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [—�IN0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Freeboard (inches): ............19....!.................................................. .................................... ................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes N No
Continued on back
3/23/99

Facility Number: b 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 main tenancelimprovement?
11. Is there evidence,of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
0
X� No
❑ Yes
❑ Yes
L9 No
❑ Yes
Vf No
❑ Yes
O No
❑ Yes
(9No
❑ Yes
21 No
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?
10 yiQla�tgtis;or d�>fi!cienc�es ry xe ugt;e� dur�rtg this'Asit. - You ivi1i•reeORe �o furtho •
• rorresnoridei7ce: abnut: this visit. :. ....... .::::. .....................
❑ Yes ZN No
❑ Yes [XNo
❑ Yes [gNo
❑ Yes [XNo
❑ Yes gNo
❑ Yes %No
❑ Yes CZNo
❑ Yes [g No
❑ Yes U'No
❑ Yes UNo
❑ Yes [WNo
❑ Yes RNo
❑ Yes � No
❑ Yes 1Rf No
❑ Yes M No
3/23/99

Facilit Number:/
Date of lrispection
Odor Issue's
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
9No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
P 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
broken fan blade(s), inoperable
Yes
6No
or strutters, etc.)
❑
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanentftemporary cover?
❑ Yes
rVl
Vl No
Additional,:qpmments.an(YpF,.rawmgs
3/23/99

_.'. �,.:.s,..,...�''.as si}.sa;...;... ,a a.'. 'a�,w...,,,.« ,z,�....,.,»p.,,i;,,.;'ro.,ro�.,.�..«a.,,«,.�,�,..i
.:D
[3 Division of Sail and Water Conservation 0 Outer Agency
Division of Water Quality
: Y
O Routine O Complaint 0 Follow-up of DW2 ins ection O Follow-ne of DSWC review O Other
Date of Inspection
Facility Number % 7
Time of Inspection a7 d 24 hr. (hh:mm)
Registered -O Certified [3 Applied for Permit E3 Permitted JE3 Not Operational 11 Date Last Operated:
Farm Name:..... 46C /�I/3l�SH Uren/ County:.....4 i C O
.................. .
Owner Name.......................................................... Phone No:.. !a - �1�'f .......... .........................
1t
FacilityContact:... ........................................ ............................... Title:....,QWA).6�................................. Phone No:...................................................
p l
Mailing Address:� .....
OnsiteRepresentative: ........................................................................................................... Integrator:......................................................................................
Certified Operator;............................................................................................................... Operator Certification Number:.................... ..........
Location of Farm:
Q.F..F...........to.........R!l}/.....................`.......c............��f..!....,..........-......d.....r.,`.........`!a.....................
�it�c+
Latitude �' �` �" Longitude
b Design:, :,Current
s` `
Design Current- - - Design Current
Swing; : Capacity', Population
Poultry
Capacity Population Cattle.. Capacity Population,;
ER Wean to Feeder
�Q
Layer
F
❑Dairy
❑ Feeder to Finish
Non -Layer
10 Non -Dairy
❑ Farrow to Wean
t,
a
y
❑ Farrow to Feeder
Other
Oth
..
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
r
Total SSLW
❑Boars
: A
Number of La goons / Holdutg Ponds
❑ Subsurface Drains Present
E7 Lagoon Area ❑Spray Field Area
3
ILI No Liquid Waste Management System
ye,
:...
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 ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ❑ No
maintenance/improvement?
b. 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

•- acility Number: -7-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures La oohs Holdin Ponds Flush fits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard(ft):. a:.5.........................................:.............................................. .............................................
................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
❑ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ 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
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type............................................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3 - No.vitilaitions•ar. deficiencies: were noted during this: visit._ Y.oit.-wvill rec_ eive.no-f4rih'er,
:. ctirrOP66dehce about this'visit:. :
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
7/25/97
• ,-fig., �,.� V;...,w-..��.��µ ;�
Reviewer/Inspector Name
� �, 3
Reviewer/Inspector Signature:
Date: // ? 9

-.,
�� E �] Division of Soil and Water Conservation ❑ Other Agency 4
'`Division of Water Quality f.
. , :�.. .�. •�•F:le.r,'".mp,�,i..;. ..:,r;re�,,:x;.g ; wR'3:, � <«a<: ���?:tmrrYa�sr�r4'x^z-�,�).,: ��d:.:',, ,'�
u '
K �
b �
Routine Q Cam faint O Follow-up of DWQ inspection O Follow-up of .D.51VC review O Other
Facility Number % Date of Inspection
Time of Inspection 24 hr. (hh:mm)
©Registered Certified 13 Applied for Permit © Permitted 0 Not O erational I Date Last Operated:
Farm Name: o ... .r4,Q .5 County:....... !/V C.OVv.........
Owner Name: ........Goa...... IV,l.T.IR49 &.................................................. Phone No: �.��%�...... ....�.$�.....3fo�
............ .... ..
it.
FacilityContact: ............. ............ .............. Title: .,.Q. �............................. Phone No: ............................. I.....................
II
........... ..... ......
// -- �L J oNvi�[.0 "v, C',
MailingAddress:.......(�P..s�...........I ...... D.!....................... ............... ............................................ ..........................
Onsite Representative:..........C7+�G / S/ tl��/... .... InteKratnr....../ 01,.�.. F........................................
................ ............... / p
Certified Operator; .......... Ca.P-..v.".2.� ...�!�����U'e�................. Operator Certification Number, .... �Y1..Q..� �..........
...... ......... ....
Location of Farm:
............................................................ ..............................................................................................................................................................................................................
A
...R.d......... 7......: c�,a.�?..,f. ......,� ?.k,P..r�..6Nz.)...r .... f- ..T�.......
Latitude �' ®` " Longitude ©• ®` i°
Design . Cuemnt
"
"Destgri Current D. esign 3 'Current
Swine Ca ace[ l'a Vulation
a p X P..
Paultry.4
Capacity Pnpulation. Cattle Capactty. Population
,
Wean to Feeder
-
00
,
❑ Layer
❑ Dairy
„ 'w
ElFeeder to Finish
10 Non -Layer
I
I
JE1 Non -Dairy
❑ Farrow to Weant
❑ Farrow to Feeder
❑ Other
y
❑ Farrow to Finish
F6
Total Design Capacity
❑ Gilts5
.;.
❑Boars
Total
SSLW
r
b«<
r,..
F
d S y
Number of`U1i j5 6 / Holding Fonds'
❑Subsurface Drains Present
❑ Lagoon Area
❑Spray Feld Area
�.
❑ No Liquid Waste Management System
a'
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
Wo
2. Is any discharge observed from any part of the operation?
❑ Yes
,4No
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 Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
,RVo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
63:zio
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EIJ�10
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
iv
9No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kor"
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
WNO
7125/97

Facility Number: o
rf —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures_(LagoonsJlolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ?
Identifier:
i
Freeboard (ft) .......... .....................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes N�o
❑ Yes C,No
Structure 5 - Structure 6
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violationsor. der'iciencies.were'noted-during'this;visit.-You:r011 rkei ive-no-fdriher
coerOO idehO ti oW this: vis t: ;
❑ Yes IR No
❑ Yes 'I
Yes ❑ No
Yes ❑ No
❑ Yes /V No
❑ Yes cx�o
❑ Yes JhNo
Yes ❑ No
❑ Yes 5�'No
Ayes ❑ No
❑ Yes kfNo
❑ Yes �KNo
❑ Yes )<No
❑ Yes )4No
❑ Yes 0 No
1 A. N aa> m µow BGilt s i bes tv -Fop
13, NOOK 'fib R6-L6WC MAP_.1464 OND All zu"E 19bic,4-m2 F02 I414If IC-tl6:L
N65b To K"p RLL Fird,05 Maw(yp 4-riD ec,4oJ cot
Z�i. L�aoN M�G�N�u..y ffi��f.� Du2►Nci �,ey PE�o�s 5h'-�4� i.16G� GCr/�s'cS
!�S "W W 444daN PosSrBcEr7S ��sc�ss .
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: 'q-44Date:

m Routine Q Com laint Q FoHow-ulp of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection3
Facility Number
Time of Inspection 30 24 hr. (hh:mm)
�+� �'� Total Time (in hours) Spent onReview
Farm Status.....�r...............y,.,�..........................._...................... or Inspection (includes travel and processing) 2•
Farm Name:. L41. f!..d.: ............. fyo< emu: :... .......................... ....... _.. County: » .. 1 � ..........................................
Owner Name: (.l ............................ ...Lu. G.................. Phone No: .... �. T5, 'ie,.................................................
Mailing Address: .... I 3........�....
......1ZJ ..................�
�n..��.t�1,J1...�.............................
..
Onsite Representative:...ti..l.1f 4 47.........................................
Integrator. ..... A.ti. i:L ......
...............
Certified Operator....... ............
.../ S> v ...-....,., ...,.
Operator Certification Number:......f
.. .� x'Z ..........
Location of Farm:
Latitude 6 Longitude 4 Q�
113 Not O erationai Date Last Operated: ..................... ._.. ......».....»........._.».........-..........__-.... .--................ ....................... -
General
1. Are there any buffers that need maimtenancerunprovement? []Yes [9-No
2. Is any discharge observed from any part of the operation? ❑ Yes Qflo
a. If discharge is observed, was the conveyance man-made? ❑ Yes E],Ko
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) [:]Yes Vo
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 !! o
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [ "No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [2NNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 2�0
maintcnancelimprovement?

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes [-No
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 111197)?
❑ Yes
9"No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[ado
Structures�f Lagoons. andlor�Holdin�Ponds).
9. Is structural freeboard less than adequate?
❑ Yes
ED40
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
Lagoon 4
.......... a. ............ _ _...... ............ .....-_.-.-w__•-__-
-......... _.......... —.--
10. Is seepage observed from any of the structures?
❑ Yes
&i�fo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
GKes
❑ No
12. Do any of the structures need maintenance/improvement?
6211'es
❑ 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 adquate markers to identify start and stop pumping levels?
21fe—s
0 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
9}No
(If in excess of WMP, or runoff entering waters of the State, notify WQ)
15. Crop type .Z.5G i.. :... ........... _...___.. -
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
❑ Yes
M.Ko
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
0"No
18. Does the cover crop need improvement?
❑ Yes
[311Qo
19. Is there a lack of available irrigation equipment?
❑ Yes
[l!o
For_ Certified _Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[�o
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
M-Ko-
22. Does record keeping need improvement?
❑ Yes
M llo
23. Does facility require a follow-up visit by same agency?
❑ Yes
uv o
24. Did Reviewer/Inspector fail to discuss reviewormspection with owner or operator in charge?
❑ Yes
�o
7Z>
er G�t,G�
1
pjt75}} /3c/ /� i ,� *&CC4frilly 7-0 1U i 5 4/R)!$j1
71
ReviewerlInspector Name
Reviwer/Inspector Signature: �i - Date: Z �'�

•
o Site Requires Immediate Attend n:
Facility No,
DIVISION O ENVIRONMENTAL MANAGEMENT,
ANIMAL FEEDLO OPERATIONS SITE VISITATION RECORD��
ATE: 1 d- , 1995
Time:
Farm Name/Owner: Fj5G f--ot okra
Mailing Address; V 3 �� r,, c r:^..c t uc �(r N C 7 J 5
County; ,0 s cv
Integrator:
On Site Representative: 422' -
Physical Address/Location: _ u m
R IP 4
Type of Operation; Swine ✓
Design Capacity:
DEM Certification Number. ACE_
Latitude:
Does the Animal, Waste Lagoon h.
(approximately 1 Foot + 7 inches)
Was any seepage observed from tl
Is adequate land available for spry
Crop(s) being utilized: r f
Does the facility meet SCS minim
Is the animal waste stockpiled with
Is animal waste land applied or spr
Is animal waste discharged into wa
similar man-made devices? Ye
Does the facility maintain ade
spray irrigated on specific
Additional Comments: ry o
et6X e
-7
InspectorName
cc: Facility Assessment Unit
gGlC;l' ���Hd
Phone:
Phone: �f
on �Q_�7 1rCif�cAir�it
Poultry . � Cattle
Number of Animals on Site:
DEM Certification Number: ACNEW
Longitude; ' •-37 Elevation: ,_ _Feet
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
or No Actual Freeboard: _ Ft. Inches
lagoon(s)? Yes or No Was any erosion observed? Yes or No
r No Is the cover crop adequate? Yes o
Setback criteria? 2U0 Feet from Dwellings''.nor No
100 Feet from Wells? es r No
n 100 Feet of USGS Blue Line Stream? Yes o
y irrigated within 25 Feet of a USGS Ml ap 'Elide Line? Yes orV6- \
ers of the state by man-made ditch, flushing systern, or other
o Vo If Yes, Please Explain.
waste management records (volurnes of manure, land applied,
ge with covert' crop)? Yes 0 No
�//
V I f 'V �✓ 1 I > > 1 AJ�- (iL L 1 fir-
Sianatiue
Use Attachmcnts if Needed
ON 377 I r1N'OS�J of L-IH J I41M ;j F,? : -21 96 � 81 911t!