310064_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua

Date of Visit: i2 Arrival Time: 1 Departure Time: 'Di/ County: Region: JnP
Farm Name: 4?r ); 419'7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �t Title:
Onsite Representative: I� wIlhrA i/h
Certified Operator: &bi sr'-?
Back-up Operator: +Gl l eklsal'
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: 26 Q 3
QQ
Certification Number: I qr� 5-J.5 2
Latitude: Longitude:
D'esygn ; Current
�,- 4.� ' Designer Current • �,
-,
Swine
Capacity Pap.
Wet Poultry , Capacity Pop
...
.
:,
Wean to Finish
Layer
Wean to Feeder
Non -La er
Feeder to Finish
59EV�=,,.:
Farrow to Wean
m - Design.q_Current
Farrow to Feeder
D i?oultry . ~ Ca aci K.Po
F o t F'n'sh
La
arr w o i � r
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
D8CitV :-CPflD.•�-- �.d'.�
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
jo No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�KNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - 6tl Date of Ins ection: 2-/
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
fo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � r' -��/ 2-vl i,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E, 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 Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes do ❑ 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 0 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
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
En"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[r No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/rNo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6. No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EDINo
❑ 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?
El Yes
WNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: -1.11 jDate of Inspection: /Z
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 [allo ❑ 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 t'J 1V0 [:3 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �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?
Comments (refer to question #), Explain any'Y,ES4answers•,an&
/� io"ewoo'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
[:]Yes Vo ❑ NA ❑ NE
❑ Yes E Vo ❑ NA ❑ NE
❑ Yes EJ�No
❑ Yes 12<1
❑ Yes VNo
"Ir
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: l j
21412015

SrDn,OftWater�ResoarCes
F,aciliW Number - 0 DIVIS1Dn ofSo�l,and WaterConset��ation ,
Other Agencyg
Type of Visit: QXempliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: J�Outiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L L Arrival Time: © Departure Time: County: �/�//, Region: L' f
Farm Name: rt Owner Email.• �^
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:t,� Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
,_-w�
.. Des- n Current Design r... n
Design Current
Capacity =:Pop Wet�l?oultry. Capacity�'p'
=Cattle
C$pacrty Rop.
Da' Cow
Y La er
Non -Laver
DairyCalf
Da' Heifer
w
�'� ,F
- DesignCurrent
D Cow
D . Piiult , , Ca ` ct Po ..;
Non -Da'
�
Beef Stocker
La ers
Non -Lavers
Beef Feeder
Pullets
Beef Brood Cow
.�
Turkeys
Otherg TurkeyPuults
;w —Other Other
r
if
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
�.
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q'ITo ❑ NA ❑ NE
❑ Yes ;�J'No ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes
�Ro
❑ Yes
❑ Yes
Jam-' "'o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

Facili 'dumber: -Q 113ate of Inspection: 1 1-3 7—ZZU
Wa a Colldction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IzNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes VNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .I J 7!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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
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
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
[,] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[2�'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
�No
❑ NA
[] NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] YesYN
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yeso
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I
Facili 'lumber: - Date of Ins ectiori:
24. Did tl e-facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZ No ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes L2"No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
[:]Yes j'No ❑ NA ❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
[;;rNo
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes 3-Vo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �' o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes TT�� o ❑ NA ❑ NE
Comments(refer, to�,questran #} Explain any YES�answerssandloc<any additional recommeq . # ons or anyto ttierxcomments. -
Use drawrn s;;of facrli ' t©', titter ex'lam situations: use.aaditjonal a es,:as necessa ' ' z
' se`yj- B � �Gt� G�Gr'� i�,- cS14,4G cS`u�/ Q fl`+�2rtBta.,
r /7PA-) AA-ol A G 6Jf-
���'.-r1 lad1� green .- _
• �Garc�S //? 7ac>C o`rreeiC
Reviewer/Inspector Name: l.C(/ h
Reviewer/Inspector Signature: 1 -
Page 3 of 3
Phone: i ! a
Date:
21412015

l
ivislon of Water Resources
Facility'Nurnber
-
0 D�v'sion of Sod and Water;Conservatton
G 41
m
o Y �.�
Type of Visit: Q Compliance Inspection O Operation Review p Structure Evaluation O Technical Assistance C7
Reason for Visit: Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: ?� L/ Z Arrival Time: Departure Time: County: Region:
Farm Name: �a A Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: l C Q (1, n lot
Back-up Operator: _ tA 4, n 6 ('m s O r%
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: Z 0? S
Certification Number: � n S-S-z
Longitude:
g Design Current * Design Current Desi Current
y Sryme x Capacity, '-Pop et WPointry Capacity Pop, Cattle.:=Capacity
Wean to Finish
Wean to Feeder
eeder to Finish
�t
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I:.Other
I Non -
La ers
Non -Layers
Pullets
=�
Turkeys
Turkey Poults
Other
„3
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 -Da
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes LZ No ❑ NA [:]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
En No
❑ NA
❑ NE
Page I of 3 21412014 Continued

1
. Facility Number: - Date of Inspection: Z
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 �j No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t ; _a o /.1 ti �.5 E7 O {� !A
I �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'L�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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
t[-t 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
m 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
❑ 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
(2] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
m No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Y I No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V1 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i"Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes m No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

t.
f L
Facili Number: -& jDate of Inspection: '_ O
24. Did the facility fail to calibrate waste application equipment as required by the permit? � Yes le No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 0 No ❑ NA ❑ NE
❑ Yes 01 No ❑ NA ❑ NE
❑ Yes lu No ❑ NA ❑ NE
❑ Yes ❑ No �fl NA ❑ NE
❑ Yes Z No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer"to question #): Explain any YES answers and/or any additional recommendations or*ny other comments
Use drawings of to hetter•ex lain situations use-additiorial� a es`as-necessa
g t}' P C p g r3`) .�
W1,I)or 1.01
(�/v/
F'rltk`)
�Al
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'I V.)776 7334
Date: ZZ2 0 / S-
21412014

~ Dtvrsion of -Water Resources
�Facil N_ umber 0 Division of Sod and Water Conservation
Q Other Agency -
Type of visit: 91compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: _G Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: I y.30 eparture Time: County: ntideL Region: 1 &
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �yt��4, Integrator:
Certified Operator: Certification Number: �t z eq - 2a'%
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
Design Current Design ::Ci
Capacity-Pop.-..� =Wet Poultry Capacity w l
Layer
I jNon-Layer
llrv-Pn11 �—�°[
Pullets
Other Turkey Poults
Other Other
Longitude:
rrent , e Design Current
op Cattle ' Capacity-, Pop:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther:
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0
[]Yes V�fNo ❑ NA ❑ NE
❑ Yes '�2f!No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes No
TT
❑ 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)
ElYes o
❑ 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
ElYes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

[Facility Number: - Date of Inspection.'
.x
�C6 aste llection & Treatment
.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PrNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ 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 G]/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 j'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑60 ❑ 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 JgNo ❑ 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 )ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Plflo ❑ NA ❑ NE
acres determination? %
17. Does the facility lack adequate acreage for land application? ❑ Yes [aVo ❑ NA ❑ NE
IS. Is there a lack of properly operating waste application equipment? ❑ Yes ENo ❑ 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 ❑ Yes �El"'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;21)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 ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �2 o ❑ NA ❑ NE
Page 2 of 3 T 21412014 Continued

D Facili Number: - ate of Inspection:
24. Didi46 facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ro.
Comments (refer to question #): Explain any YES answers and/or'any'additional recommer
DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
[—]Yes PfNo ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
[—]Yes V(No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
ons.or any_ot er comments.. r..
Use'drawings of facility to better explain; situations (use additionalpages�as necessary). _ a _-
ti
/'z/,3�/3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
s lC440 Su"/'/eb e)L. - W-1 1-I 1 V«. 2a lY
r
0.'L c - fc cdl-dJ look 5 (;Gd .
Phone: ! d�
Date: Z
24120114

-:'0 Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
4 Q Other .:`
rype of isit:mptiance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
season for Visit: _(>�outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Ci parture Time: County:
Farm Name: �2pP Aa nm Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: fir,
Facility Contact: Title: Phone:
Onsite Representative: 1-51ZZW iz1fu==j Integrator: A/A;
`?6"s s L
Certified Operator: Certification Number: 0
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
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Ury roust
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design - Current sl
Cattle Capacity Pop.
Dairy Cow
Da'y Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes P3'No ❑ NA ❑ NE
❑ Yes )2'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued
_4

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,Fee [D NA • ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 1214o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes',L3No ❑ 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 eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ��/No ❑ NA [3 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require
❑ Yes PyNo
❑ 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?
❑ Yes 124vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 4�f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes P3'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes '0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )2no
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .[�j No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I? f 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 ZrNo ❑ 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: -r. Date of Inspection: �2 3
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 ETNo ❑ 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 Ea No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;3,No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
f'-'
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesA 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)
'z
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes G^o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Z No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes XNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes jaoNo
❑ 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).
i
;2<Z//I3
Reviewer/Inspector Name:
!� 70 Z
11. q'3 ® ' ctl
O s%Jb `' 60
1'yz b a ILK + -e 512- h))
A' o r, ask- awS1 s,
2, S U,� cvc4 . UP11 l t dot �-
36 S
rqr,1 . + rc Co1'6/S
Reviewer/Inspector Signature: Zr=
Page 3 of 3
r
Phone: , ALL
Date: 3_
2/4/2011

Q Division of Water Quality
kaeility Number - Q Division of Soil and Water Conservation
0 Other Agency =`
Type of Visit: e4O Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: _2'Rtoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name: _ �— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title:
Onsite Representative: I /Gr �Tl-!:3
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
can to Finish
can to Feeder
eder to Finish
rrow to Wean
rrow to Feeder
rrow to Finish
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: vq
Certification Number:
Longitude:
Design Current Design Current Design
Capacity Pop. Wet Poultry Capacity Pop. Cattle` Capacity
Layer Dairy
Non -La er
Dry Paultry
Design Current
ranaeity Pan
Layers
Non -Layers
Pullets
_Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Current l
Pop.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Current l
Pop.
Caw
❑ Yes 2 No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes 2fNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes C;tNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes �No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes�[:] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: IDate of Inspection: '
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P3'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONO ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2- —5—
—:�? 7 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ'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 j2TNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesZj No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesCrNo ❑ 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 Z"N o ❑ 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? / X l --
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 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4�fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes_, F,/rNo
❑ Yes ONO
[] Yes 0"No
❑ Yes .0"No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 8
24`. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes A" No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo ❑ 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 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J25No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��o
❑ 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
JZ 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
E f No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'VNo
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
VrNo
❑ 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). r
-27/12- z_ 2 r Gd,/ o
0, l'3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214120111

Fac�llty:Numtier
l
,-♦p 1�inse66 of Water.Quality
0=Division of Soil and WaterConservation
0 Otlter` Agency
Type of Visit -4a"Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit-C7Routine 0 Complaint
s� 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
����
Date o£ Visit: G Arrival Time: C // t Departure Time: County: RegioitY
Farm Name: 2'� &Z 3 Owner Email:
Owner Name:
Maiting Address:
Physical Address:
Facility Contact: /� Q Title:
Onsite Representative{/
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:
Phone No -
Integrator: M
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = A = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P�No ❑ NA ❑ NE
❑ Yes 0'1�o ❑ NA ❑ NE
❑Yes ❑No ❑NA El NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 'NNo El NA El NE
ElYes. IC! No ❑ NA, ❑ NE
Page I of 3
12128104 Continued

Facility Number: Date of Inspection « l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3� �!
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ?fNo
❑ Yes dNo
Structure 5
El NA ❑NE
El NA El NE
Structure 6
❑ Yes PrNo []NA ❑ NE
❑ Yes P�rNo ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z^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 �l to ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2< ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[--]Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IQ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Cl Yes
[/No
❑ NA
❑ NE
Comments refer to question,# •'. Explain any YES_ answersandlor any recommendations or any other comments
Use drawings of facility to.betterexplain situations. (use additional pages as'necessary)
Reviewer/Inspector Name L
Reviewer/Inspector Signature:
Page 2 of 3
"... Phone:
Date:

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L?�o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n 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
Eio
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
oNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Rio
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[a<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q-N'o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L 'I<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) •
1
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
Add}}it��ional"Comments and/or Drawings
S l V/
2
3
ec .
Lr
ush �
i r
a �i � � �
t
of GEC S e a
Pe wrzM
Page 3 of 3 12128104

jewvision of Water Quality
;EaciliNumber 6 0 Division of Soil and" Water Conservation,
hr c
0 Other Agency i a
Type of Visit Ocompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: Departure Time: County: Z 24 Region_ ./11�1
IV
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: / Title: Phone No:
Onsite Representative:) ���`'l�ay7 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
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: E] o ET E__1 Longitude: [� o❑ d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�I ❑ Nan -La et
Dry Poultry
❑ La ers
❑ 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?
i
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dair Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EJ
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 ,ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1_21�o
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — 6 Date of Inspection o� U
Wee Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1.2— 13
Spillway?:
Designed Freeboard (in): 7 L %nS
Observed Freeboard (in): A
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes .' No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
[:]Yes Jallo ❑ NA ❑ NE
❑ Yes Q'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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F,?No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 ❑ Ap lication/Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .8 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes ETNo ❑ 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):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: �� vZQ e
12128104 Continued

Facility Nprnber: Date of Inspection 9*ff
Rerleired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes , [�j No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ffNo ❑ 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 .E] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ITNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ayes ❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0Yes ❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Jallo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �?No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes P�Vo
❑ 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
ElNA
❑ 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 � o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes El -No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes .�No
❑ NA
❑ NE
:'dtiliional"C. It
dmm6nts and/oDrB►VI[Ipppp r t r ye y r 'u =}
f
l M,
CCl'l/�/`cGrlo`rS
,16'r1w �f
a n `ay oon -E
12128104

[Permitted
Farm Name:
Conditionally Certified
Time:
Threshold:
Owner Name: -- - - .-- _. . Phone No:.
Mailing Address:
Facility Contact:
Onsite Representative: -------------
Certified Operator:.
Location of Farm:
�Phone No:
Integrator:..
Operator Certification N
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • ` " Longitude • 6 Du
Discharges & Stream humets
1. Is any discharge observed from any part of the operation? ❑ Yes A 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [--]Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;?rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P040
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: . __ _ .2— __ . _ !�._s ..
Freeboard (inches):
I2112/03 Continued

Facility Number: —,, Date of Inspection U
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
PINo
of seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
&No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuca= 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
No
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
JVNo
12. Crop type &Z�L-
e__1
J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N
A
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
�No
A
16. Is there a lack of adequate waste application equipment?
❑ Yes
© No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
[j Yes
No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
9No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
' No
roads, building structure, and/or public property)
ep
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
No
Air Quality representative immediately.
C (ref+er to q�oa t#} amqYl�= andlor aay . �:arey ot�in_ ...� �.
Lise�drawn� o_#`��o biter ��{� � gages �: 9r � ❑ Fteld Copy ❑Final Notes �'�.
j�e
Reviewerdespector Name
Reviewer/Inspector Signature: Date: .3 >
12112103 ` Cominued

Facility Number: 3— Date of Inspection b
Reoitired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P*io
❑ 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 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Xio
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ;2�No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P'qo
28. Does facility require a follow-up visit by same agency? ❑ Yes fijNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) OYes ❑ No
31. If selected, did the facility fail to install and maintain rainbr+eakers on irrigation equipment? ❑ Yes �No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes AfNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes XNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Lagoon Dike Inspection Report
Name of Farm/Facility QEF % ?j (v
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
Names of inspectors
r
Freeboard, Feet
K7, A Top Width, Feet
Yes No
Downstream Slope, xH:1 V q [_(1/
0
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Yes No
Yes No
Condition of
YePtNve Cover
Grass reel)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? -Yes. No
Engineering Study Needed?
Yes _Y No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes x No
Other Comments - CVPe.IL o, oU

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:lV
Embankment Sliding?
(Check One, Describe if Yes)
/Pg Names of Inspectors
(1, . lL16a'Arrz_
�j Freeboard, Feet
AC- _ Top Width, Feet
Downstream Slope, xH: IV '911, 1 -�
No ys �� 4'.
oe
i� As/,
Seepage? Yes No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
6 'Ve five Cover
Trees)
Did Dike Overtop?
—X--Yes No _ OR— C1go a c,,_
Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes _ No
Is Dam Jurisdictional to a Dam Safety Law of 1967? Yes No
Other Cigrm
,tip: �tik

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Siope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
b tat e Cover
( �rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
3t- 0L
o F'r r 9b (�
ram(
act J9 '7 Names of Inspectors
Freeboard, Feet
fk-c- Top Width, Feet �S
I (J Downstream Slope, xH:1 V
Yes No
Yes No
Yes No (X•C Gv Y-4 adz{ "n— �•[.[
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Yes �,L No T
Is Dam Jurisdictional to the Darn Safety Law of 1967? Yes No
Other Comments

Type of Visit -Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visit: , 6�� Time: �
Not Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: tE/i6 /C A"-b .7on J YIr't County: xa of
Owner Name: #0 G, _ , [%�4Ft 1¢ j� &A Solt Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: A)hP/
Certified Operator:
Location of Farm:
Phone No:
Integrator: WU✓.0h II
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` 0" Longitude ' 4
Design Current
awme
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacitv Population
❑ Layer ❑ Dairy
❑ Non -Layer I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ®• ❑ Subsurface Drains Present 11131,agoonArea 113SprayField Area
Holding Ponds I Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes '', No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (g No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes L§No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L &No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: 1 2
Freeboard (inches): Z% S7Z
05103101 Continued

- 'i
Facility Number: 31 — Date of Inspection r7 OL
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes ® No
❑ Yes No
Yes ❑ No
❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes O No
11. Is there evidence of over appliccation?) ❑ Excessive Ponjdiing ❑ PAN ❑ Hydraulic Overload /� ❑ Yes ® No
12. Crop type &-maAf, ` T / /SIG 7'7 Y ACLuc (6raze) a�4'rc/Ie4zin
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
V1 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
U3 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
91 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�,.> -
Comments"(refer to question #} Explain any YES`answe"rs andlor any recainmendahons�or�any other Oents.'`
Ilse drawings of iacilityto. etter explain situations. (use atii>thunal pages as necessary)'.
❑ Field Copy ❑ Final Notes
#U f1AM Pd It, e))5 kS;A)
INd �o d�� I� '%#Ae- I,^ -��`?d e, % 1f,J ! d� �- 3 , � A;74-' ZA /2?& it
f ff
-,Vied t� fe" W- oldf -Ar lN¢f'r
}�Q rest �� �kr�l'L �- � GC s� -T Sl` �s Aee� l�le-�fa1% ffG✓e� fe�v�
e cGr S �/� i t< r� t 4 e= GAO rte h L d
..
Reviewer/Inspector Name ( ��
Reviewer/Inspector Signature: Date:
05103101 L� Continued

Facility Number: 51 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ONO
❑ Yes E[No
❑ Yes CO No
❑ Yes N No
❑ Yes $2 No
❑ Yes 1P No
❑ Yes ES No
05103101

Dtvision of,.Water: aliE3' .. -
y x
Division of Soil and Water C6uservation '
-
Q,;Otlier Agency ... ..
-
Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 001houtine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: liddel I Time: 1 I3. rj' Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted [] Certified ❑ Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .............
FarmName: ....... i ................................................ County:. ... ..i..v....i.....................
OwnerName:.........l.!................................................................ Phone No:............................._................._.......................................
Facility Contact:
Title:................................................................ Phone No:
MailingAddress:..................................................................................................................... ................_......._........
Onsite Representative: t� . r' ''? O1'?�.._L'.y.h...�..`..�Aree�LI� g P" V !'�k...
j ....... ... ... Integrator:_
Certified Operator :................................................... Operator Certification Number: ..................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude ' 9 it
_ Design
Current Design Current Design Current
ci
Poultry CttleCa
Population Capvi6ity. P6pullafl6n
Wean to Feeder
❑ Layer I ❑ Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
_ Farrow to Feeder
❑ Other
F -E: Farrow to Finish
w�
Total Design Capacity
Gilts
zP Boars
Total SSLW
710111
' Ntyreeter of Lagoons'
3 Subsurface Drains Present ❑ La �►nn Ares Spray Field Area
❑ g ❑ P y
-
t Holfding Ponds /Solid Traps ,<
❑ No Liquid Waste Management System
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................}...................r......................_.....�........_._................................................ .............................
.. ..... ........
Freeboard (inches): 5 58 49
sma
❑ Yes XNo
❑ Yes �6o
❑ Yes No
h q
❑ Yes ONo
❑ Yes ONO
[]Yes jNo
❑ Yes,.5-No
Structure 6
Continued an back

Facility Number: 3 t — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes -�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes jal4o
(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 maintenancelimprovement? ❑ YesET-No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ATNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes-4:fNo
11. Is there evidence of over application? y❑��Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes J No
12. Crop type 900✓Kve(ci f'g r,u ii J�au Fescye 6.moti e.
13. Do the receiving crops differ with thohe designated in the Crerti
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?
Animal Waste Management Plan (CAWMP)? Yes ❑ No
❑ Yes -dNo
❑ Yes _'No
❑ Yes ONo
❑ Yes ONO
Required Records & Document
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
To *iolatiods:ok- defelondes were pied Owwg Ods'AWIt; • Y:oo 'W tteoiye do rut�tho . .
c6irs�o> dent' about this visit.
❑ Yes JZ�No
❑ Yes _[3'No
❑ Yeses 2No
Yes ❑ No
❑ Ye�No
❑ Yes ,❑-No
❑ Yes �No
❑ Yeses®No
❑ Yes_No
❑ Yes,,,ff&o
13 . rrz 1d Z rv11 s 4 4.4 S dec.'c to Cd cs berotv4r, end vvvil oei ;n -eke
WaA p[c,n 64 -f kCV e' if -Pellcve 6Vt +�1e,,n J?I -JIe JPi0td - Need 4o
1 S, 411, vQ WaSf e r4q - Gt r►� Gfa�O i �z e 1�C, !i"
Ive-ed +o ioe47 ra%� r ,
wrn �' G roar an Fie Iq L4 leas ed riej d , IV -e ?o( 4a
em AR
d��� w ►'� dD dq s of
ezPPC, cc,,4torn eve-n 4s .on 4tie -:rX -2' _
Reviewer/Inspector Name
p Sao rLe.: Reviewer/Inspector Signature: Date: i S/pp

5
Date of Inspection
Facility Number: "7 — j !
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes'13RO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ��o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J;?'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 O"No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JVNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes ❑ No
4ddifional Comments ail or.: rawings: _
D VC V-A 1 4e �a a; v q 1 C ra�Ds1 ✓`ec are o eql y ke
5100

. .1
Lagoon Dike Inspection Report
Name of Farm/Facility _3` &q
Location of FamvTacility 0 6 d"
Owner's Name, Address t3A4R f 1AJ50,t1 _
and Telephone Number
Date of Inspection ;)q Names of Inspectors _ H-- 5;14,tsCrM
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
t
1P Freeboard, Feet
2! 7— A--- _ Top Width, Feet
_ c,
ts'
Downstream Slope, xH:IV -,9 F(. 1 -
Embankment Sliding? Yes No _ OKO� _
(Check One, Describe if Yes)
e AP
-
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes) �
Condition of
Ve five Cover
ras Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to e Dam Safety Law of 1967? Yes No
Other Cia TT
�J �, w- pf >✓�

1E
Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
:?l— fvC
M
act 19 `j Names of Inspectors �-1314A.[Sc,�
i
Freeboard, Feet 3Q
1k�= Top Width, Feet f S
Downstream Slope, xH.1V
Yes No
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No�
(Check One, Describe if Yes)
A, .UA.,' � � .a; rAaj4- ,nj
Condition of
to e Cover
ass rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?'
IY ..mow111111
_J >
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Yes �C f
No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility /g/ c 1S1
4, 4n- lc
Location of Farm/Facility
Owner's Name, Address
i3Fr—)j5d_.✓
_
and Telephone Number
Date of Inspection
Names of Inspectors
_!�[ nEscil.x
Structural Height, Feet
r
1b
Freeboard, Feet
K7,
Lagoon Surface Area, Acres
6k
Top Width, Feet
Upstream Siope,xH:1V
Downstream Slope, xH:1V
` F4I ( V_ _
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
Seepage?
Yes No
(Check One, Describe if Yes)
Erosion?
Yes No
(Check One, Describe if Yes)
Condition of
g , 've Cover
Grass rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
�11 ,
!� �r
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Engineering Study Needed? Yes _ 4 No
Is Dann Jurisdictional to the Dam Safety Law of 1967? —Yes, No
Other Comments C'VeAe4 % 9, oc..r`
1� A�
aA&a�444&-e4

Facility Number Date of Inspection
Time of Inspection 1 24 hr. (hh:mm)
Permitted 0 Certified p Conditionally Certified 13 Registered 13 Not Operattona Date Last Operated:
Farm Name: &raid.Ba:insortXzrjn..................................................................................... County: Duplin WIRO
Owner Name: HutbA rt.Rmcilay................. Brinson ...................................................... Phone No: 91II-285-297.3.or..916.7.285:39.81......................
FacilityContact: .......................•---.--.............-...---.............................Title:............................................................... Phone No:....................................................
MailingAddress: P.O.Box.J31............................................................................................. CWEL uapin..NC................................................... Z852.1...............
Onsite Representative: .......................................................................................................... Integrator:.lhlurphy..Family.Farms......................................
Certified Operator:HabartA.............................. Brinsoia ............................................. Operator Certification Number: lfx7.0.............................
Location of Farm:
Latitude ®• ®� ®`
Design �_ • urrent-
Swine Capacity_=Popalation
❑ can to ee er
® ee er to mts
Farrow to Wean
❑ Farrow to Fee er
❑ Farrow to Finish
p Gilts
❑ Boars
Number. of -Lagoons ® u surface rains resent ❑ Lagoon Area ® pray ie rea =-
Holdiog Ponds;! SolidTrapse= . ❑ No Liquid Waste Management System -T
-
Discharges & Stream Impacts
1. , Is any discharge observed from any part of the operation? p Yes p No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? p 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 p No
2- Is there evidence of past discharge from any part of the operation? p Yes ❑ No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway ❑ Yes []No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............1.R.............................. 3fa ............... .-...-...-.....3Q................ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes p No
seepage, etc.)
3/23/99 Continued on back

Faci ity Number: 31_64 [late of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
❑ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
[]Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[]No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
p No
b) Does the facility need a wettable acre determination?
❑ Yes
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
p No
15. Does the receiving crop need improvement?
p Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
p No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did ReviewerlInspector 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?
p Yes
p No
C[ :Div:viulations:or' -deficiencies:were:il-oted during: this :visit. - You will •receive' na further. ' ::
....... . . . . .........................
corresO66deki Ooit( this:visit::::::::::: : .::::::::::. :
Comments (refer to questi6n #) Explaan'any�YES answers and/off any recommendat�nns or any other comments
Use dtaw�ngs of 771
facihty to better _explain situations (use_ additional pages as necessary)
)n of lagoon vegetative cover is good. No seepage or erosion was observed. Creek (drainage ditch) along the east
ment, trees are growing along the toe.
#2: Observed old erosion along east side. Lagoon #3: Observed old erosion gullies on the east side (ground cover is
Reviewer/Inspector Name Alan?Johnson C: Koontz (DL()
Reviewer/inspector Signature. Date:

z_ tviston of Water
0 Divrsion of S d Water Conservation
f.h =R�`� v ' ther'Agency
oil an
Type of Visit N Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: UIU—W Tune: © Printed on: 7/21/2000
Q Not O erational Q Below Threshold
14Permitted [3 Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold
FarmName. PQ —.1? .................... Count`°:.....- 11_........-.-................. ............... ...
OwnerName:........................................................................................................................... Phone No: ...... ............................................................... ......... .......
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ........................ .................................................................................................................................................................................. ..........................
Onsite Representative: --.-fit-- z .....----........ ..... -- ............... Integrator:......
Certified Operator:. .. Operator Certification Number. :............... ............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� Longitude �• �' u°°
Design Current. Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca achy Po ulation
❑ Wean to Feeder 10 Layer I JEI Dairy
Feeder to Finish q 91&' JE1 Non -Layer I JE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ L g-�on Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 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-tnadc''
b. If discharge is observed, did it reach Water of the State'' (If yes, notify DWQ)
c. If diseharge is observed. what is the estimated flow in gal/min-1
d. noes discharge bypass a lagoon system" (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure I Structure 4 Structure 5
Identifier: .................................... ....................................-....
Freeboard (inches):
5100
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes PNo
❑ Yes [9fq0
Structure 6
Continued on back

Fa 'city Number: 1 — Date of inspection C� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes XNo
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes t�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
kNo
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
❑ Yes
Jj�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
No
elevation markings?
,Yes
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
19�No
11. Is there evidence of overapplication? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
❑ Yes
Wo
`�\
12. Crop type]
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
91No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)E�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
NNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
t*No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
>�rNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
13 : 10 vi...'fi...... ficieht&9 •were hated- duiririg 4iiis'visit: • Yoi* will fecd*ge iio Jruf they
:: corres0oiidence: A' , f this visit • . • ....:.:.:.:.:.:.:.:..:.:.:.. .......... .. ' . :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Q i ,
l� ��•`� �ct.-� �s�� �. � ^-- S1 t'~�-2 � aa`{ � ��ti� 3 >��-., aes ��+r f
w
Reviewer/Inspector Name
Reviewer/Inspector Signature:
o---39S -3WO )(—
Date: \ "'3c)-GG 5/00

.Ficility Number: — Date of Inspection Gd Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Ador below Wes ❑ No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land- application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 'N(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover? ❑ Yes t(No
ittona -ommen and/or.Drawings: _ _
5/00

0 Division of Soil and Water Conservation Operation Review r 'r
a -
0 Division of Sail an3Wateir`Conservatiori --Compliance,.Inspection
x
A Division -of Water Quality .Compliance Tnspectian
z a w
0 Other Agency Operation=Review
Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection3-
Time of Inspection ® 24 hr. (hh:mm)
Permitted 13 Certified !�� Conditionally Certified 13 Registered E3 Not O erational Date Last Operated:
Farm Name: ..-.....Y... County:......... 1t p
Owner Name: ........................ Phone No:......................
FacilityContact: .............................................................................. Title: ........ :....................................................... Phone No:............. .
Mailing Address: .. ...............................
......................................................................................................................................................................... ..........................
Onsite Representative: 0 1^:!�.re1.................. :........................................................ Integrat[�r:.......!`...............................................
Certified Operator:................................................................................................................ Operator Certification Number :..........................................
Location of Farm:
Latitude �' �� Longitude • �' �
Design Current Design .. Current . ,. Design Current ,.
Svt?ine s
Point`
Capacity Population-,"-I'Y. Ca achy .Po ulation Cattle _ Capacity Population 2.
❑ Wean to Feeder _ ❑Layer ❑ Dairy
ceder to Finish = ❑Non -Layer El Non -Dairy
❑ Farrow to Wean -
-
❑ Farrow to Feeder ❑ Other
21
❑ Farrow to Finish
Total Design °Capacity
❑ Gilts,
-------
-]Boars Total SSLW
Number of;Lagoons•.❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
0
HoldingPonds / Solid Traps '_ ` ❑ No Liquid Waste Management System _
Discharges & Stream In�cts
1. Is any discharge observed_ from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ElNo
h. 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. Dees discharge bypass a lagoon system? (If yes, notify DWQ) El Yes [I No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [YNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i} l
Freeboard(inches): aT` 3�.........................................a.......................................................................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3123/99 Continued on back

Faci0kNumber-3 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of oyeF application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0_ N-6•yiblati6is ;oi•• deficiencies •were jnot;ed diit�ing 4. s.vis. t. - You wiil•r6v6*i6 tiro; #urther •
corres�oridence. about: this visit.. .
❑ Yes XNo
❑ Yes XNo
❑ Yes NirNo
❑ Yes CR(No
❑ Yes gNo
[]Yes P(No
❑ Yes XNo
❑ Yes Di(No
❑ Yes ❑ No
Oyes ❑ No
❑ Yes D<No
❑ Yes O(No
[]Yes 9No
❑ Yes D(No
❑ Yes j (No
❑ Yes N( No
❑ Yes XNo
[]Yes KNo
❑ Yes XNo
❑ Yes 21 No
❑ Yes gNo
nestton 4) Ex lain an�-YES�answers and/or an recommendations or an other co � Comments (refei'fo'g" P Y - _ y y _ ., mments
UseArawings oflacilrtyto fetter explain situations {use additional pages a§ necessary)
rva _
'''-�' 610y s RR -a ,,�-� � Y� -��,r. .
TQ 1..c3�, Mkt►— s�r�: i c�c-,� �1� �]d� C-��1�2alse
D,S 5 I,�r 6 Q� L`.kt.4<0 3 z4<61t
rbeVO7 Ile e_-4 5Z4
�
I 77
Reviewer/Inspector Name M +~ r
Reviewer/Inspector Signature Date: I (--;t3 17
3/23/99

Faciliry Number: —
Date of Inspection a 3
Odor Issue's
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
WNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
2$.
Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes
*No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
C "No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
,�No
31.
Do the animals feed storage bins fail to have appropriate cover?
El Yes
WI No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
3123/99

..; ❑ Dairy
y ❑Division of Soil and Water Conservation 0 Other Agency,, ".
�a
Division of Water Quality
Routine O Com laint O Follow-up of DWQ inspection O Follow-uE of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 3l b 24 hr. (hh:mm)
© Registered (l Certified © Applied for Permit E3Permitted JE3 Not Operational Date Last Operated:
FarmName: .......... ca`.di..-...fk9' ....... .Y.m.................... .... County:....!h...............................................................
OwnerName: ...............V!—OA............... .I&IM- m........................ ............. Phone No:... ........................................
FacilityContact: ............................................................................. Title:........................................ ......... Phone No:
;>~... . 7. �xd...----
14iailtn Address. Q......�G.�S...... l3.............................................. . �, �....-�-------�-•---.....---........... ...
Onsite Representative:......-
�... .:.....tirtSvx�.......�...."......................:............................... integrator: ........mf.I.�?�......................._............ ............
Certified Operator........... �6a.,f:�..........L....... ..:[�fa`mAr. ...................................... Operator Certification Number-110-k .......................
Location of Farm:
...... f.......HA"..SD... ...........................................................................
......... . .. ....... .. .... --- ..........----.................. ....... w
Latitude Longitude•
Destgn Current Design " „<Current Design ' Current
$wtne Capactty: Populahon. Poultry Capacity :Population C" Capacity Poptilatron,
❑ Wean to Feeder
® Feeder to Finish
y
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Non-L
❑ Other
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? MYes. ❑ No
Discharge originated at: ❑ Lagoon t.Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? 09 Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) Ye No
c. If discharge is observed, what is the estimated flow in gal/min? tip rUnef-�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 51 Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes L No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes jM No
7/25/97 Continued on back

Facility Number: j —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes �d No
Structures ll.apoons,flolding fonds, Flush Pits, etc l
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes J21 No
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................... + .................... ... �.fir............................. �.�................... .
Freeboard(ft):..........,7.r.7..............................z-.............................. .............................. ..... ............. ...........
10. Is seepage observed from any of the structures? L� Yes ® No
11. Is erosion. or any other threats to the integrity- of any of the structures observed?
12.. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State_ notify DWQ)
�eY.+ 1.. .......... .............
15. Crop type ..........W...fir..........................!+�t�.....-Yt�tt^.......................-.......... .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑Yes
®No
Cj Yes
❑ No
1
❑ Yes
No
Yes
[]No
t
.............................................
❑ Yes
)0 No
❑ Yes
CA No
❑ Yes
ID No
❑ Yes
EN No
Yes
❑ No
El Yes
No
VYes
❑ \°o
0 Nwviolations or deficiencies were- noted. during this.visit..You.will receive no further
correspondence ahoitt this visit:.: :.
❑ YesIMIA
Um No
❑ Yes IKI No
El Yes MNo
Co menu (refer`to question #): Explain any YES answers and/or any recommendattons or any otherrcomments `
Use;drawingsot factlity to better explain situations. (use additional pales as necessary),
fro. �o�C►r M wcs C}. S�roU 4e`a
42- kii,
�. Low arts.% ih
S�V" J�tcO
sG,og
15ef " tVlcj, P&Y
duali!
Z-00 TKU A��!
11Q
�r• {G1QFw
{ � S�+at�to
�p �fcft�V�ti1 OY `-
an
es,istr a+`4Ce t.�o.�1 0� �a�oot�
Dti�h
�r
1 l S�otl�d t+tio Ikm r-
er,-,,
c.d� . ati {a con rhov�0
6e �,i AJ
og`i
c
c 7 . S Qrc l r4to,4s
- 10 Q be_
vzb�
by 1 l
c w �
7/25/97
Reviewer/Inspector Same
Reviewer/Inspector Signature: ,IV:_ /I Date:

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DS*VC review O Other
Date of Inspection
Facility dumber Time of Inspection S: 24 hr. @hiin
Total Time (in fraction of hours
Farm Status: [KRegistered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review Z-L
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: i
Farm Name:..._i�S,an ... �C....._..... .. ...... ........ County: ..... .... __.... _..., _..... .....
4
Land Owner Name: rlSe11..... ,. ......... ...... Phone No:.......................... .
Facility Conctact:... Title: ,.. _ Phone No: �R 1� — 3' �►t)
c t, _...z�.�...._-_. _...
Mailing Address: _ ..._. .L __ .... �..__ ... ..... _ _.._ ... �llkl^ .... ..._
Onsite Representative: 1
p �f�..�Y.:K�....�..............................._..............�...._ Integrator:..._.... V!':�._.......r............._................._......_...
aa ,
Certified Operator: .. .1 Y�SQY��..........1.':. f 1L50.*,N ., Operator Certification Number:
Lneation of Farm!
Latitude �' �� 03. a Longitude ©• ®` �"
Type of Operation and Design Capacity
;�
Swine Desgn
,4 _ Ca ace
Currenn�Mat Designs CurrentRIlesign Currents
. °Po ulatan r , Poultry _ Ca acr Pu ulateom rCattle CaDaciw Po ala#,on
❑ La ❑ Dairy
❑ Wean to Feeder
❑Non La er ❑ Non -Dairy
Feeder to Finish
o
Farrow to WeanOM
all Dew Capes lty oo.
Farrow to Feeder
Farrow to Finish
3
�4���, � , v . �� � � . tom- ��. V..��, �•
other
s
N Eier of Dons:/ Ho[du P ds ❑ Present
.,, age g 3 �
eDrains
LagoonSubsurface
field Area
❑ g Pray F
��
�. � --`- ••yy�_ �'[. 9 '� �?�ri�f �-"'+�:%. ��i �
��. :. .:._ . _ ..,_. _
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/47 maintenance/improvement?
❑ Yes ® No
❑ Yes M No
[I Yes 1K] No
❑ Yes 15 No
❑ Yes
M No
❑ Yes
(A.No
❑ Yes
JA.No
❑ Yes
[A No
Continued on back

Facility :Number:
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
()6 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
%No
Strugtures (Lagoons and/or Holding Ponds)
9, Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
[21 No
Freeboard (11): Structure i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
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
9No
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
0 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
CKNo
(If in excess of WMP, or runoffenteringwaters of the State, notify DWQ)
15. Crop type _ CQg5 1... 1 mu ....— ................ .... _
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ 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
Cjj No
For Certified facilities Ong
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[XNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24. Does record keeping need improvement?
❑ Yes
No
Comments (refer to,q,Explain any YES answers andlai°any recommendaUons`or any other comments'
Use diatsnngs,offacihty to'better explain -situations` (use additional pages as necessary)
I?-- ErostoN oa eb s on it%he r/&Ar_r IQj, 60A wn(1 sk wld s 6e- A (i13 a.,d reSoOO, LaSaor, wa(l5 4
skovl6 be *wu erg+ (A`1 *kWe_e. (Q r.$) . , Y S Or• ascort A AOU(3 $ e. 1'e�ed .
cc: Division of water Quality, water duality aection, Facility Assessment Unit 4/30/97

•
•
Site Requires Immediate Attention: Ja
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
AINTMAL FEEDLOT OPERATION SITE VISITATION RECORD
�� eY 02C.-7 t�-7� DATE: .1995
Time:
Farm Name/Owner:
Mailing
County:
1_31 C_1WhV&Z)AP1)
Integrator: Map1�'t'1
On Site Representative:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity:
2-1
Phone: 6qo — 01VI I l
Phone:
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 q - �� ' Longitude: ° ' Jnor Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 ear 24 our storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard'! Inches
Was any seepage observed from the lagoon(s)? Yes 9Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: ( iVffS1f1(f `L
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es No
100 Feet from Wells es r No
.Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific ac=ge with cover crop)? Yes or No
Additional Comments: bd,0.) Al G OA/ eD
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. ;? 1--
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: `Y , 1995
Time: ! 5 0-01
Farm Name/Owner: LPi W, 4—p-I wk&,7� )313)
Mailing Address: ' z-, %
County: -� !� 1-I �✓ _ -
Integrator. Phone:
On Site Representative: Phone:
Physical Address/Location: "11'9 19AI I AC!F
,ems Cr Vr- 1VG LNAA:7 �d
Type of Operation: Swine A Poultry Cattle
Design Capacity: �o 7O J Number of Animals on Site:
DEM Certification Number: umber: ACE DEM Certification Number: ACNEW
7 Latitude: 3� ° 7' Longitude:.* �' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes No Actual Freeboard: Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes r No
ve
Is adequate land available for spray? Yes ia7-4-t
Is the cover crop adequat .Yes r No
Crop(s) being utilized: 2 kO- • ' 8
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 160 Feet of USGS Blue. Line Stream? es or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of a state by man-made ditch, flushing system, or other
similar man-made devices? Ye or N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
• G�
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] Aug 1 '95, 9:56 P.10/17
;Site -Requires IrainodiatcAU=tion
• Facility Number:
�- SITE VISITA'I"SON RECORD
DAM: {�� 1995
Owner: _ hcs�e "IPL 11M Farm Name
county: T j i
Agent Visiting Site: Phone;
Operator. _ - ... _ _ Phone
On Site Representative: Phone:
Physic4 Address: _ s /4? areg A Dx .»� -e --
c�r�rt d
Mailing Address -
Type of Operzdon, Swine Poultry Cattle
Design Capacity: Number of Animals on Site. -
Latitude: o ' _ Longitude: 0 •
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficiNo
aboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 lathes) Yes Actual Freeboard: Fect _ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o(D Was there erosion of the dani?: Yes or No
Is adequate laud available for land application? Yes or No Is the covcr crop adequate? Yes or No
Additional Com=nts: - -41aulo fYl 1 _
Fax to [phone] Sipature of Agent