310014_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

!&t Ms 14; .sty the a -g-D - 4EITivision of Water Resources
Faeilit6Nutnber - E� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (Z"pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qr50—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I I Departure Time:l�l� County: tt Region:
Farm Name: W ti( F%—r -y 3-1-3 ijiwl 3— D Owner Email:
Owner Name:g74-46,' Phone:
Mailing Address:
Physical Address:
Facility Contact: oft f ` i Kffl Title: Phone:
Onsite Representative: { Integrator:h+Y
Certified Operator: `f Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dischar es 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 DW R)
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes � o DNA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑rr1 o
❑ Yes [g—No
E3-'TfA ❑ NE
CT —NA ❑ NE
E NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment ,--�
4. Is Stbrage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]-tCo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ��NA ❑ NE
Structure 1 Structure 2 Structure 3 jo Structure 4 Structure 5 Structure 6
Identifier: S- 1 -.3 3�_ -- S/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (� . `t Z'�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes Z?'<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2rNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S C'r+ ' j" S G 0
13. Soil Type(s): MUr x7`0_L1L_ /f (A- r` o r e--7T-
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?
0 4-1 �lJpPdL �i4f �� LC-3
❑-Yes
0 No
❑ NA
❑ NE
❑ Yes
2--No
❑ NA
❑ NE
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes ftfNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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
d"No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F!rNo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: ,.
Awl
,r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[_3e'JL�] NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[-}fi75❑ 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
❑,Pdo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[�r o ❑ 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 []J-i o ❑ NA ❑ NE
❑ Yes EE No ❑ NA ❑ NE
❑ Yes ®oKo ❑ NA ❑ NE
❑ Yes 1a<0 ❑ NA ❑ NE
[:)Yes do
[:]Yes 2.fgo
[:]Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C',C,G
CTS - its
31
4�co-. VA
Reviewer/Inspector Name:
Reviewer/inspector Signa
Page 3 of 3
i 1 Phone: � C `
tore: Date: V.j L
2/4/2t?I S

(0-Division of Water Resources
Facility Number ( - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: o ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `f Arrival Time: Departure Time: I Op County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: k� 4- /,,\ l ,, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: I o 5-7 3-*-
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
I d I Non -La er
Dischar es and Stream Impacts
Layers
Non-L.
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
L`+tfb
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesWNo
�o
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: - Date of Inspection:
J 9
Waste Collection & Treatment
4. Is storage capacity (structurai plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3
Identifier: 3 — t -;-3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SZ_
Structure 4 Structure 5 Structure 6
3 -3-5 y s/g,
w
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�a Z
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
�� 9-O
❑ Yes To ❑ 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 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cl No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ NA
❑-NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[DI o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej`No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: - -31 Date of Inspection:
24.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2-N-o"
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
es
❑ No
❑ NA
❑ NE
the appropriate box(es) below.
❑e 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: _ �'�cI '� S�G
7dr ZPi3
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[D-1Go
❑ 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
io
❑ 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
[D No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to°question #) Explain any`YES answers and/or any additional recommendations or any other comments:. �
Use drawings.of facilito better �4
ty `ez ' p
lain sit ahotise (use., as.necessary):;-
or-lt t�� �i �p`�1
Z„-3s3s
Ta K-e C3, 54'//
/Tq PC-ey'' onite
s4 � l
.Ats , �a 5 5�1.��.(-� a�sLk�� c-r'f�
La L__5o, r V 4 d'07 fit �7
Reviewer/Inspector Name: QV t/I C' 1 o4-e �/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 9 (° 77G 73a/
Date: !2�7l _r
21412015

0 Division of Water Resources /
11
facility Number �3� - /�/ Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Qf Compli nce Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: / Arrival Time: "2�c� Departure Time: n County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative:)
Certified Operator -
Back -up Operator:
Location of Farm:
Swine
Wean to Finish
En to Feeder
eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: F (0 Y�
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Discharges and Stream ImDaetS
Dry routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes ❑-iC'o—❑ 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 D 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 gNoN NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: t
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
Identifier:'` f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
10 ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
3 Z j —3 3p 3-' s_d -7 --Y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3,"Iro—
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rNo❑
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
% No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes �rNo❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ YesgNo
NA
❑ NE
Required Records & Documents
l9. 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
❑ Yes9�N`oo
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 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Plumber: ''� - �' Date of Ins ection: I b
.•
2, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No CIA
❑ 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
0No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
rNo❑
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yest�lo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional pages as necessary).
Jp.pC1
�frV;o s lr 71
t" (r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
hav4 t,cCn 4.%.[. .
Phone: 71,7 7 ,j 7�0
Date:
21412014

(V Division of WaterResources
FaciKty Number - © 0 Division of Soil and Water Conservation.
Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: EZ;Z= Departure Time: ® County: roue tmJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: D(30G- ,)
Certified Operator:
Back-up Operator:
Location of Farm:
Design _Current
Swine Capacity, Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
Integrator: Certification Number: l b (�
5
Certification Number:
Longitude:
Design 'Current Design Current
Wet Poultry Capacity .•Pop Cattle Capacity "Pop. -
La er
Non -La er
Design Current 1.:::
11
Drv.Poult" Capacity,_ _Poo - : -
Pullets
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2 rNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
J 1V
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: at - Date of Inspection:
Waste Collection & Treatment
4.`i[s 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 S� gture 4 tIS vrct_urrei 5 S ctu�rre 6
Identifier: _ _ 3.� _ _ GC_ W�L+�'Ij> �1-b ���!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LP iI Jj d -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [A 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 [a'./No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes hlo ❑ 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 ARDlication
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 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
l2. 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 �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesC3N'o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 51<0 ❑ 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. 0 Yes []�IQo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfalI ❑ 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 �To ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Y 's No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check VYes ❑ No ❑ NA E] NE
the appropriate box(es) below.
TFAareto complete annual sludge survey ❑ Failure to develop a POA for sludge levels
n-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 Qlo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Signature:
Page 3 of 3
7`'' ❑ NA ❑ NE
FNo ❑ NA ❑ NE
No ❑ NA ❑ NE
CJ No ❑ NA ❑ NE
NA ❑ NE
r3/No
NA ❑ NE
❑ NA ❑ NE
Date: ,
2 4/20l

`i�`x V Division of Water Quality
N., "aciltty Number, _ 0 Division of Soil and Water Conservation A
0 Other Agency
Type of Visit: CJCo 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 0 Denied Access
Date of Visit: I TLi3 I Arrival Time: ® Departure Time: ® County: Region:
Farm Name: l Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: yCs i.J'S Integrator:
Phone:
Certified Operator: Certification Number: 9g5r7✓1
Back-up'Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design. Current Design Current
.Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish Doa
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
`Other
Other
L
ayer
Pullets
Other
Poults
Design Current
Design Current
Capacity. Pop._: 77.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
NA
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

F-icility Number: Date of Inspection:Mb
C} 1
Waste Collection & Treatment
4. I`s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jljr � t 2 I--u(Ijb G I. ;5(iG 3-2- SkS-3 P AwC_ 3` S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lt �'1
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 [: 1V o ❑ 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 I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O/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 PI/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?
❑ Y s
[jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Vs
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:1 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ca�o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes VN
[:]Yes
❑ Yes ]�No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
0
0
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
19) NCB 5�=l. TEST . 0-:E�F4XVJ 30 V A'?S , C'A L L, D WK WMT-k
o �C c `?Old --� ZA , .�a PTzl ?UW 00 f7
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: rj _733a
Date:
2 4/20 1

140 Division of Water Quality
V acility Number ©- l y 0 Division of Soil. and Water Conservation
Q Other Agency '.
Cype of Visit: (3rCogpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
teason for Visit: ORoutine O Complaint O Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: '�'J Arrival Time: . 5 Departure Time: County: L-)UP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: D14 J Cr ATya"\_S Integrator:
Certified Operator: Certification Number: - R -
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish aLkjq
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet. Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Cattle
Design Current
Capacity Pop.,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
t✓J 1�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: 5- Date of Inspection: "N
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: W(i!2i W_Jffif s c 3
Sp c 3-3 P C 3-3
S tc
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
(n
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ; 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 [�KNo ❑ 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 �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?
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.
Wy
es 0 No ❑ NA ❑ NE
es ❑ No ❑ NA ❑ NE
[:]Yes C]KNo ❑ NA ❑ NE
❑ Yes 5N�o
o ❑ NA ❑ NE
Yes ❑ NA ❑ NE
[:]Yes M/No
❑ Yes [: o
❑ NA ❑ NE
[]NA ❑NE
❑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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesWKNo
` ❑ 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

11
Facility Number: ` 61 - 4 to Date of Inspection: 7 I i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes UNo ❑ 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
E3�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
YNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
["10
❑ 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
.E�`No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes dNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below, ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
f No
NA
NE
[
❑
❑
6No
❑ NA
❑ NE
o
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain'any-YES answers and/or any�additaonal'recommendations or any other comments '
Use drawings of facility to better explain situations (use additional pages as necessary): �• . , w -
1 c.t�D �D A - KA S 'Z,> L'�-,O cL aC 41, C�IJ Nu Lav6-ER vs�
Tr,t- v/a s-re
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C % —7 �q r
Date: - ! 'L6?__
21412011

N r-
Number ®-
U Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: i�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Oo County: N)PtZ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: - dut )Cj—_s Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Certification Number: 9$ 5 2 3 9
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Canacitv Poo.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Da'X Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Fj/No
❑ NA
❑ NE
of the State other than from a discharge?
M
Page 1 of 3 21412011 Continued

e
Facili Number: - ILI jDate of Inspection: id,
,
t,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0/No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: w&a1 `74 W"� 34q 3-3f
3-1
_ 3-Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i s 3 b Ll'4 59
5. Are there any immediate threats to the integrity of any of the structures observed? V
large trees, at4d
❑ Yes
12fNo ❑ NA
❑ NE
(i.e., severe erosion, seepage, etc.) 2 o,
6. Are there structures on -site which are not property addressed and/or managed through a 3-
❑Yes
No ❑ NA
❑ NE
waste management or closure plan? la. OZ14t
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
If No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2(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
E�No ❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
d No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
E�No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [ Yes ❑ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes YNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes 011No
❑ Yes YNO
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 1 Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑WIN ❑Checklists dDesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DIN
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EdNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNO
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: 3 -ILI Date of Inspection: Iv I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L.Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or.:anyother comments•;�h ,- ,
Use drawings of facility to better explain situations (use additional pages as necessary):
15.) FZc-trp P_)f WAS 7_a Duets A�3vOt 3 Cam use �ipA. Sbz� SAAP�-C
SNdcJS 1(UC1_5 GC-LoA) 3606.
?.a) I..A&avo rjesz&� FoK Qn-EU�vd.S 1n &A� Noosccs t4(-cw To S�b4 lit-0 I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �i>5 11 7 5 i f
Date: i" 1 11
21412011

Facility Number
Division of Water Quatity
0 Division. of Soil and Water Conservation �
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: it EArrival Time: �Departure Time: County:
Farm Name: �Ec-TJ •+Fi- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: D112! LNZAJS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current,
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder oatis-r>
ER Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e 0 g Longitude: = ° = , = ,,
Design. Current. --Design Current F
Wet Poultry Capacity. Population Cattle m. wCapacity ::Populahon',
RILayer
Non -Layer
Dry Poultry:-
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
1
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
N'umber`of Structures, ;:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El
❑ Yes
o
ElNA
❑ NE
El Yes
El No
❑NA
El NE
Page 1 of 3
12128104 Continued

1 r• '
y�l acility Number:^ Date of Inspection l+ 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structqre I Structure 2 ire 3 Structure 4 Structure 5 Structure 6
Identifier: - j 3+1 —Y kKh*i r7—& i-L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 56
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R(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 [2/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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yeso
Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
WNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
Comments (refer to, quest�one#} :Explarn:any YESaanswers and/or any recomu endattons or any other c mo ments
4, ,...
6e drawings'offacility to better explain situations. (use additional pages as necessary`,): z
�
ReviewerlInspector Name
c�
Phone: f — -7 3 9
Reviewer/Inspector Signature:
Date:
Page 2 of 3 4 12128104 ' Continued

�1
Facility Number: — t Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Nc ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;jNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Mans El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P(No
El NA
(I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
64zo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[)No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[)INo
❑ NA
❑ NE
Page 3 of 3 12128104

0
{ 4.
FactlityNumber� '>)
Division of Water Quafrty,;
�vQ,Division of Sotl�and�WaterConservatton��,. h:-
I Type of Visit (b Zloutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access JI
Date of Visit:
Farm Name:
Arrival Time: Departure Time: County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: __ 000&- AT)IZA/5
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: [� 0 0 I [� 11 Longitude: = o = 6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
O� ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
17
® Feeder to Finish
Q a
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
El Other
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
ElDai Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures: F1
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [I 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 Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑NA
ElNE
ElYes
Zo
❑ NA
❑ NE
12128104 Continued

I
V Facility Number: 31 —
Date of Inspection it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 l ,Structure 4 Structure 5 Structure 6
Identifier: Z 3 '3 e 3_ 1 S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5'L s O t? 6
5. Are there any immediate threats to the integrity of any of the structures observed.
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
'LQ 3 �9 `t7
❑ Yes [(No ❑ NA ❑ NE
❑ Yes LY 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 �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CNo ❑ 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 6o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
l6. Did the facility fait 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
E'No ❑ NA ❑ NE
No ❑ NA ❑ NE
9No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
Commen#s(refertogorig#) Explain anyYES. ans�wersand/orany recommendations or any other comments.:
;Usegs`affaerlity t�bettere%lan uahons ;(useadcit Iipages�as necessary):
25,) 5Lv vG F loon tlfrr o a d D YK 3~6�7� S
Reviewer/Inspector Name.` j2'jNPhone:
Y°s'_�
Reviewer/Inspector Signature: Date:
12128104 Continued

f Facility Number: — y Date of Inspection k�
Renuired Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
;ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
01yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PTo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�ffNo
L] N.
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,_,/
ld No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
12128104

�Dtviston of N
Fac >ty N_ u.Mb Q:D�viseon of s
�AOther,Ageh
Type of Visit O CCO pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit C Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Dots Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =] o = ` = Longitude: 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder -b-wo a -
Feeder to Finish 1'90
❑ Farrow to Wean
❑ Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d o
❑ NA
ElNE
❑ Yes
l No
❑ NA
❑ NE
12128104 Continued

Facility Number: - 4y Date of Inspection L 1 u
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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: 33 -Z 3-3P 3S W NpY 3_+4 W(-.Qp-e S4 1JCi.-joe +�
Spillway?:
Designed Freeboard (in): a0'
Observed Freeboard (in): S 4 =(S7 _ � _4 4 ­7 317
5. Are there any immediate threats to the integrity of any of t ructu�� obseryed? ❑ Yes ffNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) I XL1 v o �J�
6. Are there structures on -site which are not properly addressed and/or man ged ❑ Yes [I No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? dyes ❑_,/N'o El NA El NE
S. Do any of the stuctures lack adequate markers as required by the permit? El Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application ,,��,, //
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C'No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L"J No
❑ 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 acre determination?[:] Yes
E:rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�0No
O No
❑ NA
❑ NE
3 -Z sT-rA_A- NE E CS 0 4L-C
P p_cUx_Vus secc.-r $a,J
Reviewer/InspectorName F7 00uo, RitaL- Phone: Lgtb Ici L
Reviewer/Inspector Signature: Date: lL zl 1 b$
I -age l of .f la1Zaiu4 o-unrnnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
111 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
No
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
VNo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYesY�4
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7?40
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fait 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Commentsand/or Drawings:
❑ Yes
2NNo
❑ NA
ElNE
ElYes
EJ o
❑ NA
❑ NE
❑ Yes
EY o
❑ NA
❑ NE
❑ Yes
L"J No
❑ NA
❑ NE
❑ Yes
ET/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

td Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Visit V R Reason for outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j f��� Arrival Time: } a t, Departure Time: County: J Region:
Farm Name:
Owner Name:
Mailing Address:
5
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: A 'Z$jS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= r Longitude: [= ° =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ _ ❑ La er
U DLL I IQ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [n No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑ Yes
Z"'o
❑ NA
❑ NE
ElYes
LJ No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection d"l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Stru ture 3 Structure 4 Structure 5 Structure 6
Identifier: 3--, 3 *- _ s 4 b '7 41
Spillway?:
Designed Freeboard (in):
�y ` G
Observed Freeboard (in): S $— � Zb
3
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes
,,{
EJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
eNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? E I "Y"es
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
;io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
���
E ;11 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E)xo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNoo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,ham
EK
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L3tvo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ 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):
'R_aoeji D ?e_cuzoa3jt LF16_ro�,� .D2+11S, WALLS IX/ NEC o e>F CovEf__ Aj,6 As o-r
7Nss Sospcc rztn N Srr c L Egos. 3 Y .Sa1u6 OF -UO F (ZC- QL r2_6 G-" s5
C60 qW6 4G dN +?-" � wALLL 5 - 5dmMR" OF VOR- _ T6 3E SNaOJ Iv.t 01
Kf,(A0S.
L
er/inspector Name �j6 Ti 4eA)6 ( Phone:(916 ti6 3?er/Inspector Signature: Date:
12128104 Continued

Facility Number:j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EIN""o ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ldYes ❑ No ❑ NA ❑ NE
EKWastc Applic tion ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
El Rainfall �tocking Zc­rop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes GI/No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ'No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �ErNNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ,❑,, Yes b No El NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ✓Lf Xes ❑ No ❑ NA ❑ NE
Other Issues
29. Were anv additional nroblems noted which cause non-compliance of the Dermit 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
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
fTNo
❑ 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
LR o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number Division of Soil and Water Conservation LA
O Other Agency
IType of Visit .j Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: P Qp Arrival Time: g!'30 / eparture Time: Jr,��� County: ���G�N Region: !4 !J
Farm Name:�wner Email:
Owner Name: ir✓vy? 6aArss Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:/ Phone No:
Onsite Representative: f NP©Pl— �� �G , / ' f` G'JS Integrator: � 6624/ -. �tq cj'u
oe
Certified Operator: rA_� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 1:1 V = = 11
Longitude: = c = d [= Ai
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder ,D0 Ii
Is Feeder to Finish 110,0001
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - — -
❑ La er
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EYI-11
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: 'j/ — / Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 54 -5-2 q-30Q2z1V_ 3 3 51C _ mil/- 2 /V -?) _ 4-4
Spillway?: _ 6611 _ Nd NO /VO No AV A41
Designed Freeboard (in): �//', � 2r, 91 H.5' 19' 5"
Observed Freeboard (in): Z2®4q3ZS L Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Z 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
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) B eXi U/0R-/ W9i1) . 5 • G (Cr4A 51!:.A-o ] , C_VR0 , C.�.���7, S©1,664,jy, s � (�.� Z,
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 acre determination ? ❑ Yes /� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes Vj No ❑ 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):
�� �omF GtJo,R)� f iJH�Q,�o
Reviewer/Inspector Name I Y r rF Phone:a��� u3�t7
Reviewer/Inspector Signature: Date:
Page 2 of 3 :/zo/a& 12128104 Continued

Facility Number: — Date of Inspection[((
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yesyj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JAI No ElNA El NE
the appropriate box. ❑ �p El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
$ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10
0 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
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1
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
X.
[I NA
[I NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewerfinspector 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
Additional Comments and/or Drawings:
Page 3 of 3 12,128104
Page 3 of 3 12,128104

s
Division of Water Quality
Facility Number r 0 Division of Soil and Water Conservation ,
— 0 Other Agency
Type of Visit ��C((ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JU Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of'Visit: / Q Arrival Time. �QDeparture Time: i 0 County: IZ41&rztl Region:
Farm Name: /1 5 7�` 7T�G �TfS _ /'� G[��5 Vwner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �✓ Integrator: ,/r1.P�s�l/�./.✓
Certified Operator: �(�� 7f/Z,niS Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0= 6 = Longitude: 0 n 0'I=]"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
(�1 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .0No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes PNo
❑ NA
❑ NE
❑ Yes �KNo
❑ NA
❑ NE
12128104
Continued

Facility Number: 31—
Date of Inspection .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes eNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structuurel6
Identifier: 3 3 weon 3-3 5&_
A)-Z- 3
N�7
Spillway?: Alp /VO O A49
/yo _,_f ), p
Designed Freeboard (in):
Observed Freeboard (in): 20
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )?fNo
❑ 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? 0Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes �No ❑ NA El 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VrNo ❑ 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 Winddow/ El Evidence of Wind Drifl ❑ Applicca�tion Outside of Area
12. Crop type(s) Al"5gln t1,0.4 I / /,* d '5� e. / SEEDV A/ ��S:�s��0gd►.:.4A- s.t�_
3. Soil h'Pe(s)GR�+rfDn11/zGGf ��/ptit/G TOlJ LO�
-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[--]
Yes
/VNo
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 No
❑ NA
❑ NE
,• wry ��-'A =r
ther. Comments (refer to question'ft ,Explain:any YES"answers`and/or any recoinmtt endaotts or any,ocomments -
Use drawings;of facility to better expl.ain.situations. {use addthonal pages: as necessary) q
r. -
1
L!�-G
Reviewerfinspector Name I 1 Phone: !D 6 — fi7./o4f'
Reviewer/Inspector Signature: Date: ZZ (a Q
12128104 Continued

Yr • - 'jo
Facility Number: — Date of Inspection s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes'0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [VrNo ❑ 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
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
�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
D
A�ddi�o`nal-Comments and/or. rawings.: .
,G�}>
2 � fir✓ �,Pa CASs Qi� a.�� /c�z c�
S,
7 4 r< .�a� `N ��PE � L��o�� 3 -z /ate ���.✓
12128104

Type of Visit b Corgoliance Inspection O Operation Review O Lagoon Evaluation I
for Visit QrRoutine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Mune: ! 30
O Not Operational O Below Threshold
Permitted CfCertmed 0 Conditionally Certified © Registered Date•Last Operated or
.WA_bvThreshold:
Farm Name:DV�ARMS o 2S(-F - L----IC County.�Ugt'Tr
_--- -. - ----
Owner Name:
Phone No:........ ... W
Mailing Address:
Facility Contact: ____ .. .. __ Title:._. _ . _ , ___. Phone No:
Onsite Representative:� _ p��„7 Utl�1br`J Integrator: _,_, M Q aXL�
Certified Operator:
Location of Farm:
Operator Certification Number:
w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' r4 Longitude F--j' ` "
-
-- Desegp ;CIIrrea YDe Igu
t Current
�Currt
..
Po lion
_
ci Po Catde r
tiod
= FPS
on:
ffwcan to Feeder l p Layer
Dairy
to Finish �< Non-I.ayer
_= Nan -Dairy
:der
Farrow to Wean
-
Y
Farrow to Feeder
-
`: 4 Total Deftni'Cao a-_tp
-
Farrow to Finish
.
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ N
2. Is there evidence of past discharge from any part of the operation? ❑ Yes l.dN0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ NVNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 _ 3..'Y _ . _. 3" 3 �.. _ W 14 -14 . . _ W E 54.� .
Freeboard (inches): 2S
12112103 Con2tnued

Facility, Number: Date of Inspection
g. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ffNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 0 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑.No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 27No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type iZ6V_T. ^. U0A 10 "Vi
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
L,A(,, J WE 1 + $ RY 35" x�L0(:S ,
❑ Yes
MWo
❑ Yes
L. Ko
❑ Yes
❑ Yes
�❑446--
L2No
❑ Yes 3
❑ Yes 6 No
❑ Yes ONO---'
❑ Yes
�10�
❑ Yes
61 o
❑ Yes
2r il� O
Field Coov ❑ Final Notes
7) C.oj3 T tMUC to %,J uft-iC a rJ (,o JC4Z_ of OT-K_c W A LA,S ,
0 WC "1 Je $ WAsk bV-T Vo.,*v^ Pz-nxa v-"ATtr— 0F1- 140,'-Y�s (L.LHVO-T$.�— to �7,CCL-0,
C� orA 3 2 �ttie� ti��( �1�xt T� t_ac � tj 6-05' A'P'Pt.tca b� u�- C
jv�E; ON APVtt61AT Z04.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112103
Date:
Continued

Facility Number: 31 Date of inspection �� O
i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes O No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /N
(iel WUP, checklists, design, maps, etc.) ❑Yes O7o
23_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rio
❑ 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 U 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?
(iel discharge, freeboard problems, over application) [IYes ffg� o�
27. Did ReviewerMispector fail to discuss review/mspection with on -site representative? ❑ Yes L,d'No
28. Does facility require a follow-up visit by same agency? ❑ Yes To
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �O
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EW9
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6<0
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 0<0
34. Did the facility fail to calibrate waste application equipment? ❑ Yes WO35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes L11-1ro-
0 Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

do
;.
:O,Division:of:Soil and Water Conservation - Operation Review
v © i 'ion of Soil"and Water Conservation "Compliance Inspection
a A
pivWon-of Water Quality w
-
- - Q ty -Compliance Inspechori -
.- . er�A`enc O .eration Review =
M_
©'Oth. _ � _ y " ' P.
I Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of bispection 9
Time of Inspection ia.a0 24 hr. (hh:mm)
Permitted [3 Certified 0 Conditionally Certified [3Registered 113 Not O erational Date Last Operated:
........................
FarmName: .-Yam.. J".."...` 3 WQ•� �32►tea County: -.......?.�1.................................................. .......-. ..........................7.----------I....--............... ......
Owner Name.
..... .]!..l.t&..s.......... .......... Phone No:�Ga4i.—fe
...
Facility Contact: ... ....-.....--..--. .......'Title: --... �` . ....................... Phone No: .......................................
j --....... ................ .
MailingAddress . .............. .......................................... ............I................................................. .................................. .............. ..................... ..........................
Onsite Representative: ......................... '•T . ..... Integrator:........'..::` .%................................................
Certified Operator:...
2✓!�� O Operator Certification Numir: �,.,r�
........................................................... .
P
Location of Farm:
Latitude �' �� �� Longitude �• ���°
Design _.... Current
Design Current Design Current
Swine
Ca acity` Population
Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
I 'a-00
❑ Layer I
I ❑ Dairy
eeder to Finish
jg g%10
ILI Non -Layer I
I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE1 Other
❑ Farrow to Finish
Total Design Capacity_-. E
❑ Gilts
I
- _ -
❑ Boars
Total SSLW ��
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area JEI 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?
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? (Ifycs, 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?
W ste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes UNo
DtYes ❑ No
Structure I
Structure 2
Structure 3
Structure 4
Structure 5
Structure 6
Identifier: W 3rLi
W -/6'
W r) jr
3— l
13-10-
3--3
Freeboard (inches): t
.....................
.........................................................................................................
i'
a9
9
...................................
g
.................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc-)
3/23/99 Continued on back

Facility Number: -- Doty of 11tstwc-tion
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
, ❑ Yes
No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/impro,"O.cment?
❑ Yes
gNo
9. Do any stuetures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
7KNo
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
tKNo
11. Is there evidence of over application" ❑ Excessive Pending ❑ PAN
❑ Yes
ff No
g
�
12. Crop type Gi Q'^"t" p� r J P 1"A_V+�514 t1\- { 59
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
XNo
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
XNo
16. Is there a lack of adequate waste application equipment'
❑ Yes
XNo
Required Records &.Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
❑ Yes
14No
19, Does record keeping need improvement? (ie/ irrigation, freeboard.'waste analysis & soil sample reports)
VYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IVNo
21. Did the facility fail to have a actively certified operator in charge?
El Yes
allo
22. Fail to notify regional DWQ of emergency situations as required by General -Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes tKNo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
�• N6fl ,MMi6n5_or• deiicieni:&. eTC' ROt.@d (�[H to 41llls_vtsit; • Yoit will-feeeive iio further • : •
corresponderzce. about th' .visit . . . . . . . . . . . . ... . .... . .... . . . . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as neces_ satry_ ) -
g Stti G ► rg �1eo—,--cc.�z- LCs
511-4
Reviewer/Inspector Name v, e, o 3` !r-3106 r t?
Reviewer/Inspector Signature: Date: l �_-- lG — 11
3123/99

Facility Number: _3 I — 1 I?ate of Iu.spection
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 property within 24 hours? ❑ Yes �(No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes 2f 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 KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑ Yes j(No
itionaComments and/orDrawings:
4,A
n) G�� �� v--,z;A
V.ees e "emu
3/23/99

Division of Soil and Water Conservation ❑Other Agency x
w Division of Water Quality
19 Routine O Com faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 �
Time of Inspection :Oo 24 hr. (hh:mm)
E3 Registered EXCertified [3 Applied for Permit Permitted E3 Not Operational Date Last Operated:
FarmName; ......5 4-:.....3 ..S.-A.s....i::1-1 ....... w .. ........................ Countv:......bvp.6 ...................................... .......................
OwnerName: ............................ ...... �Cxh�r.............................................................. Phone No:....�`�.La� Z � .-.1 L`ig..........................................
FacilityContact: i�xlx_e<...t... s.............................. Title:....................................--..---..-----..`............ Phone No:.............................----..................
MailingAddress: ... O.L ......nV. ln+-................................................................... ...... Y1a.`►f. ........................................ ... n4i�:........
Onsite Representative:.............�............................................................... Integrator: ......... ku(44.................................... .....................
Certified Operator;
Location of Farm:
...................................................................... Operator Certification Number..........................................
t...vsac f..... ► .L..Q........ 52'. 1.1.3 ..}... Z....af►65.....ie.U........ $&lL13................................................................................................rV
..................................................... .----.................
Latitude • 04 0" Longitude ' 4 44
Wean to Feeder
�p
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
1]LJ Non -
Other
❑ Dairy
❑ Non -Dairy:
1
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
MNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
[)9 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 gaUmin?
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
qj 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?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time c f design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
l No
7/25/97

�4
Faci `ty Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9No
Structures (LagoonsBolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: W..1. .... ..................................3.-..-..3............. .
Freeboard(ft): .............. :. ......................... till .............I:.7.............. ....................................
.
........ ............................
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
[B 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
V1 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
Rd No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type QA.ur+m�..............Yr�u�t�... ffK��.�ST....'.. SxN!.:t...Yttii."06................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
IN Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[3No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�] No
22.
Does record keeping need improvement?
MYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P9 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0 No.vinlations-or. deficienc'ies.were-noted-during this: visit.- You.vdll i•eceive•izo•ftirtlier,
:-:•correspbndenceatioutthis:visit.:,:;::.:•:.::,:,',:::::.:.:;::.:._ : ,.:...........
:
C moments (refer, to -question #) �E�'Ai any answers andlorfany recommendations or any tither comments:
Use drawings of ty W _better eplarn sltuata s (use addttitsnal pages as necessary}�"��t.. x��.
�• C, 6s;or o as aT o��cr chi l[Q We O of Ikon s W 14- 8 -bo`- 5-3 5 kt%j .J 6, ��tc}
reseeaa v1� �� r. 1 ecr t�'1'�f-F� hr��2c� b� ek�u.�►-� of
Gcc9 , e
`l�F
�i}$6p•vGr Ornrno- h1 s.hoLL�g�oeryca LLW. �a
tc a,. tAc_((i rof c.
t
{hJ.��S O1r+�.Sac�(,To's SkoV� LL G1IPJ 3
�iko� ti-F+Wb� r'se-O- S^04jj 6_,—Y4WeC.
WL �V r` Geld V9. WLIu c_#A{l �`or 1 -nwa . 0-1
6UWWJk k.o I-1V . WOW 7/25/97
Reviewer/Inspector Nameso
,F"BEIR
Reviewer/Inspector Signature: Date:

FIkcility Number: �.. �. �. Date of Inspection: 4 zz
Additional„Comments and/or Drawings
vi-ILs Ayi►n,y` oartkss in 4,,_ 1s"'- zkc (Qva" 0f �-3. `iG�;t siou� �Jc OwLcUec -
N fL VA W k Ci-ORCk3-
4/30/97

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint 0 Follow-up of LINT_) inspection 0 .F oll.mv-up of DS1VC review 0 Other 1
Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
19 Certified ❑ Permitted
Date of Inspection
Time of Inspection Lj : _2-0__j 24 hr. (hh:mm)
Total Tirne (in fraction of hours
(ex:I.25 for I hr IS min)) Spent on Review
or Inspection (includes travel and processing)
113 Not O erational Date Last Operated:................................................................................................................................................
SS r. 3 County:... �V �.................... Farm Na�me:.� iM � .1.�............ .....................x..�.i.1
Owner Name: .........r. ............A }y r ....... Phone No : ..........................
........ .. ......... ul,1.................gY...YV14.....................
Facility Contact-.�.1A.1IC.e. �'iVCct'4.5� ..................... .. .. Phone\'a:tD Zr%..'.Ay1�Ler�
............................
illailing address:.. .��..1r.... t?.Y�1[�4tY11,...• �?1.:.......................................... .............. 4..�a......
.....fir
........ ..................... .. ..`{5.. .
Onsite Representative:...g.x l..c .£....... lit. n..&.................... .... Integrator:.......
.Y f ..........................................."..........
Certified Operator:............................................................................................ . Operator Certitication `umber:....... ......
Location of Farm:
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...�.�.w.......►.,!.r.........�. .Ll..l.........�.,..!n �......D.�i.4.tx�
Latitude 3[ 0 4 13T]=4 Longitude • ®° 49
Type of Operation Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number of Lagoons/ Holding Ponds ❑ Subsurface Drains Present ❑ I moan Area [I Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
❑ Yes ® No
❑ 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, slid it reach Surface Water'? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? A
d. Does discharge bypass a lagoon systein? (If yes, notify DWQ) ❑Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes FU 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
mai ntenanceli mprovement?
4/30/97 Continued on back

Facility Number:.............. �....
i
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®.No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ®.No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes allo
Structures ("a oons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ELNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
L• l5
10. Is seepage observed from any of the structures? [--]Yes R] 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?
(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?
M aste Applica don
14. Is there physical evidence of over application?
(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)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For 'fi ciljjjes Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
® Yes ❑ No
❑ Yes allo
❑ Yes E[No
B Yes ❑ No
❑ Yes 9[ No
®-Yes ❑ No
❑ Yes E[ No
❑ Yes J3 No
❑ Yes ®_No
❑ Yes f9-No
® Yes ❑ No
0-Yes ❑ No
Comments(refer to'question f#) Expla°any YES'answeis and/or' any recommendations'or any other comments
Use (rarvings of facility to better explain situations'. use additional pages as necessary} t
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Reviewer/Inspector Name
Reviewer/Inspector Signature: r �`� � ,, , - Date: 3,1 4q
v1�t
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
DIVISION OF ENVIRONMENTAL MANAGEMENT No.
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7+2 (o , 1995
Time: / , S 7
Farm Name/Owner: Fgr,#75 Sec&A 3 3
Mailing Address: Po i6o X '75'T 66se 1411 23459
County:
Integrator: SI
2✓,o? 5
On Site Representative: 6ri e &Y?.n 5
Phone: 28q— 2 11
Phone: 2 89 - Z 111
Physical Address/Location: _(_ VV 2TSCY7 Na • 11121 t)c 10-
Type of Operation: Swine ✓ Poultry Cattle J 5h "49
Design Capacity: -7q Z O Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 4," 5'3 Longitude: U_" 0 (P ' 33.1a Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 9or No Actual Freeboard: �3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No : Was any erosion observed? es r No
Is adequate land available for spray? or No Is the cover crop adequate? Yes r No
Crop(s) being utilized:
m
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue'Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 0& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with co Iver crop) Ye or No
Additional Comments: _-- 2 S_ ��� Ll ':2_q.CXj1 ' r low oe- �-::or Fm fiP !l
zs f �E
Inspector Name
cc: Facility Assessment Unit
s
zz�� /" -_
Signature
Use Attachments if Needed-