310112_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental dual

"- 'Division ofWater Resources /
�F,pciility Number ©- // O Division of Soil an&Water.Conservahon
J
fEP Other
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; ao Departure Time: E� County: DLX2)1:� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 720aq
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
i5�
tDesign
3
Currents
''f , 2
k ° i;:
Design
eii -
Cuirr3e3ntk,
3l
�.§ -
Design Current:.
g 7E
Swore+�,d(i.
Capacity
E
>P©p
"92.i
Wet Poultry
°:.
?§ -
Capacity-,'
1 '..�;
Pop
6`< E.
Cattle
i
��Capacity9Pap. �-
x
A E°
:
�;..-
�PAUk
.; n :.-.
3ry
.:-
a
De19
sn
I
Current
Dry
Wean to Finish
Wean to Feeder �.
Feeder to Finish
Farrow to Feeder
Farrow to Finish
Gilts
g
OtheNMI �:� `��,... �I
Other
Farrow to Wean
Soars
La er
Non -La er
D a Foult ;�;;iCa aciik Po �
Layers
Non -Layers
Turke s
Turke Puults
Other
Pullets
La er
Non -La er
D a Foult ;�;;iCa aciik Po �
Layers
Non -Layers
Turke s
Turke Puults
Other
Pullets
D a Foult ;�;;iCa aciik Po �
Layers
Non -Layers
Turke s
Turke Puults
Other
Pullets
Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ NA ❑ NE
Discharge originated at: El Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No DNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?W d. Does the discharge bypass the waste management system? (If yes, notify DR)
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?
Page l of 3
❑ Yes [] No ❑ NA ❑ NE
[:]Yes B�<�Z[:]
❑ NA ❑ NE
❑ Yes NA ❑ NE
2/4/2015 Continued

Facility Number: 73 t jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LI-lQo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
� ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej.?<o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L IN_0 ❑ 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): —&I.- 'X_ J _
13. Soil Type(s): ��`---
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yesrr;o
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D""'
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3-lq'o/'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E j o
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ Ko
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspecti;N"q
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3 f. - Z IDate of Inspection: !a /
V4_
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
I
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
ILNo l� NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NAB
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No E]-NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA
E E
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
"E�1`1 iO ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
©'lQo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ergo`❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-tdo ❑ NA
❑ NE
Comments(referto question #) s Eaplioany;;Y ES answers°gkintd/or`.s auy addit,onal recvinmentlations orany other comments. "
j
�
se drawmgs;of facility to getter explaip�situation. (use additianal pages a's necessa r5)
�
� g`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CeL1,+f7�Ct7L---\ r<Ca—
�'n
Phone: gala 7`16 7,37�
Date: -�111
21412015

Division of Water Resources
Facility Number '--'--�� - © 0 Division of Soil and Water Conservation
0 Other Agency
type of visit: 0-co 'sri'ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L2' �_J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
7
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title: Phone:
Integrator:
Certification Number: e7 9 t� e 4
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HLayer
Non-Layer
Wean to Finish
AVfa-n— to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
rou
Pullets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
<o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facie Number: :3( i 2 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ql o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 E31No ❑ 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
Vj ]No- ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesgNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
eNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 6;oil 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 E3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - I Date of Inspection: 111
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA �N
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
'No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EJ
❑ 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/NNo
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other.: comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�ckf���.���,, souj s�,-�Py spf�
recgrJS
Reviewer/inspector Name: DQ I'C. L r� �� �I _ Phone: TO 9 '7 gGI3 Q
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

("ivision of Water Resources
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (D-Mo`utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: •p)tE Arrival Time: 2A Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: vl G 5 P ��c L� p
Certified Operator:
Title:
Phone:
Integrator:
Region:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
can to Feeder `P OQ
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Non -La
Poults
Design Current
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑S - [] NA ❑ NE
❑ Yes
❑ No
❑ NA
0 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes
Q-/
❑ NA
❑ NE
[:]Yes
[�] o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

acili Number: - 2 _ Date of Inspection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[]No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �_� 57
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E"l-o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ICJ l o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 9-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
[3-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[] ko
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'<o
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0"NNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ED No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3 o
❑ 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.. [3 r es ❑ No
❑ Waste Application ❑ Weekly Freeboard ` Waste Analysis E3Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q_?110
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412015 Continued

Facili umber: jDate of Inspection: III I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L3"1"o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No [D-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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 10 ❑ NA ❑ NE
❑ Yes [21C ❑ NA ❑ NE
❑ Yes [ fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ko ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes E--No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
15 Page 3 of 3 21412

(d Division of Water Quality `
Facility Numbek - ® 0 Division of Soil and Water Conservation
l 0 Other Agency -
Type of Visit: 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 j Arrival Time: ® Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: UA9C. MACKY Integrator:
Phone:
Certified Operator: Certification Number:(�(� !
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder ipd
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Nan -La er
Design
Current
Dry Poultry..
Canneity
Pon- -
La ers
Non -Layers
Pullets
Turkeys
TurkeyPoutts
Other
Discharees and Stream Imoacts
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 ,r
Cattle Capacity :Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes a No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes 2 f No ❑ NA ❑ NE
❑ Yes jrNo ❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes EA No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGMf�!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoE]
❑ 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
fi/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
WNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 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 [!3/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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P(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
Et No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�(No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. dyes ❑ 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 Pf No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [j�No
❑ NA ❑ NE
❑ Weather Code
[;?Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: `7r
24. Did the facility fail to calibrate waste application equipment as required by the permit? �es ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes�No
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
OZ o ElNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No, ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
VNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes❑
NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause lion -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
❑ Yes
❑ Yes
7❑ NA ❑ NE
❑ ❑ NA NE
❑❑ NA ❑ NE
Comments (refer to question #t): Explain any YES answers and/or any additional recommendations-or.a©yother.comments:
Use drawings of facility to -better explain situations (use additional -pages as -necessary),.,,,_.
CoN wASrc AMAL�ST-S, SLuDG-C 5V2'JE''1 'A/4P cAaW
0_E. COO 0 ( ?tea l')
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: 7
21412011

77 - Division of Water Quality
Faci0.Division of Soil and Water Conservation
0 Other Agency
rype of Visit: 7Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L LI-_L`_i� Arrival Time: ^{1 Departure Time: ADO fW County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: smz i
Integrator: (]�
Certification Number: �'" U S29
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
I. Other
Latitude:
Design . Current Design Current
Capacity Pop., Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Catacity Poo. .
Discharges and Stream Impacts
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current:
Cattle Capacrty_` =-Pop
DairyCow
DairyCalf
DairyHeifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Bro
od Cow
1. Is any discharge observed from any part of the operation? ❑ Yes VIo ❑ NA ❑ NE
Discharge originated at: El Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes XNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes �No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? TT
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
);�'No
❑ NA
0 NE
❑ Yes
hTo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:CJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNO ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 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 eEno ❑ 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 JE!rNo ❑ 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 OfNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes pjrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �3o ❑ NA ❑ NE
acres determination? ZZ��
17. Does the facility lack adequate acreage for land application?
[:]Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� o
❑ NA
❑ NE
the appropriate box.
�"
❑WUP [_-]Checklists ❑ Design ❑ Maps ❑ 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 I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )2T'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2"No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
aali Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required�by the permit? ❑ Yes X No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNo
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?
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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �/ No
❑ Yes J ' No
❑ Yes �No
❑ Yes No
❑ Yes XNo
❑ Yes 9 No
❑ Yes
❑ Yes
❑ Yes
91No
FxN 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
VA,I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q r� U_
r�
r^*-� Date:
21412011

Division of Water Quality r
Facility Number 7) - ®� ivision of.Soil and Water Conservation
x , 0. Other Agency
Type of Visit: Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: H 5 !
Certified Operator: T_�5(.0 LA
Back-up Operator:
Location of Farm:
Design , Current
-,.Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Il��
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
:'Other
Other
Latitude:
Phone:
Inte rator:
M)Q
Certification Number: 19 CK)09
Certification Number:
Longitude:
Design
'Current.,
Wet Poultry
Capacity
Pop.
Cattle_
La er
Da' Cow
Non -La er
Dai Calf
Dairy Heifer
. Design
..Current"
Dry Cow
Dry Poultry
Capacity'-""
'Pop
Non -Dairy
Pullets
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Beef Stocker
Beef Feeder
Beef Brood Cow
Design Current 1%
Capacity 'Pop T
❑ Yes , No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [:]No
❑ Yes [] No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

facility Number: 1 - / Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 777❑��� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes j No ❑ NA ❑ NE
waste management or closure plan? i7�1
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 ❑ 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? 0
Waste Aaylication
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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes9No
No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No
❑ Yes 9 No
❑ Yes No
❑ YesNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Q WUP OChecklists Q Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ V aste Trans ers Q Weather Code
0 Rainfall ❑ Stocking '❑ Crop Yield 0120 Minute Inspections Q Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -_� / - / / 0 1 1 Date of Inspection: 1() Iq /,(
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 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 N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No �z NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
" �
❑ NA ❑ NE
Comments (refer to question �Ex lain an YES, answers and/or an additional recommendations o
� �• p y y r.anyotbei!=comments':�
Use drawings of facility to better explain situations f use additional pages as necessary).
CA u g��cvJ 1�� a�S 13
�cLA-V'�Ge SU(LL)&ky pPU7, J o b
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: )0'N6 330�
Date: LJ9I10
21412011

.r1
Division of Water Quality
Facility Num_ ber 1 3LJ - O Division of Soil and Water Conservation
Q Other Agency
type of visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
teason for Visit: Routine p Complaint O Follow-up O Referral O Emergency O Other Denied Access
Date of Visit: Arrival Time: 3 s Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �jC�� �{.; Integrator:
Certified Operator: {� CA i
`[]a-14��-C� CHASE ��CCE � Certification Number: 990009
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
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
Ll
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:
Cattle
Design - Current .
Capacity Pop.",.!,-;.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
d F.
❑ Yes 1] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Fiteility Number: -11= Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
0
❑ 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 P
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 Aonlication
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 D Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes a No
❑ Yes No
❑ Yes 9No
Yes ❑ No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Vyaste Trans ers
0 Rainfall ❑ Stocking [] Crop Yield Q 120 Minute Inspections Q Monthly and I" 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? ❑ Yes No
❑ NA
[] NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Q Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - _ - I I Date of Inspection:
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 N No ❑ NA ❑ NE
the appropriate boxes) below. Tl
❑ 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 �4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 14 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 4No ❑ 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 N 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 ]J�LNo
DNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes jNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or: any, other, comments�S �--
Use drawings of facility to better explain situations (use additional pages as necessary). Z.,;
w.A.
nnj
p�l� E
�r CAuQg-Q-) vu
7o � �-f ion
��d
IN
r� 4
�' C a I ,— � l S c- S � 01 t� � CSJ�Ds
op T �`"0Goi C_`Z.1'ti 1 T `� �c� 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
WAS Dui
Phone: '1 U �0►'1
Date:
V412011

'of Water Oualit
FaCIf1 "Number t �� 1'D�vision of:Soel and WatervC '?� onservatron -,
Other_Agency=
Type of Visit C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: q p Arrival Time: �1 DC Departure Time: County: tL X04 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative-y ",a Nvp4o rn n_w?
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer 3$ tPQ ❑ Non -Layer
❑ Wean to Finish
© Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
LiTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
[ID Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
El Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[I No
❑ Yes
d o
ElNA
ElNE
ElYes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 4 Zr Date of Inspection g o5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U4Cya1J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviroo ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes d] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 6CJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application_ �f
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U/ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[dyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6/N)
El NA
[-INE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
t_aAsc r-z£Lz BIAS Nb aloes AThn, PL.,"S� AobCrESs. awn4 Ir=c.1.05 �i
�.� To,►4E s��nPc.6 of So.T-�_ oN 'oskL_C WA J:;^P"U4- G-"UYN a( cove&. C1aAss,
Reviewer/Inspector Name �jo NN.N Phone:0 10� -7rft; �i 3d
Reviewer/Inspector Signature: Date: S' Z a9
rage L of .s lzic0iv4 c,vnssnuru

i
Facility Number: 'j — Z Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ["No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LZ! 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
LI No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dN o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[..�(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
( ?f
[IElNo NA
NE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
E� No
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dN o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,(
IJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
12128104

V
wD1V�S1on of Water-Quallt3
r 4
._ . ..
Facility Number, 1 1 12, Division of Soil and.Water Conservation
m
O ,
Other"Agee
Type of Visit �C,opliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ( outine Q Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: -J Departure Time: County: DVPLX-. '- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: JtAA"Wkl f►' �/�,� "4 k Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up 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
Other
❑ Other
Latitude: [::] [:] " Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
8 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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 I No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑
❑ Yes o
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number:. — 1 _il Date of Inspection
ikyaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (�(L4�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z _.
5. Are there any immediate threats to the integrity of any of the structures observed? ElYes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ryes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes d No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application El"
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Cf/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesEI'Nco
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O ivo
ElNA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4o
❑ NA
❑ NE
7a� oEk_E wau. Nbws tv?i2fC. sr&ewT raEL .wtL,6. "rrxmK
,) 11AA ifwNE A. 546AI lvEw wr/P "IJ9 XtAID CPY Td 004 Pit✓o.
ReviewerAnspector Name �Lo (r Phone: I 79-- 73 �r
Reviewer/inspector Signature: Date: eJ G
lHgG 4 Vf J A--
v-r vv...sra races

Facility Number: —11 7j Date of Inspection 9 d
iReauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to ha�!Wup
ponents of the CAWMP readily available? If yes, check [xYes ❑ No ❑ NA El NE
the appropirate box. ❑ Checklists ❑ Design
g ❑Maps ❑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 Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � [I NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ° ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes CrNp❑NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes d No ❑ NA ❑ NE
❑ Yes DNC ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑Yes �o ❑NA El NE
❑ Yes
id-/ o
El NA
❑ NE
El Yes
O No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number I IZ
Q Division of Water Quality
0 Division of Soil and Water Conservation /
0 Other Agency ./
Type of Visit (5 C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit Routine O Complaint O Follow up\ -. 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t o JJJ 161 i Arrival Time: L 7 30 i Departure Time: 4-ounty: w-L_L N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Mn L—A _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c [=' = N Longitude: 0 ° = , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
FLayer
3�Ua 8�s Nan -La et
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: F]
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 LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
�/YN
El
❑ NE
El Yes
o
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — 1 I I Date of Inspection Eo as u
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: C A ��,)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a1
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 To ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviTyes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 D/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ET'No
❑ NA
❑ NE
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
121/No
❑ NA
❑ NE
j Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
fUse drawings of facility to better explain situations. (use additional pages as necessary):
7.) Dp=E WALL- 6"SXbsl PA C`Js r-o 43i— A00ftk S E D, Ictre c - 1.oi Sep�=_1JG- d F �5 � . AL
(1A=.0fAL,- _1JZTtAvL 24�c LLCSJ-P� G{E�iWlfaRiL NOT- ADE-(�UfdT�c . 5Tou4Sr�1(, n1E6'9(L
tic C_ o NFL✓ ►'i uP �,ti tj C vwrj La—
�� {oii_.. SIIlO(rE W__CDED u j, �'tca DAMS,
Reviewer/Inspector Name T. N o, j rArWCE,` Phone: _.? 3 Y K
Reviewer/Inspector Signature:
Date: / c`
12128104 Continued

• Facility Number: — I ► L Date of Inspection b
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
3 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
❑ No
❑ NA
❑ NE
the appropirate box. 6 WUp ❑ Checklists ❑ Design [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Ej es
❑ No
❑ NA
❑ NE
❑ Waste Applic on El Weekly Freeboard ❑ Waste Analysis ElSoilAnalysis El Waste Transfers
El Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections LI Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
WW�4o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
014
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Q 1Yes
❑ No
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElO No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
9No
❑ NA
ElNE
29.'Did
the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
❑ 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
rJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,/
L�J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

0 Division of Water Quality
Facility Number 3 ( � if Z 4 Division of Soil and Water Conservation
_! O Other Agency
Type of Visitpliance
Inspection
Operation Review Structure Evaluation
0Technics! Assistance
Reason for Visit
TRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: td vS Arrival Time. gy S Departure Time: County: ��'f'c Region:
Farm Name: 3 — MAC1G �gr�.�-�,s _ Owner Email:
Owner Name:,,
Flailing Address:
Physical Address:
Facility Contact:
Onsite Representative: GE'Ja 1yc�tJ�O`-t'
Certified Operator: 13 RA►� (Y)KC-1cef
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
Title:
Phone:
Phone No:
Integrator: � 37 G- ` gCLA
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o = I ❑ {f Longitude: ❑ ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
$�O ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 71
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[-INAEl
NE
❑ Yes
,_eNo
1/J No
❑ NA
❑ NE
12128104 Continued

Facility Number: - Z Date of Inspection to `
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes El"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �,A C l
Spillway?:
Designed Freeboard (in): i �f
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ff No
❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir7yes
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
6] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of
Area
12. Crop type(s) 13CR.vyu. rJC�. CA)
13. Soil type(s) AyTa,q V.tu-C-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�,(
LI No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
211es
gNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
EI No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I
El NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Zo
❑ NA ❑ NE
KEC-P C-0PY 4 C6RT-�tF_T.0 tE OF cOUC(iac,6 ApjjP �c zr wL—rt.� KC -CA AS.
C3ET A ' Nts.� t_E.ASE. A 6 CeEmr—"t- Fat. P rSc. W 2-
-TOO) w art.t_ o r..1 G P-A S s Cs,JER— V a� t_AC: a0 '�J o: tcr_ wA _L.E
9A )iaA,NsVOL A.W> vP DAT-C 06_(d
ReviewertIns ector Name _ °`E K h x 3
P r ' C�f,[� g k , I-; Phone:�9/o, 3S�i - NoD Zo
Reviewer/Inspector Signature: Date: Arlo s�
12128104 Continued

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

Facility Number Date of Visit: 2 Time:
Not Operational 1213elow Threshold
® Permitted ® Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 4x A lax Lf4 e v ____ � _ County: /v+C 1 t
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 0 u Longitude ' 4
Design Current
Nwme Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
n Farrow to Feeder
Gilts
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I I IEJ Non-Dai
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1' ❑Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
_ . ..
Holding Ponds 1 Solid Traps JEJ No Liquid Waste Management System
Discharges 8& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): 7i b
05103101 .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: 3l —
Date of Inspection Z /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Ni'aste ADnlication
❑ Yes ❑ No
❑ Yes ❑ No
Co Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maiitenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ElPAN ❑ Hydraulic Overload❑ Yes ElNo
12. Crop type &e:A t 44Z — 4A Xi 54' el *jZ_ ,t in eaMae&Z
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA AMP)? ElYes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17-
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie! discharge. freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
1 .� Esc,, -^�. ��xa�"--r.,+.:•�-�ss.�x� •�:�•�...�W .� .�;
Comments'(refer to gnestioii }::Fjipl�; anyYES answers aadlkir aaiy recommentZa nuns :ar v other mmems. 14 .'n
Use drawings of facility to better explain dWationi. (use additxoaal pages -as n iy) ' ©Field Copy ❑Final Notes
7 lb apt /o p Duh
f/'►'t
/ �� [1 0I'�I O o G1O'l
�
Reviewer/Inspector Name
Reviewer/laspector Signature: Date: -2d
05103101 '1/
Continued

a
Facility Number- / — /!2 Date of Inspection
Odor lssuec
26. Does the discharge pipe from the confinement building to the storage pond or lay==oon 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 rind 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 biade(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 pennanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

and:WateeA0 6nservii
Type of Visit (&Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit S Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: �D .+f
Facility Number
Not Operational 0 Below Threshold
M Permitted '® Certified ,,©yy Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: / •�n
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: C ad &A122 - _ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude ' ° u
Design Current
twine Capacity re ulation
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Number of Lagoons 0
Holding Ponds I Solid Traps
Design Current Design Current
Poultry Ca aci Population Cattle Capacity Population
❑ Layer I FP —Dairy
❑ Non -La er L ID Non-Dai
❑ Other
Total Design Capacity
Total SSLW
Present ❑ Lagoon Area 10 Sorav Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Coligetion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SUillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches):
05103101
❑ Yes R No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
tR No
❑ Yes
14 No
❑ Yes 14 No
Structure 6
Continued

Facility Number: — 117 Date of inspection 7 Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IRNo
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
(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 N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes q No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 10 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®,No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type - - LTV
13. Do the receiving crops differ with thos�signated 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?
M, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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?
❑ Yes
'K,No
❑ Yes
®,No
❑ Yes
❑ No
❑ Yes
❑ No
®Yes
El No
❑ Yes
[K No
❑ Yes M No
❑ Yes M No
❑ Yes MNo
❑ Yes VINo
❑ Yes ® No
(ie/ discharge, freeboard problems, over application) ❑ YesNr,,{{No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes Z(No
24. Does facility require a follow-up visit by same agency? ❑ Yes MNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ElYes UN
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
AvlJ �revli Z; aO d -�✓ .'l��l 1. N[t� 70 llliiA
4^I i't3 �o j'�FG �ji/.�1.t•/�� ��t91� �v/Afe
l�ae. nee4 4,ael •es :NW%ccIrl J/ s.;/
p r7-e We 4-,�&.,-ilf *6vx H,
Reviewer/Inspector Name ' - <.xri„ :;,. y.
Reviewer/Inspector Signature: Date:
05103101 C./ Continued

Facility Number: 31 — /7i I 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?
kr,-F of reaewl V'- %;�-M L 010 e:�eo4-1'
O5103101
❑ Yes �&No
❑ Yes 'WNo
❑ Yes 4 No
❑ Yes ONo
❑ Yes CgNo
❑ Yes PjNo
❑ Yes gLNo

Division of Water Quality
0 Drvrsioit of Soil and Water Conservation
-
e
"othey Ag ney
-
s.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit x Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Dateotvisit: ZG` Time: � Printedon: 7/21/2000
,'a-
0 Not O erational O Below Threshold
Permitted [3 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold
FarmName: ...... �..... Q.y................................................ County:..... 71� . ���"...._...-...........................
Owner Name:
Facility Contact:.............................................................................. Title:.......
Mailing Address:
Onsite Representative: _. �.. �Q-
........................... ......................
Certified Operator:
Location of Farm:
Phone No:.... ................
Phone No:
................................................................................. ..........................
Integrator:..... ... U.P5, .5�-r..... .
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 6t Longitude • 6 "
Design Current Design Current Design Current
Caad Po ulation Poultry Ca aci Population Cattle Capacity-,-" p Po tilation
Wean to Feeder 0 ❑ Layer 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer I Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total-SSLW
I..
Subsurface Drains Present
No Liquid Waste
Discharges & Stream lmpacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Area I❑ Spray Field Area
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 flaw in gal/min"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure; 2 Structure 3 Structure 4 Structure S
Identifier: .......................................................................... .
Freeboard (inches): 3
5100
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONo
❑ Yes
j (No
❑ Yes N(No
Structure 6
Continued on back

Facility Number: I— I)ate. of Inspection Printed on:
7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
[]Yes
kNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Cl Yes
XNo
(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
9NO
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
O�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[&,No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
0�40
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
kNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
D(Yes
❑ No
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
N(No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
'Z No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5f No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JyNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes bfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes NNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? [7 Yes k�No
:: �10 yiolati¢ris:oi- defidencies were noted- du-rtng 4ib.s.visit: Y'ou will ree6V6 iio fui•th&
• cories�o deirce. abouk this visit.. _
rstion #) Explain any YES answer
�� • ,� `1 15.E ll &5 V
';LCOG `—t L C--r p t.c,1'C � '�.1 T'l�c\ rj tr d G �Q G L��••
1-7) 1
cGC L55k1;_'j ,
Reviewer/Inspector Name v-� a` Jq, �ri u'11511
z
Reviewer/Inspector Signature: Date: — 3-Q-L-- 5/l10

Facility Number: Date of Inspection "�'—" ► ,
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below WYes ❑ 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 4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kfNo
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 ONo
ry
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes No
itiona • Comments and/orDrawings:
A,

t AO-111 of Water uahty
Q Division Soil Conservation
`�
s
of andWater
.,,:,�
, f wr
d Other Agency
�'
Type of Visit 'Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit JgRoutine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number
Date: of Visit: IO Z1i Dd Time- SDD Printed on: 7/21/2000
� � i i �
Q Not Operational Q Below Threshold
© Permitted OCertified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold : .................
a-e r+:.S �,�Bs U? M s 1 q e-r.-% County >tl l) h
Farm Name: ............................ ...............................................................
�..
OwnerName:..................m.°'�r............. i.(. ..L.................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title: Phone No: ...
MailingAddress: ...............rr........................i�.................._......._.........._..............._.__...........................................
........_.._..._.................
.......
...............
Onsite Representative: _...�e.h.....,i'�.e nn��................................................ Integrator:..G._....NpL,�q./.d
Certified Operator: ............................. ..................... Operator Certification Number: ........
Location of Farm:
jig Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current
Swine Capacity Population
Wean to Feeder
3 4 p
/,9 2,0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ subsurface Drains Present 110 Lavon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharl;es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fiTNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes :J�(No
h. If discharge is ohcerved, did it reach Water of the State'? (If yes, notify DWQ) ❑yes gNo
c. II' discharge is observed, what is the estimated flow in gal/inin? }j
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes KNO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes JONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes *0 No
Sn-uGture I Structure 2 Structure , Structure 4 Structure 5 Structure 6
Identifier: ................ I ................. ....................................
Freehoard (inches):
5100 Continued on back

Facility Number: 31 —11 Z Date of Inspection Q Dd Printed on.. 7/21/2000
-5. Are t6re any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Li Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes $ 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 CgrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [:]Yes ,� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type '6ce rLA � t Vot0i) Si'%qr, }}
i I t.7y'a I n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Pff No
b) Does the facility need a wettable acre determination? ❑ Yes $No
c) This facility is pended for a wettable acre determination? ❑ Yes � No
15. Does the receiving crop need improvement? Yes ❑ No.
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A 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) XYes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 19 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?
Oe/ discharge, freeboard problems, over application) ElYes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 9-No
24. Does facility require a follow-up visit by same agency'? ❑ Yes ,� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
N6 •vialaf%ons or def ue'neies -were noted• diWirig ;this;visit: - Y:oit will-t&I lye do furl ther
�corires 6Tidence:about: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):
1S. a r� 40 e.1 ,/)-% e b rnl vd&;i Vey I,? f'to►tit F_ie,14-Z .
18: 1 eda� 0d01' Ca►-f�l c�ec1
117• clA 4 o -10 � e so i 1 -4e.e 1, yept V- . t-JA-s-/e of V1,q ! y s;s new �a
be 4gker Arid da4e�4 da7s o,rA)po/;cjjfort;
a►�q�ys,ls
node llerCeof for OG-I "q-1 A,v -TUrpe Zoos a ve►Z-ts- k er)n.1q
Wee o, );w ere toe ;,,vz a rod 4e54 gsW.
1�j4Tf' _ ,o l u 1; w,e �CGDr+D1 � moo,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: % -z r%P _ 5100

Facility Number: Y J — f ;L Date of inspection Q 2 0 Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below .0Yes ❑ 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 JVNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fiZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
Additional Comments and/orDrawings;
5100

r
Division of Soil and Water Conservation Operation,Itevrew
�.Dtvision of Soil and:Water Conservation ,.Compi once Irispecbon
Division of Water Quality - Compliance jnsp,6ction , r
ift0thier Agency eviw Operat,on.Re-
-^ Y
Routine OComplaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 2 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[] Permitted Certified Q Conditionally Certified 0 Registered [3 \iot O erational Date Last Operated:
- y I.
Farm Name: : .......... ..... J '�11.iV1... County................Yt�f.t.?�.--................ ....... ..� o.......-.
...-.......................
Owner Name:..... . -Yiis ..-... �^ %� tt!l5.... PhoneNo:....... �SL� �loQ�555
.1.411. . ............... .
...---..............--...
Facility Contact: .. a ............. Lt.�-� 1.17t.�...................... Title:.......0 wvl a Phone No: -..,....,..... .
MailingAddress:. ... ............ !(.! .f........... ...... .r.................-........ .. ..1.!n ...Tl.l.` ...� ..I-XC.....-..-........-...... f3 ?Z.....
Onsite Representative: ,�,�. 0.................... ..�1...�.�!.n��.............................................. Integrator:....:.. ►.1.:.. ..:....... lh!Ae^( ............................
Certified Operator: ................................................... ........... ................................................... Operator Certification Number:...................-......................
Location of Farm:
r
....... ..—I........................................................................................................................................................................................................................................ �
Latitude ' 6 Longitude • 6 9.
Design Current
Swine; Capacity Population'
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons.Subsurface Drains Present JFff Lagoon Area eld Are -
Spray::
-Hold�ng'Ponds./Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 00 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 IQ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 00 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [tA No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):....................................................I--...................I........... ........ .-.-............... .......... I........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: -- 1 Date of Inspection
i
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes JLMX� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ;dNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )'No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
ANo
12.
Crop type _ Afj
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
U(No
b) Does the facility need a wettable acre determination?
❑ Yes
PqNo
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15.
Does the receiving crop need improvement?
❑ Yes
J 'No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�10
I &
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
5kNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Wo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O(No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
W No
23.
Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
,) No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
. .. .......... ........
�Vo yiolattons:or deficiencies mere not:ea• during this:vis. iL • You wdl•i-eeezve titi further
correspondence. about this .visit. .
Comments (refer -to Yquestion #);Explain;any YES answers and/or any -recommendations oiyany ot)E_ter comments:
Use drawings of facility to"°better explain:'situations` {use additional pages, as necessary) m
in ,
Y
WL a Ike r try - n," 6e a rt- c"iy�i� j r1S% wr
Name
Reviewer/Inspector
—4 1 . . _ Date: ll — 7 A—d!4
3/23/99

❑ Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
IV Routine O Complaint O Follow-up of DWO inspection O Follow-up of DS`i°C review O Other
Date of Inspection
Facility Number 'a -
Time of Inspection a4 24 hr. (hlt:nun)
13 Registered Certified 0 Applied for Permit 0 Permitted 10 Not O erational Date Last Operated:........
.................
Farm Name:........�01rrt S....... l� County:..........��.'1..................................................
Owner Name: ` (G S 1` Phone No: a"� b �r'.
r.
Facility Contact: ... &....... ::.......I.... ... Title:
MailingAddress:.....................................................................................................................
Onsite Representative: .... .0.,.....�15 ................
...........................................
Certified Operator............ !v...& .............................................................
Phone
.......... ...................................................... I.................... ..........................
I n t egra t o r:....-
....J ..... ..................................
Operator Certification. Number-,
Latitude 0 9 " Longitude ' 6 66
N Design ;Current Design Current Design Cu�eent
Capactt� "Population Pn"Itru _ .. ' i`anarity Pam ulatinn f atfiP i'anarit r PnniEluiii�n
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [I 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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
KYes ❑ No
❑ Yes 1�(No
❑ Yes M No
❑ Yes Q0 No
r 1_
❑ Yes Wo
❑ Yes 4 No
❑ Yes KNo
❑ Yes KNo
❑ Yes 0 No
❑ Yes t4No
7/25/97

Facility Number: — a
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ( — oons.Holding Ponds, Flush „Pit
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):.... ........................................................................ ............
10. Is seepage observed from any of the structures?
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?
❑ Yes KNo
❑ Yes N No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess o W1MP, or runoff entering waters of the State, notify DWQ)
15_ Crop type ............... .......................................................................................................I...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0° No.vitilations-or'deficiencies:were-noted-during this:visit.• Yon'W'IH-recei've,no•f&ihei~.
:-,•correspondence. aliou�this:visit:•"•.• �;.-.... :�.:�::�...�.�:•.�::�. �.: .••::::: .•.•
❑ Yes 0No
❑ Yes OkNo
)4Yes )KN�
❑ Yes 6lo
❑ Yes PNo
❑ Yes MrNo
❑ Yes KNo
❑ Yes 1ANo
❑ Yes [)(No
❑ Yes N No
❑ Yes Wo
Yes ❑ No
❑ Yes P(No
❑ Yes 5� No
❑ Yes qNo
rl
�LL. e
L.
Q.. '
{'tee
s► �� 17r �'
l 1 GO hie f mac.. t4J .'_4L , rip 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

0 Division of Soil and Water Conservation [3Other Agency
0 Division of Water Quality
® Routine O Complaint O Follow-up of MV0 inspection O Follow-u of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection U=24 hr. (hh:mm)
Registered J8 Certified` y © Applied for Permit © Permitted 113 Not O erational Date Last Operated: ..........................
. .......f..S. ... �].Y._�..iCountv..b.15.................................:.....WFarm Name: ..... .............................. .3...gZ? Owner Name:.... Li.oar,rti..S.......................... -v ',........................................ Phone No: .q.S..q .... �.�a. S.... .LSss....................
Facility Contact Title ....... Phone No:
Mailing Address: Qt�.......... .....f.!n..Lr-...1..i.�... C-:................ SZ
3. ?........Q.a- .k- ........................ ..:.......
Onsite Re resentative:.. r , t t
p �1.�:a.�-�r..�.�..�`�:�:....�G�..._4.1.1f.,n��..... Integrator:..�].�_.�.,.c....i:.1•.R.u�.tr-�"..........................................
Certified Operator,..... ............................................. ............................................................. Operator Certification Number;.........................................
Location of Farm:
4 ~.....e..•r-d�....n.......5.1 1........fJ......... a.n...... ,. ..... a... ...... x-.t...Wit.............................
- - . - - -- - ....... ... .....-- --.
Latitude • ®' ®" Longitude 1= • =1' 4511
'Des Ign; Current
Des�gn� Current;.°R Designs Current"
_ _
i rS�vmep: , „ Capacity Population Poahry Capacity Population CattleCapacity Population
a .a ..
ER
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy >
❑Other
�
w
Total Des>Ign Capac>Ity ^
g .' j'
"# Total SSLW Zoo
K"
Number of Lagoons / Holding Ponds 0 ❑Subsurface Drains Present ❑Lagoon Area ID Spray Feld Area
s t:
❑ No Liquid Waste Management System
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
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?
A. Does discharge bypass a lagoon system? Of yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at.the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes O$ No
❑ Yes N No
❑ Yes
Iff No
❑ Yes
K No
❑ Yes
§qNo
❑ Yes
R&NO
❑ Yes
19 No
❑ Yes
C9 No
❑ Yes tCTNO
❑ Yes ®No
Continued on hack

Facility Number: 11 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lapoons,lloldin fonds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ........ ,Z, -1..
Freeboard (ft):..............................................
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes KNo
❑ Yes X No
Structure 5 Structure 6
15. Crop type L"..•------ .................................
.... ...._.......................................................................................
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 Reviewerfinspector 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
KNo
❑ Yes
No
❑ Yes
® No
❑ Yes
No
$Yes
❑ No
..........................
ayes
I— -
❑ No
❑ Yes
OfNo
❑ Yes
19 No
❑ Yes
91 No
❑ Yes
® No
❑ Yes
No
&Yes
❑ No
❑ Yes
IN No
❑ Yes
9No
❑ Yes
jil-No
0-No.violations°ordeficiencies.werenotedduringthis.visit.-You�wiHi&e'ive',n'6 iriher
correspondence about this.visit:-:
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Na� c
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: q, ," .jr 1 � �„ x Date: I% f `1- / d-]
LQL
I"4t

n
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: _ A c !n -goo re —
Mailing Address: �f • b /� . /�2� _/U� �4S_
County: __ad ;11 - - - —
Integrator.
On Site Representative:
Physical Address/Location:
G
Type of Operation: Swine ,� + Poultry
Desig=i Capacity: 2C�06
Phone: z? 3 -- 36PCZ�)
Cattle
Number of Animals on Site: ' Z - COOO
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes No Actual Freeboard: Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes o No as any erosion observed? Yes r No
Is adequate land available for spray? Yes r No Is the cover crop adequate? a
Crop(s) being utilized: f.Q25tol
Does the facility meet SCS minimum setback riteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o ONO If Yes, Please Explain.
Does the facility maintain adequate'waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?LL es r No
Additional Comments: C—r651-on b-F ,'XSr1]Ul1.5 (3
65 e- -12orj)A5
5
L Cemi5
Inspector Name
cc: Facility Assessment Unit
r-i5s Sfzh, !r z .zh cvn . - 5
1411a,
Signature
Use attachments if Needed.

ti
! Site Requires Immediate Attention: NO
Facility No.)��
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: Z , 1995
Time: / 2a
Farm Name/Owner: Mailing Address: [L S zl r
County: G/
Integrator. c Ll A/,or Phone: 4�q
0
On Sitd Representative: j0 dA1 ' /1"Re Phone: a_ rs - g9y&
Physical Address/Location: ' 4, � PlG% eg cw5r DAl Se In e"m
1b051 �Y"i'�/ /• S MlL2S S� OA/ .D1ru
Type of Operation: Swine _ /� Poultry Cattle
Design Capacity: joy_ SOld/41iihSNumber of Animals on Site:16.1
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Np 6PS Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes No Actual Freeboard: 4 / Ft. G Inches
Was any seepage observed from the lagoon(s)? Yes o DWas any erosion observed. Yes No
Is adequate land available for spray Yes, r Now Is the cover crop adequate;YpesoCrop(s) being utilized: /�F�pJS l � Sr•�L 00O.Q
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings (-Yes)r No
100 Feet from Wells?, e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 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 otj
bestate by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acrea a with cover crop . Yes No
Additional Comments: SC- ,9A✓9, -,Pr— . /U S r" A4-L-
,ZoS/on/ ,� . A' 41,0 _ YIDS - - A1,0 - 01\/
Inspector Name
cc: Facility Assessment Unit Use Attachments.if Needed.

ti
0
•
Site Requires Immediate Attention
Facility Number: 51 --.I / -L
SITE VISITATION RECORD
DATE: 17-11 . 1995
Owner: Farm Name: 4
County:
Agent Visiting Site: VL l; 5 Q Phone: _q 1 D 2 z r z!
Operator: _ _ _ Phone:
On Site Representative: Vt %ti sc-r-� ., Phone: 9 U• Z�- 3G
Physical Address:
Mailing Address:
Type of Operation: Swine ., Poultry Cattle
Design Capacity: OZ.I' Number of Animals on Site: ?,alr 1 F4k, F 6U
Latitude: _4 Longitude: o „
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or (9 Actual Freeboard: Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oo Was there erosion of the dare?: Yes o
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone]
Signature gent