310166_INSPECTIONS_20171231

Z V
NORTH CAROLINA
Department of Environmental Qual

0
I.
Type of Visit: UCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: —6—(7 Arrival Time: Departure Time: ' County: '.11 � Region:
Farm Name: L
Owner Name: L Fj G f <� t-t "
Mailing Address:
Physical Address:
Facility Contact: (� i �� %i7ov /'� Title:
Owner Email:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: j�'�j L Y,—� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer I
EE
Dairy Calf
eeder to Finish
3 7
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
U
D , P,ouI. , C•_P,o ,
a
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
11
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes M No ❑ NA ONE
❑ 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
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Z] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Z IDate of Inspection: og 7-Z, —/
Waste Collection & Treatment
i 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '[Z 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 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes JK 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 J�a No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �allo ❑ 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 B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA 0 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 ❑1 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3ee,'-ru[' rla
13. Soil Type(s): At W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qg-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? UKYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes _3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E. No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
B No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EjNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
1
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 1!3.No
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ( No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes D�_No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes CE�No
[-]Yes 0 No
❑ Yes [�_No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES"'answers andlor any additional;recominendations'ar.any other=comments.°.m
Use drawngs.ot facility to better explain situations -(use additional -pages as; necessary) .w
7
�ar�n 1?as air w n�a�i� r- ��w� ll �� ��s%����r� r1- .s-�-•-�
70
Reviewer/Inspector Name: ,I) % i5_'v`r_1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 0—/3D3--Ot 5l
Date: =Z ` f
21412015

ivisssion of Water Resources
Facility Number ®- �(� Division of Soil and Water Conservation
n
Q• Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: J&Poutine 0 Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: / Arrival Time: O/4 Departure Time: County: OLA PAL^ Region: Q t
Farm Name: % (��C�{ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: C tn,,r z2 ,2o fa Integrator: /11/4�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Wet Poultry
La er
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Feeder
Non -La er
Dai Calf
o Finish
ioWean
U
Design
C►urrento
cker
EBB
Feeder
o Finish
D. P,ouI Ca aciP,o
La ers
Non -La ers
der
Boars
Pullets
Turke s
Turke Poults
Other
od Cow
IMI Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]'N10
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[D'No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
�o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
eo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facib Number: - (( Date of Ins ection: 3
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
J2?No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[�J'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: y�l
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
P3'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 [;?fTo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 12,14o
❑ 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 VYes Oo
❑ 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 eo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100% 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 EyNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fj'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2rNo
❑ 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
❑,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
0-f4o
❑ 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
Ej-iTo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PAo
7
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

FacHity Number: - Date of Inspection: 2 ,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:kNo ❑ NA ❑ NE
1
26. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No DNA ❑ 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 Plo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes 'EjNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
jD,,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
[�J" 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
[TNo
❑ 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:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E5_No
0 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
❑-Ko
❑ NA
❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawingsof facility to.bettergexplain situations (use additional pages as necessary).
c7) L. a_5d6 n �a r of /1P s /�° Le. `e�� / re
f 05.S lQ .
067
Reviewer/Inspector Name:
Reviewer/Inspector Signature: 1`
Page 3 of 3
Phone: 9 7Y6 _7 3 2
Date: 4 3 f
21412015

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: (fj Arrival Time: Departure Time: County:
Farm Name: —�4" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: r'41.
Facility Contact: Title: Phone:
Onsite Representative: �; go_T__�� rp _ Integrator: , ILI
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
L
Non -La er
Design
Current
Dairy Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
IJ . P,oult ,
Ca aci
P.o
Non -Dairy
Farrow to Finish
Gilts
ILayers
Non -Layer
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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?
Page-I<of 3
G G(� Pr l�s��. lerrc S
❑ Yes eNo ❑ NA ❑ NE
❑ Yes fNo
❑ Yes r—
❑ Yes ff No
❑ Yes ❑'No
[:]Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
21412014 Continued

Facili Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ZNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C Zc _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes �No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes r�1Vo ❑ NA ❑ NE
waste management or closure plan? ";I
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 'E2'N0 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N' 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_,El*7No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PJ'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;:],No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes TT qo
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes j2no
❑ 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 -EYNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -ffNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PJ'No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the -facility fail to calibrate waste application equipment as required by the permit? ❑ Yes )2no ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes P�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?
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)
[:]Yes VNo
[:]Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes jZfNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [' No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
JC2'fVo
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
4 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
efNo
❑ 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).
� �el /Q�1f't /eUe/s QS �l�el�s/Ji�s.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Z
Date:
2 4/20 14

Type of Visit: Q11pompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: jaRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /1- / Arrival Time: eparture Time: County: U /r l�i�„ Region: I T•—�
Farm Name: �. I G Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
ity
Finish
7rFdcr
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
er
Design C►urren11111�t
CattleiiiiiiiiiiiiiiiiiiiiCapacity Po
Dai Cow
Feeder
ULa
Non -La er
Da' Calf
o Finish
Dai Heifer
o Wean
o Feeder
Design Current
Dr. P,oul Ca aci P,o ,
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
PNon-Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Boars
Beef Brood Cow
Uther
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
EJ'No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[;I'Iko
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage' capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �' o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �3 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 ,EfNo ❑ 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 oNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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 _oNo ❑ NA ❑ NE
❑ Yes ET'No ❑ NA ❑ NE
[:]Yes O No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ,-No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA ❑ NE
❑ Yes El -No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �-' 10
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facili Number: - Date of Inspection: 1,7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'ffNo ❑ NA ❑ NE
25. Isthe facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes EfrNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D 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
❑ NA
❑ NE
❑ Yes
r0
E]-INo
❑ NA
❑ NE
❑ Yes
P114o
❑ NA
❑ NE
❑ Yes
[,_j-f4o
❑ NA
❑ NE
❑ Yes
❑Ao
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes o
❑ Yes o
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: h `
Page 3 of 3 2/4/2 K4
r

.. ®Division of'Water Quality
Faciliumber - 0 Division of Soil and Water Conservation
' QQ Other Age„ncy
Type of Visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: p Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z j Arrival Time: / d Departure Time: County: DG 1 /�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: ���. fgjdj.L Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region>—J Zd?p
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Gow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
MIMEgn Current
Dr, P,oul Ca aci. P,o
Dai Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Non -La ers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
i
Beef Brood Cow
Other
Other
M
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)
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes EI—No ❑ NA ❑ NE
❑ Yes _,ETNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes o No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 4ETNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ONo ❑ NA ❑ NE;
of the State other than from a discharge?
i
Page I of 3 21412011 Continued
.I

Facility Number: - Date of Inspection: / Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PD"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j' 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 2fNo
❑ 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 �'`IVo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0No
❑ 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 L?fNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ,❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes [' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[%f No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[—]No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[�J'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑, NE
Page 2 of 3
214120I1-Continued

Facility Number: Date of Inspection: L
24 Did the facility fail to calibrate waste application equipment as required by the permit? of Yes ❑ No ❑ NA
❑ NE
25. s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
❑ NE
the appropriate box(cs) 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 J�rNo ❑ NA
❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L2 &o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes_,.,171 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 j2 No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fait to notify the Regional Office of emergency situations as required by the ❑ Yes ZNo ❑ 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 C2"No ❑ NA
❑ NE
❑ Application Field [3Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No ❑ 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).
P l Pos e c c5m e1 e.-�e cc 1 �or� ns
SGoK\ "11 S Pss� L6 .
r8 d o),i PieuIGUS Cc,-►�br�fro.-,
Ito-
( ✓r hq ea ! i bra 5
C")O 4,(
jae /D ��r� �,1 `scj°�(��
as) /Q c, p>re���us
for
>ru�y �ur� ;]
Reviewer/Inspector Name:
Yac (yr .
- Ad a cel o �( cW(ev7+ v
_10 b c o k-
yk U 60.&J Cs� Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Fac�lity-Number°��
/G(j
,; .
Division of Water Quaitty
Division of Soil and Water"Conservation.
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit <5"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .` Departure Time: County: Region:
Farm Name: �C _-� Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: QQ Title: /Phone No:
Onsite Representative: 1t�� �� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o = Longitude: C
Design Current` w Design ' C.iirrent
Swine Capacity Population Wet:Popltry, Cappcit} Pop, onN :.
❑ Wean to Finish ❑ Layer [
r,' ❑ Wean to Feeder ❑ Non -Layer [
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry [
❑ Farrow to Feeder "' [
ElFarrow to Finish ❑ Layers I
❑ GiltsNon-La ers [
. ❑Boars ; ❑Pullets [
ter [� Turkey Poi
Other . ❑ Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry_
Non -Dairy_
Beef Stocker
Beef Feeder
Beef Brood (
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
o=d =«
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
9M No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

+Facility Number: Date of Inspection $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [6 No ❑ NA ❑ NE
Struc re 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 El ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IV No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
{ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
7 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
RfNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
Cl Yes
�ffNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers ;and/or any "recommendations or any other comments.
Use drawings p
of facilityto better explain situations: use 'additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewerllnspector Signature: Date: 3 41rld
Page 2 of 3 I-4/28104 Continued

ection
Facility Number: Date of Inspa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ff No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vio
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VTNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Vj No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
�1���0 3 ►1
/Aa
4, je fits r
k a
Page 3 of 3 12128104

IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 911outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11UJ
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: 0 Title:
Onsite Representative: L/C
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region:
Latitude: = o = Longitude: = ° = & =
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
JEJ Layer I
10 Non -Layer I I
Dry Poultry
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
ElNon-Dairy
El Stocker
El Farrow to Finish
❑ Gilts
❑Non-ts ers
El Pullets
ElBeef Feeder
El
❑ Beef Brood Co
El Boars
❑ Turkeys
Other
IE]Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is -any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?.
❑ Yes 1z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
/ffNo
❑ NA
❑ NE
❑ Yes
JC2�o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection d
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?
Stru r
re 1 Structure 2 Structure 3
Identifier:
Structure 4
❑ Yes P�No
❑ Yes ONo
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? - ❑ Yes 0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA ❑ NE
/P
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �kNo
ElNA ElNE
(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 y(No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZiNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA ❑ NE
/EfNo
❑ 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
JD 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 acre determination?❑ Yes
6"N.'o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
IReviewertinspector Name - Phone: Q I
Reviewer/Inspector Signature: / Date: Q d
rage -, of J "nrtnuea

Facility Number: Date of Inspection Lr
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2`No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WN-o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�No
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ON
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
�Mo
❑ NA
El 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
PNo
❑ 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
PrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
50V
Cd��o`l08 1.6
S' t5wL
Q S/ C.PS ,SGOliC �S a Ssl� ,
-Ae ju".--o /' "�' , //,/,/ -.5- scivi��
Page 3 of 3 12128104

Type of Visit OCompliance 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
G!
Date of Visit: D (� Arrival Time: � Departure Time: 9. 04 a r, County: Region: /
4
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
6CA"LOnsiteRepresentative: /
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = S Longitude: = ° 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Lff Feeder to Finish
3 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection
' `y
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?: pp
Designed Freeboard (in): 167,
Observed Freeboard (in): ::;? C/12
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
RjNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
VNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures 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
Z No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J6 No
❑ NA ❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
VfNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP?
. T
Yes .rc-' o
❑ vim`"
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VrNo
❑ NA
❑ NE
FQrw lS lvI Pi1'(�/ Ae a7i-C/ S / f ea ,f-
cvel/ MeZ lA-eW
Reviewer/Inspector Name I < Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: ,3 — Date of Inspection �T D
Reuu6d Records & Documents ,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes .CI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q"N'o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VfNo ❑ 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
RfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PTNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W(No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
QfNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes tZ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JZ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�(] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WrNo
❑ NA
❑ NE
[kdditional Comments and/or Drawings: _ = - .- - - _ o , =.M ., .._,: -• �_,� _.. �;_.
12128104

(Type of Visit QPCompliance Inspection O Operation Review O Lagoon Evaluation I
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of visit:
[] Permitted 0 Certified JO C. aditionally Certified 0 Registered
Farm Name:��� __ ...
ional O Below Threshold
Date -Last Operated or A ve Threshold:County:, V .. _.
Owner Name: _ .... _ .. ...w . _ � M. .. ..�_. Phone No:
Mailing Address:
Facility Contact: . __ .. Title:. .... Phone No:
Onsite Representative: �rr�.1�--- �- _._._ „ ._... - -- -•• Integrator: ����
Certified Operator _. ... _W .. r . .. - Operator
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • < 44 Longitude • < �C.4
_ Desagn Cnrteat � -- '.-�Desagn x Cnlrent: Desagn — CIIrrmt
-Swine i:Ca -Po'' "t;on:--•"p "9 Qty iiP tioft,. =Cattle" r 10o han
rGilts
o FeederiZ Layerto Finish Non -Layer Nan -Dairy_ to Wean to Feeder Otherto Finish ' _ = Total=SSLIT _
mks.. -
Dischanes & Stream
1. Is any discharge observed from any part of the operation? ❑ Yes ,0 &o
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes :L�FNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes _�E'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 131�o
StrucSure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier
Freeboard (inches): Qg W
1211VO3 Continued

Facility Number: ;3 ` _ Date of inspection } ,
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes re o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes J21No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes j2Vo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ;�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes PNo
27_ Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes 'rWo
28. Does facility require a follow-up visit by same agency?
❑ Yes 'Q�1Qo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
,EI'Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes -.ONO
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ZNO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes B'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes L No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes 'ONO
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
7 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-elGOs r2
j'f�
- s`ia�
�- �✓e// �ii7 Pc�
CG �S Q/'� 11L�a � 0` 6✓�i�IX7,Kkl
12112103

�Dinstgn of Water Quality..- -
; F r Dn�-1466 of Soil and Water Conservation
z
s d Other Agency
x
Type of Visit Q"Compliance Inspection O Operation Review O Lagoon Evaluation
Beason for Visit_013outine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
ate of Visit: l Ib ze- Time: ICt = �4 Printed on: 7/21/2000
D
Facility Number �1 ! (��
0 Not Operational 0 Below Threshold
[] Permitted d Certified [] Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name:.L' i�t �1�e...N'"ti County:.__,�:�.Uf.r.1.'"1................
.........................................................................................._.....
Owner Name: t" G�Ce Phone No:.......................................................................................
............................
Facility Contact:
Mailing Address:
'title:....
Phone No:..........................
Onsite Representative:.,... L...... i GIP e , Integraton ... niv YO0 h
Certified Operator:................ .................................... .. Operator Certification Number:..............
Location 'of Farm-
r
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��° Longitude �• �� ���
Design Current
Design Current Design Cuirreat
S Cs -Population
. Poultry Capacity Population Cattle C P Lion
Wean to Feeder
❑ Layer 10Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean z
Farrow to Feeder
❑Other
l Farrow to Finish
Total Design Capacity
aGilts
'v Boars
Total LW'•-
�.
Nta oiLag000s ;
l
❑ Subsurface Drains Present
❑ [.agnon Area it-] Feld Area
- Ponds! Sold Traps
No Liquid Waste Management Syste
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/rnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2, Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:............................................................................................
Freeboard (inches): �Q
5/00
❑ Yes erNo
❑ Yes JO No
❑ Yes ONO
h /a
❑ Yes 2fNo
❑ Yes ONO
❑ Yes 'ONO
❑ Yes ONO
Structure 6
Continued on back

Facility Number: Date of Inspection
5. •Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes FfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes o
(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 0`N0
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes Ff No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes allo
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes ,UNo
11. Is there evidence of over application?❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes ONo
'
12. Crop type Ber- r-Ly et ej 1f c,t s' i rrr, 6 r`g i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes P/ 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 JVNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes J�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 9No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
eyes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 9No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ONo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
�f No
(ie/ discharge, freeboard problems, over application)
❑Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONo
24. Does facility require a follow-up visit by same agency?
❑ Yes f'hlo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
WYes. ❑ No
P. Yi u�iQns'e defieiencie ftre po.ea �irrkig Ns.visit; • Yop w01•00KO 40 fuftb .
corresbor deir>tce taut this visit: :..........:.:........::..:........ .
14. T'Lle ekCreanC5 sl•t.ow-.. aL-t 44e irf; y4 tia� a[csigh wt,,lp dt{�F'e� a^-� -Ae `
c3ere��GJ S dt,v� �� -}�C i✓'r���;a�t !�¢slrtti -}abbe. �K�ac� �f. �ll��
de4eAn;n,e wh,,c&, gc,,CogcS nee- coer U. j%ve
- i,e L.'r�I�G /o��-t f,Jl: �"� 6_,tsed opt c,_eTc4 eLG�(c/l5 G1',d ,ice
�r�:/�Cr�i oE, r'8C[�✓d,f G�-CGP/'d;riCi�y,
IS. Yoz, need 4 a ek I 1;�-ie a�J�Il-►e , �e a� I -l.S-F�hs�� cue ��r
j`,erd cys &%^iertdeA by s-ed re5U1f< s lndr'Ca e—A 6co..10
Reviewer/Inspector Name J yxW _ '�
G z..»..Y ,. fie: -l= ?� z'�--.=w
Reviewer/Inspector Signature: Date: ) 1 (oZ. 0 Q Z 5/00

Facility Number: 3� - / (aLJ Date of Inspection 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/ur below ❑ Yes ZNo
liquid level of lagoon or storage pond with no agitation?
27- Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J2No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ';J�iQo
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 -.2'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.,,ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionaUComments an or swings:
�s.(ea>�-1►�,��d� d�f� egrl'e�- ;n5feC4-a,2s. tmv,. Pt'ckeye sa►� 1,• e
Iasi App ) ieA 4e,.,- li ajo .
1q. Neeod 4o be svre 4e vs c of L-'r-f4e �t na 1 w 4k, h
(oodg s of ct ✓)i�r�+'6h evertllS +o Calc71g4e +fie rAAJ aep�,cd
on 411e
ZS. &r'ocve,•,s ,recvro(S SC�DI.J - � WkeccT 'Lucas q�f lied fo
��l�O�� Y►?a � 2bD� . `r�� S�1) JroL.� CrpP �e�dS -�O
6e, �ri-loved b� �P�;1 PRGIr y�� GL�'�/ �ir�T►®ns
A G Lf sTe;Oi `�O be t y"t uAci � he ry ot-Fie.' .
Also, otre 4 kree pv)I s , pa 1 l s
beo), added ;n -�h ;,^r+t 9C14;0-, desi9h -�ab1e gpe���n-F1 b
�<• i�esaer � l�ol,t�o✓Gr, -�LI;s gCrQG.yG >s nab TnC1�,dcd ,n �e
�✓C<S�G �1�► for rh✓�° �� Swh or,"
LtJA.s--fie 6s bee, a p) ; e A -4Q -• 4e-,Te u -4 4
InAve 41,ese 415 ind deal ;n -Ae wc46 Pk^ clnt
;,,clad ed en - Ae n,ta 1'( 44el w'1 be v.seA
lVoM , Yo -- -Fares. AAA a ►?mIl7 kep app�a!'a�ce %net
4he crops of ppeeir 4o be do;lio w,e11.
A6I
5/00
J

Ihvision of Water.;Qaahty _ -
Q Division of Soil and Water Conservation
Q:Otbier Agency'
Type of Visit )J Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &,Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Titne: �a Printed on: 10/26/2000
Q Not O erational Q Below Threshold
Permitted 13 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold
Farm Name: 9.� ?... � :-...'.(.�. - `� .........................
........ ........... �..<..-........................................................................................-. County. 1.1h�.\I`.1...........................
OwnerName: ................................................... ........................................................................ Phone No:.....
FacilityContact: .................................... Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: ✓.................... ................. Integrator: ..... 6k -:� ..................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • C79 14 Longitude • ° «
Design Current
Swine C:anacity Pnmdation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ID No Liquid Waste Management System
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation? ❑ Yes j2rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed- what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �%No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CkNo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.................................... .................................... ................................... .................................... .................................... ....................................
Freeboard (inches): `{
5100 Continued on back

11'acility- Number: '3 —\C Date of inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
,XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONO
(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
J�[No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
allo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
&NO
11. Is there evidence of application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N�No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
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
gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
[YNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1�(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
toqo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
4No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NrNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
01 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E(No
-EU
No.yio1aiioristotdeficiencies-wer) potted-ditr'ingthis:visit:-Yohi dj•teeeiveridfurther-: :
corresporidenee ab"f this visit. - . - .
Comments (refer to question #1): Explain any -YES answers and/or any recommendations. or any other comments. - -
Use drawin of-facili to better explain situations. (use additional pages as necessary):
ty P P g :
rC�m sl� (\1 I",
Reviewer/Inspector Name s 2(0 3 iS -3g Cl ()
Reviewer/Inspector Signature: Date: �`� la —G a 5100

Facility Number: Date of Inspection a Gil Printed on: 10/26/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes TO
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 qNo
31. Do the animals feed storage bins fail to have appropriate Cover? ❑ Yes C�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JKNo
Additional omments an orDrawings: W
{� t A.
5100

i
❑ DSN C Animal Feedlot Operation Review
DNN7Q Animal Feedlot Operation Site Inspection
® Routine Q Comnlaint O Follow-uD of DIVO inspection Q Follow-uP orDSWC revieµ• O Other
Date of Inspection yy I
Facility Number { Time of Inspection 24hr. (hh:mm)
0 Registered ;l Certified © Applied for Permit p Perm tied 113NotOperationAl Date Last Operated: _
1'(AY County-_..
Farm Name:.-�..�
Owner lame: w � h {! �r__K �� ._. Phone do
Facility Contact: _.. _ _ _ _. _ .. _ — Title: _ _ Phone No:
Mailing Address:
Otkite Reprt-scntative:. -a �r _..G ....�... �... �. _ Intent-ator:
Certified Operator;
Location or Farm:
Operator Certification Number: - .._,.._,_-
_�:a_.—.i+�•�--..s►yl--- _.��.. � a �i�.:r.�_tr�l G�...YtR � ... �at�..�?�...�_..._----•-••-----.....__-.�-............. ..�.....�._.......
Jw
�
--- ...
Latitude �' �` u Longitude
: Design',-, v, Current a_ Design Current :Des�ga f Current
:Somme „. Capacity.; PopeilatioQ Poultry.r,Capai�t�' :Population Cattle, Capacity.Poptlaban
.
❑ Wean to Feeder] Layer ❑ Dairy
Feeder to Finish 3 Z ,(] Non -layer ^�� ❑ Nan -Dairy.
:...
" ❑ Farrow to Wean
El Farrow to Feeder JE1 Other
❑ Farrow to Finish ... ToW Design CapaClt : i
❑ Gilts
❑ Boars :Total SSLW;::
r IliiitAaber of Lagoons./Holding:Ponds' 4 Subsurface Drains Present 11OLagoonArea JM Spray Field Area
❑ No Liquid Waste Managementtrt ,r S�ste
General
1. Are there any buffers that need maintenancehmprovement? ❑ Yes T No
2. Is any discharge observed from any part of the operation? ❑ Yes [)I No
Discharge originated at: 0 Lagoon 0 Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? 0 Yes No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) E3 Yes No
c. If discharge is observed, what is the estimated flog;' in ;al/min? X
d. Dries discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes O No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes lO No
4. Were there ariv adverse impacts to the waters of the State other than from a discharge? ❑ Yes EM No
S. Does any part of the waste management system (other than lagoons holding ponds) require El Yes (] No
, maintenanceiimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes � No
7125197 Continued on back

Facilit} \umber:
6. Are there laeoons or storage ponds on site which need to be propt-dy closed?
S ructures (La.-oons Holding Ponds Flush Pits. etc.,
9. 1s siora ,c capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
El Yes )M No
❑ Yes M] No
Structure 5 Structure 6
Identifier. _
Freeboard (ft) - j
10. Is seepage observed from any of the structures? ❑ Yes ' No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes P No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered ves, 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)
15. Crop type��_
16. Do the receiving crops differ witb 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 reviewirnspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlr
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?
lio, 25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violafions or deficiencies. were-ntited during this.visit..Y:on' v�ii] receive ao further
corresj*idence.abouf €his.visit:::. :
[--]Yes P No
❑ Yes P No
❑ Yes 0 No
❑ Yes ®No
Yes ❑ No
❑ Yes [ No
Yes ❑ No
❑ Yes J81 No
IFA Yes - ❑ No
❑ Yes No
0 Yes ElNo
!!� Yes ❑ No
IZ. EYcys�pn w� ��. :nytp!' r�;ai� G (�5mr� t��-�! .,�.00i� �Je. �t`LiAr) "JL4— eSan� rc U,
�• CJ,Or.�iY1Ue -gz0S 1O iM&,Cdvf- �Qfywu� . I
Yx' n 5e 1�� Z �orry. fO c-A Vie— Uses} � ea,-L co . Yc. carvrck- PAN
sl,. J be- used �o r � c i, ex�. lz`' -amwir
or` Srr+alk Cr
rw 6- ,461 3E1 14Ei
f-�l�c.l (,A (6sjLL, W J1s/4c, rts,PeLAjvt(j, Ovevo� �fe� wi{�rf, S6jJ 6-subfmc U, ,
QYIc2S • 7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: 11N t�-- �,. Gjf Date:

I!aRoutine O Complaint Q Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 Time of Inspection i�_ 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
[9Certiiied ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _ _ . .. ..........
Farm Name: . _.. rli.G��fi1.�. ..........._...._ ....._ ..... County.k ...........ICYI..Q
Land Owner Name:. .. _....1T.� .... _� .... ....._ Phone . .............. _..... ...........
FacilityConctact:... ..... _............... _....... _......._...... _...._ .--- _... Title: _.. ....., .... _ _... Phone No:
Mailing Address: �rJ�. .IO��-vtY{w .... fAv►G� +1 -e
Onsite Representative:..._. _ .........._... _........ Integrator:
Certified'Operator:...�[ �C .....,........-CA-�-t .......... ........... _...... . Operator CertificatioYlumber:
Location of Farm:
��ktMac�:b, �!1,... 5 �.~ _ .... _...._.......__......_....__...._............ ...._............. _............ ............. _...... _..... _........ �y
Latitude ®' S1 & " Longitude ©• ��®
Type of Operation and Design Capacity
�Des�gn Current Design ° CarrentDesign� Current
SwEcre F,....HCa TactPo tlatonoultTYa.� ' Ca aci "�_ Po ilatton�e :Ca aci Po Mahon
�1[] La Dairy
❑ Wean to Feeder �� ' ❑
Feeder to Finish ❑ Non -La Layer ❑Non -Dairy
Farrow to Wean r { h
Farrow to Feeder T©`tal Design -apkdt" (� Z �� }
r r
Farrow to Finish �� � � �
❑ other. ,�. .. _. <' Tots! SSL�W
ra
iitbof Lagoons
lot
I Holdeng Pond`s ❑ Subsurface Drams Present 4 v
P
§
eN
" u«� ega
Lagoon Az ❑ ❑reaSpray Field Area
Hera
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/inin?
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
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes [& No
❑ Yes ® No
❑ Yes [R No
❑ Yes
M No
❑ Yes
J21 No
❑ Yes
® No
❑ Yes
allo
Continued
on back

Facility Number:..-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes IN No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures agoQns and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (fi): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes {$ No
❑ Yes 91 No
❑ Yes O-No
Structure 5 Structure 6
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?
R'aste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type . ....... sl!Y�Aj...q.w . v.,. _...._�. _..... _.. .._ ..... _............
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?
FQr Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes E No
❑ Yes B. No
la Yes ❑ No
❑ Yes A No
❑ Yes ELNo
❑ Yes Z No
❑ Yes 2tNo
R Yes ❑ No
❑ Yes &No
❑ Yes IN No
❑ Yes ®.No
❑ Yes E9 No
❑ Yes allo
K Yes ❑ No
Comments (refer to giieshon'#) "Explain any YES answers and/or any rec`ommendahons;or any other comments.^
Use drawings of facility to better explam,situations (use additional pagesas necessary}
.
t z. Co -- e_ r_t en o S. . fl ,.. a r-a 1... f. -.:. -
J - - ; e � - -k o.-d J ate
5 Cv r ,.�..vc1 0. Cw� CY�V�-'
i ,, w �i�r IrO--p oo vi W Q- ti V i.0..�- �•�y Yri6
(�-►q%
$ E-0. C-e Y\ ;
t $ C a ,.. ►, v 8 Y' a OV E p - a s .. C_ a r✓ sin I i/�.cd t� . , d Q--V--eL q va
�qJ�
�- 4� C w � �. � ri 6 O c!�-v�.t S 0 � a
� • T a 1C.� 1 a� o-o x w a.-t fie.- S °^"'� Y �
,.,
,T v t �� eJt-d 1►1 v �.. e�eL� q ,�
Reviewer/Inspector Name
R .I,
"
Reviewer/Inspector Signature:
Ag
Date:
-1
1 7
q 1
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

0
= Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STTE VISITATION RECORD
DATE: 9" 3 , 1995
Time: 3 . Z g
Farm Name/Owner:
�—
�' G
��
FCC' YY1
Mailing Address: j
4S�t3
�`re-rG�'1
geul�yil�� 2851
County: 1- i )
Integrator
On Site Representative:
Physical Address/Location: 50
Phone:
Phone: ZVI- _20SE
7r►5yij�er le-Ff on
5(z S 3 m', on lei+
Type of Operation: Swine Poultry Cattle
Design Capacity: 2J�� 2 Number of Animals on Site:
's Asco
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 " 51 ' Z7. 4- " Longitude: "n ' S 1 ' 5 5 % " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6Lr No Actual Freeboard; 3 Ft. 0 Inches
Was any seepage observed from the Iagoon(s)? Yes of V�o Was any erosion observed? Yes oir—OD
Is adequate land availableforspray? Yes or No Is the cover op adequate? Yes or No
Crop(s) being utilized: t x rmv(L3 cu ++'1 �'J�' (J� e2 i 31, 5 QC_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(g)
Is animal waste Iand 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 org) 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)? (S)Or Nof'
Additional Comments:``LY C>44 S bW . 1�35 i2e r mj S S 1 'c>n
it ph +� ,e i r
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.