310831_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

rype of visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: , Arrival Time: , A-t Departure Time: �County: DLtO L-PIJ Region: We
/t� 1
Farm Name: d 2 .3 S Owner Email:
Owner Name: Ta rq S ��+\CQ Phone:
Mailing Address:
Physical Address:
Facility Contact: VQ ►-v'eS 5('1`CP _ _ _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Non -Layer
Dairy Cow
Dairy Calf
Wean to Feeder
tayoa
'0Da
Feeder to Finish
Dairy Heifer
E
Farrow to Wean
Design
Current
Dry Cow
Non-Dai
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
+'
Other.
L 10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes t 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
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
[3NA
❑ NE
of the State other than from a discharge?
T
Page 1 of 3 21412015 Continued

Facility Number: - 4
X3j Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA [D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No J!� NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r ,j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [$] 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 D Yes &5)No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �t No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR 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 ❑(�Eviidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): tep{/L+05-6l �'�' �7'�SS lL���� �r1 • l? 'a^1�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,
No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
[:]"Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�3 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
['M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
(q 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilit , umber: - Kqt IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EpNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KZ 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
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
[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)
T
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
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1 J-
f-flp
Phone:
Date:
21412013

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: . 00 Departure Time: County: 0, Region: S1 /ij
Farm Name: 15// C4, // Z 3i ,f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Y
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator: ✓%"`%
T'
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity op.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
EEI
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
l) . P,oultr� Ca aci Po ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
J#Turke
uultsOther
Discharses 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 ONo ❑ 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 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tr ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes �No
❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes 'ErNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes U*No
J
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes FLNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
7
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.
No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [a
❑ 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 2(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 Z] o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VNo
❑ NA ❑ NE
lComments (re11 fer` to,question#} IExplainanyYES answers andlo�any additional recommendations grainy othercomments" s '
use'd iwngs,,uf facility, tofbetter$explili6itu" sJO ns,(use add tl6tW pagesaas necessary)
kbW % f O26 OYN
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 2 e
14/2015

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l z S 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? / [—]Yes ZNo ❑ 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 PNo ❑ 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? D Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O-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 [2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Zf No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PNo ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 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 �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 No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

V
Type of Visit: Cam liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: - Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3Q Departure Time: County: D/i Region: (�
Farm Name: ' d— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
(
Onsite Representative: �.e Integrator: Z?i a
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultt:y
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
!
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
MURMUR
C•a acit
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
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?
❑ Yes , No ❑ NA ❑ NE
❑ Yes �No
❑ Yes �IVo
[:]Yes �No
❑ Yes P No
❑ Yes �Ko
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes N ® o
❑ Yes R No
Structure 5 Structure 6
❑NA ONE
❑ NA ❑ NE
❑ Yes '.�o ❑ NA ❑ NE
❑ Yes ?No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ;jNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes a3qo ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes �No [] NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate bo elo ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground He y Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Fa 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?
151 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?
❑ Yes �No
Yes ❑ No
❑ Yes ;2-No
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
'Eallo
� No
P40
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [/,Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard JZWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VO
2'N❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24.1.id*the-facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,E]�No ❑ NA ❑ NE
25. 1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ;^No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes O No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes )2]^No 0 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 ff 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 ;EfNo ❑ 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 ,J�TNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
VNo
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
ffNo
❑ NA [] NE
Comments (refer to question #) Expltiin!any-YES answers, and/or any,additional,recomiiiend'ations,or.aay-othercoinments
Use drawings of fgcility to better explain situations (use additional pages as'necessa ) , ,.
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ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
t
Phone: 0
Date: Sbell
21412014

i ype or visit. %p I.ompnance inspection l.1 vperanon iceview V structure rsvaruauon V i ecnmcal Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I/G1,T Arrival Time: Q Departure Time:Coun
Farm Name: C(Jj'j(Q �� Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: !"e rpj��[ p
Certified Operator;
Title:
Region:
Phone:
Integrator: I
.,,_.,.
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design t►urrent Design
Swine Capacity Pvp. Wet PoulUIN
try Capacity
Wean to Finish Layer
C►urrent Design
Pop. Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dr P,oultr, Ca acit
Layers
Current Dry Cow
l;a Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Puilets
Beef 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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
[:]Yes p No
❑ Yes qNo
❑ Yes 0 No
❑ Yes �]'No
❑ Yes [a'No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Z I -
Date of Inspection: G
Waste Colleg igm & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: T 2, 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �[ ' Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
P�No ❑ NA ❑ NE
C'No ❑ NA ❑ NE
Structure 6
❑ Yes � o ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes jo 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 '�10 ❑ NA ❑ NE
maintenance or improvement? TC
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 dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation designn or wettable
❑ Yes
P 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
�2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
r7rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design [—]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ' ❑ Yes P"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 [� o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120.14 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C31�o ❑ NA ❑ NE
25. Is theme facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �I o ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ 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 ❑ LagoonlStorage Pond ❑ Other:
❑ Yes rZ No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes Mo ❑ NA ❑ NE
❑ Yes �no ❑ NA ❑ NE
❑ Yes ,ffNo ❑ NA C] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [I 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 o ❑ 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).
8ll8 //y 'dui �ii sad ,fs-V 1h%s 1/az
�/'a-gk
!2/ 1C)/l3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: l
/4/2 4

Type of Visit: J2Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: A!7`koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: °�eparture Time: County: Region:�1
Farm Name: T 117 ! gpoll /. L, -4 t J "i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: (j2^
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:00K,,XQa�3
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry C*apacity Pop. Cattle Capacity Pop.
Wean to Finish Layer DairyCow
Wean to Feeder
Nan -La eii;
DairyCalf
Feeder to Finish
DairyHeifer
C*urgent D Cow
Dr. P,ouitP,o , Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
PI-lo
[DNA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
❑ Yes
ZI No
❑ NA
❑ NE
Page l of 3 21412011 Continued

Facility Number: - Date of Ins ection: '
WAte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C9 Z
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
Ef 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes o No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require 0 Yes P 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 ZNo ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EfNo ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ff No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZfNo
❑ 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
Q 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
❑ 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 ❑'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O—No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fartilify.Number: jDate of Inspection: 'Z
24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0No ❑ 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 dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VNo ❑ 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 concem?
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Ef No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
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 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesgNo
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).
�rf s
17
C�nn�f
-5-1111-3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6 /& k
re
6zt% 4 da/C.rL
Phone:
Date;
l/4/201

Type of Visit ,,C,00mpliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit— Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Z L w Arrival Time: �6 Departure Time: County:
Farm Name: 12/�J' ( /ZIIUlJ L. 41 S _ d° r ) Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: /j Title: Phone No:
Onsite Representative: Integrator:
EY
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =e =& Longitude: 0o=, =«
Design Current Design C►urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
I ❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dai
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
❑ Other
Number of Struc#ures:
❑ 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?
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 ,8 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�rNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

- Facilify Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes,;2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;"No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: , -2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /ffNo ❑ 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 U No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑'Ao ElNA ElNE
ElYes �No ❑ NA ❑ NE
❑ Yes ❑❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J2 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 �Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z'No ❑ NA ❑ NE
L� I+
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;�No ❑ NA ❑ NE
❑ Yes [:�No ❑ NA ❑ NE
Comments (refer: to question #):, Explainany YES answers and/or,any recommendations or any3otherpcomments ;;
ry)
UseArawings of'facilityto better explain situations. (use additional pages='as necessatu
QjQj ko
4e 5`�-
A.
sclq�v�.
.
Reviewer/Inspector Name`
Ark
4
lli°1 q . fi1
Phone:
ReviewerlInspector Signature:
Date:
Page 2 of 3 1128/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes �io [I NA ❑ NE
El Waste Application [I Weekly Freeboard Waste Analysis El Soil Analysis El 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
[ FNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ 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
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�&o
ElNA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[*o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
"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
JZNo
❑ 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
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
PNo
1
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
VA
�t
z4 3
2. 3 f
d � �
lot 50,0^
Gn 6Oe'i ePkLe S .
UY" 1 0.1
cPrf��14'W_
44-p- 4wo
k---s
Page 3 of 3 12,28/04

Type of Visit e'Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit CrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: // lT %� Arrival Time: Departure Time: [� County:
Farm Name: / -!? Z,4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
0 Technical Assistance
0 Other ❑ Denied Access
/ Region: '�f�
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a o =' f--] Longitude: = ° =' = «
Design Current Design Current
Design C*urrent
Swine Capacity Population Wet Poultry Capacity Popuiation
C►attle
C*apacity Population
❑ Wean to Finish ❑ La er
❑ DairyCow
❑ Wean to Feeder ❑Non -La er
El Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
Other
❑ Other
❑ TurkeyPoints
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J;Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
G214o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�' o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

F,gcility Number: Date of Inspection / 7
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?
Struc re I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �2rNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Structure 5 Structure 6
S
❑ Yes
[jNo
❑ NA
❑ NE
❑ Yes
;ZNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
30N� o
❑ NA [3 NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
1J 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
,fNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
7No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ENo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes oNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes O'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes O-No ❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes �o ❑ NA ❑ NE
A : k4 S a "k.Y-' �5 i� i' Pi �.�y:i -a q �4 ,'1 .' `k ? �;- A .`NA � )^ � A: '�6'rL i e ' 9. ik . ; . , .. .. 'ice . - 'V+- ..� II , , X ...
Comm �nts (rtefer to quest�6n' i4p� E pllalntunyA Y. answe�r�,0an4i r giiyy recommendatipps or any.other comments.
Usedrawmgs of, facilitylto.betterexpatn situations. {use additionalpAgeasnecessary:}:y
r
Reviewer/lns ector Name
P �; ��i(/l/�
� Phone:
Reviewer/Inspector Signature:
Date: ='_e�7.• Q
Page 2 of 3 12128104 Continued

Vacilitx Number: c3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zo ❑ 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 ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. /VrYes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly FreeboarP20
aste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
El Rainfall ❑ Stocking El Crop Yield Minute Inspections PrMonthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
. P110
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Zo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;2-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
?No
❑ NA
❑ NE
Other Issues
✓
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P*o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;ZNo
❑ 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
❑'RTo
❑ 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
[4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
¢"'rnin nf'sinil/oEll r awin Ad'ditional�Co e ` s�
. �e
vl ce
ell,
G A Sever
o6e Cadre-1 eK1a.s.4_
Gt'haly s/ t.
44 Xa /lZli� � lh rle
Page 3 of 3 12,128104

Type of Visit W Compliance Inspection U O ration Review U Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint Follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
27 0$
Arrival Time:
Departure Time: County:-DOPUN, Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 60PA L3r—r-cc Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: c = I ❑ " Longitude: = ° = ` = "
'
Design Current
DesMn,-,I,,urrent
WDsign
Swine k .
@apacty Population
Wet Poultry
@appulation
'Cattleacity
PopR! lion
❑ Wean to Finish
❑ La er
§ ❑ Dairy Cow
Wean to Feeder
44OC -
'15
❑Non -La et
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ La ers''
❑ Beef Stocker
'
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
�
Qther
'
❑ Turkeys
❑ Other'
❑ Turkev Poults
'Number of Structures:
'
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Z No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
[I Yes
IQ Zo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
L�
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 3 1 —g3 l Date of Inspection o8
Waste Collection & Treatment
,_,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
F Yes
11 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ f No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LW Cho pj I LA Cro cry Zz L.A Coo tJ 3 LW ,j A
L A ",j .S
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in): 20 7A I q
Zo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L7 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo ❑ 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 Ej`N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes L'1 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
(❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
[ 'No
❑ NA
❑ NE
t5. 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?
❑ Yes
`
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
14,) 14 4:4 F"E8 ot12,p oN LA6 --3 1"rC0 -4• TWU-ro . ►jaV W=t'44
Gdfr,ti E Nr
`
Bb ooN� }jNl7 sew-►-�T6 EDCJtC (aM1-ZLE ASAIP. Aiff-9
t6 tsul- roa.
1,) W A S r( A Pees GIA- `-" tJ NE Eb $ to ae P OJT G m pra P4 s- & &wt s
Vq,) 30 0AYs TO 4A(16 CA L-13RA7Zo,l se -Air 1'0 01vio .
Reviewer/Inspector Name J., No r42oPhone:
9/0 %74 -73f
Reviewer/Inspector Signature: Date:
a
12128104 Continued

e
$acility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
NNoo
El NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
V,
U No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does cord keeping need improvement? If yes, check the appropriate box below.
Yes
El No
El 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
u No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[I'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Z Yes
❑rN
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
3 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2/ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LEI 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
Er*/
❑ 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
N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility Number 83
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 1) Compliance inspection O Operation Review O structure Evaluation 0 Technical Assistance
Reason for Visit .0 Routine O Complaint Q Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
/d 3
Arrival Time:
Departure Time: County: Exam Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: E8DJ& 9316UE
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 =di Longitude: = ° 0 ` E
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder 11040o I t0000
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Capacity. Population::
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
INumber 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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
—❑ /No
j
ElNA
ElNE
❑ Yes
L✓J No
❑ NA
❑ NE
12128104 Continued

Facility Number: j — Date of Inspection to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AA6oP.1� lAa _ __ Z ZA6'ow (f�r;/06N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31, _ Z� 4 q 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[2(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
}J No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
K
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
FN
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
El NE
18. is there a lack of properly operating waste application equipment?
El Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
tA) 3o >DA` j Tu ODA7E LA)W f . A, oetV ) w,JOti A+un 106,) VX&LD,
ZO XDATC 19A,7., j ra 1516a O6-) GaP YT e_tD ) R,XA � aN b �,,e le Yu 0 Q
,.y) Oy p CALUO 9� :z j l5' �7
L} t-y—C.P Swine SOkv£
Reviewer/Inspector Name L70 H d /Z k-Lk, Phone:(9/d 3
Reviewer/Inspector Signature: 9 Z., A46Date: /0 p
I2128/U4 Continued

Facility Number: Date of Inspection 16
V1 !
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Y No ❑ NA ❑ NE
20. Does the facility fail to have al components of the CAWMP readily available? if yes, check Yes []No ❑ NA ❑ NE
the appropriate box. UP ❑ Checklists ❑ Design ❑Maps El Other
21. Doe record keeping need im ovement? If yes, check the appropriate box b ow. Yes ❑ No ❑ NA ❑ NE
C Waste Application eekly Freeboard ❑ Waste Analysis S�Zonthly
alysis ❑ Waste Transfers ❑Oweather
al Certification
E Rainfall LJ stocking 2/crop Yield R 120 Minute Inspections and 1" Rain Inspections Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ? No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ s �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
Yes i<o
❑ NA
❑ NE
�/es GKo
❑ NA
❑ NE
❑ Yes EJ o
❑ NA
❑ NE
❑ Yes ❑ No
EIKNA
❑ NE
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
3 I. 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?
Comments and/or Drawings:
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes
[:I o
❑ NA
❑ NE
❑ Yes
9<'oo
❑ NA
❑ NE
ElYes
DNo
❑ NA
❑ NE
12128104

01
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2 /(Q Arrival Time: Departure Time: � unty: GZ Region: G
Farm Na.me: 2 Owner Email:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
vnts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator: 6clJ
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 6 Longitude: = ° 0' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
LO% J W I HezeZ_0 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
1EITurkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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)?
Number of Structures:
®�
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
'0
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number• — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑NA ❑NE
❑NA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 44- l //2 _ Al3 00;1
Spillway?: Na Vo AIV
Designed Freeboard (in):
Observed Freeboard (in): le 2� _V 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed []Yes P No ❑ NA ❑ NE
through a waste management or closure plan?
ZYes ❑ No
❑ Yes No
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 J2�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J`J No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
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 ❑ 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 Wind o ❑ Evidence of Wind Drift ❑ Application O
of Area
12.
Crop type(s) V5%e 4401q Q I�/Q-
/f'de
r✓l/�iQ,s�
13.
Soil type(s) No A NM
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 7rNo
❑ 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?
❑ Yes YfNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ;dNo
❑ NA ❑ NE
i t Vai,.,i� i, t
Comments (refer to question #) Fxplam any YES�ggattswers and/or any recommendations ors any otherxomments
Use drawings of factlity to better explain situations,(use adi ona,page ls ashnecessary)
M1
�fPo2�`
/� /� 3 DS S�� d5� �c�f0: Wi►'t� �co�
FfO��r ��.f. 7/,O �•"3'�
Axylo
r
/Y'IDRF GtJ�s�� o �3�
Na
Reviewer/inspector Name AAA
got
phone: ,9
Reviewerllnspector Signature:
Date:
12128104 Continued

Facilij Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LdNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
X Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking )� Crop Yield 9120 Minute Inspections ❑ Monthly and I"
Rain Inspections 9Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P�No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
pl'!No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑
[ "No
El NA
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
//Yes
❑ No
❑ NA
ZNE '
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 JA No
❑ Yes to No
❑NA ❑NE
❑NA ❑NE
❑ Yes yfNo ❑ NA ❑ NE
❑ Yes
;,No ❑ NA ❑ NE
❑ Yes
PfNo ❑ NA ❑ NE
/Yes
❑ No ❑ NA ❑ NE
3 Fti.i } 1 , : . r .d
Addltivnal Comments and/or-.Drawm s
$���,.,.., ti a .
&)w N OS o �N60 �� Qu>s�,�/2 ri1 rei: 14- �tgc
000 F60KD� /l,s�- oC!!
�r�7 Pai✓c. �/En1t.,5
T,,f
�7 N/K�e�r�G_aC
2`F �i4s2zGl�-��or 6R g.-7,AVA1 A*49XO
s'�e', D.'
L/�oonl A'/ rAs✓T, l's Gr%AS �irlA Eyck
,V a
"."" / "V'&Ws 755 / 2 An�
/�f �O !v �OLtl.!/�1��/? �i►�vL%N
'-frvtD I-WosuCr0404061 1212&04

���5`.i -- h_ _ " ad 5� Y3iy',i'e" ] 't�'.'i' - ••' +Se `.:y.qKj •....... .. .
r j7Drviision of Water Quality
0 bivision of Soil and Water Conservation
„A y Q Other Agency
:Facility Number4
Type of Visit 'Compliance 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: 1 ////(//0& 1 Arrival Time: I /l !
Farm Name:
Departure ime: pCD County:
0ey / Z.3 "C> Owner Email:
Owner Name: /�w/r� L/Q?-C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �DO��zc G -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:_. a_.::&
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c ❑ 4 ❑ " Longitude: ❑ ° = I ❑
11
Design Current ��Des�gn Current Design Current
k':Swtne. Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La e
Wean to Feeder O ❑ Feeder to to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
jr
❑ Other w �.
Dry Poultry
❑ La ers
Type of Visit 'Compliance 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: 1 ////(//0& 1 Arrival Time: I /l !
Farm Name:
Departure ime: pCD County:
0ey / Z.3 "C> Owner Email:
Owner Name: /�w/r� L/Q?-C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �DO��zc G -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:_. a_.::&
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c ❑ 4 ❑ " Longitude: ❑ ° = I ❑
11
Design Current ��Des�gn Current Design Current
k':Swtne. Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La e
Wean to Feeder O ❑ Feeder to to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
jr
❑ Other w �.
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
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 ANo ❑ NA ❑ NE
❑ Yes
1
❑ No
❑ NA
❑ NE
❑Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes �ffNo
❑ NA
❑ NE
2/28/04 Continued

r �
Facility Number: Date of Inspection
Waste Collection & Treatment / 'I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural frceboard?
X
cture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: /yo o /V' v
Designed Freeboard (in):
Observed Freeboard (in): 57 2
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 /No OINA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /No
9. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Y(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 C;AWMP?
LJ Yes
IZNo
U NA
L NE
15. Does the receiving crop and/or land application site need improvement?
Yes
El No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
XJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
AN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any, other comments. -
Use drawings of facility to better explain situations. (use additional pages as necessary):
Zv) tow ,w- '5 a
I
-e, Lly'Oer44r u1��
AL
21) &oe XL 540o,! .O. cc�
/4sJ9 114::,�/ Z'
%N
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 I2128104 Continued

Facility Number: — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 14 'No
❑ NA
❑ NE
20,
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Xyes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard XWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking 9CropYield ❑ t20 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;!fNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
OF1 Yes ❑ No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �11'o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
XYes ❑ No
❑ 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 ONo
❑ Yes /Z No
El NA El NE
❑NA El NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes [--]No ❑ NA ONE
❑ Yes YNo ❑ NA ❑ NE
XYes // No ❑ NA ❑ NE
Additional Comments and/or Drawings:
z5)
S UXIF_ 544AUZY
ep-c"4eg ®> 146;1\�a
V00 Z&;o 6 0 e&'OeA f257 DA)-
Are/��✓ Ti�CL U' "i/� �Ii�/� ��/ ����
X!�/514
Page 3 of 3 �� o� �,� 5 q "8104 001jr
Nb1,_'; teAPA-i1t. 7v z c ow � �f v tFp �N 6 yz �[G�MF +a8OEcTCo�%�1�5

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Hate of visit: 7 T
ime:
3
Not erational 0 Below Threshold
M Permitted Wertifted ©Conditionally Certified [3Registered Date Last Operated or Above Threshold-
Farm Name: t l f.gc County: 'I
Owner Name: ke.6aeill
�✓/Q4?3 Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title: Phone No:
Integrator: Y Z!
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 0 44 Longitude 0 1 «
Design Current
Swine Capacity Population
23 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 ❑ Dairy
❑ Non -Layer I ❑ Non-Dai
❑ Other
Total Design Capacity
Tota1;SSLW
Numberof'Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holdin Ponds I Solidira s £ g p „Q .g �r - ❑ No Liquid Waste Management S stem ,.. .
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ 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 ❑ No
WasteCollection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �% Z
Freeboard (inches): -. 1
05103101 Continued

Facility Number: 3 —jg3j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If anyof questions 4-6 was answered yes, and the situation poses an
El Yes
El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
Yes
❑ No
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste AnnIication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application'. ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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?
❑ 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?
(W 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 duriog this visit. You will receive no further correspondence about this visit.
F6timmen61(fa - to 46 soon ^E ]sin le AYES ahsweis` ndloir an i "recoiriinetaditions er"aa otliei coiameitts.` mow , w , � '
%se drawings of facility, to better explain sittiattotis..(ase addtticttal pages asmecessary) �, . � ❑ Field Copv Fal otes
',v ❑inN
kudd
Oh 7A416 3 ,,r�` � Q ae,- eo`zex,/ wa sAe was �C�a�.��lr� yr,ikl
do
�L �✓Ddll� r`rty�t�7;bn �vrt�C `�f�� /i0 w�G le� 7��-�`'P���'o�� , /1�e7�r �5,�
l-a m !ezr L ele -AA OItle Aek.,
: UI' p,
Reviewer/inspector Name '- 4# ' :. �r ' t o �� . ; A ��; ° t��t. ••� ;�i
. s,"' z l.i ��. .tl''itK ta'C V�? .�lk?� ct.X#.i¢:Kav'A°.I I,YANia try d5%�,i'r3r
Reviewer/Inspector Signature: Date: G
05103101 Y
r
Continued

Facility- number: 3 - gj( 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?
29. 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. Vdere 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?
mments and/or
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ )'es ❑ No
❑ Yes ❑ tvo
❑ Yes ❑ No
05103101

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason far Visit Q Routine Q Complaint 0 Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: `—t-'�-' Time:
Facility Number
Not Operational 0 Below Threshold
Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Ud Ht O �fl nt/_' County: A 111.n
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ' Title: Phone No:
Onsite Representative: Integrator: k_
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude I " Longitude ' 6 16
Design Ci rrenf
Design ' Current Design
Cureent
Swine Capacity Population
Poultry Capacity Population Cattle CapHCitV
POIDU12tiOn
Wean to Feeder
❑ Layer ❑ Dai
❑ Feeder to Finish
❑ Nan -La er ❑ Non-Dai
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other -
-.,
-
❑ Farrow to Finish
Total DesignCapacity
❑ Gilts
❑ Boars
Total SSLW
r Y
Numbesr goons
❑Subsurface Drains Present ❑ Lagoon Area ❑ S ra
Field Area
Holding PondsSi
It
- ❑ No Liquid Waste Management System I
k
g.
.,..
Discharees & Stream Impacts .
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 1 f 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
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
No
Structure I Structure 2 Structure 3 Structure 4 Structure S
r
Structure 6
Identifier: tf 2 _T 5�L
Freeboard (inches): 36 -37 3
05103101
Continued

Facility Hum er: Date of Inspection's--= a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [A No
❑ Yes %No
❑ Yes KNo
❑ Yes D� No
❑ Yes i No
Waste AURlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q? No
It. Is there evidence of over applications?? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload El Yes W No
12. Crop type AIA6f � aS e , 5"Ad��,.E'c CJ�/Q/,fP�.`i,_.:
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes FLNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes JgNo
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
RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[XNo
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ENo
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
Wo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
( C�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
§No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
R No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
g No
153 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.ems.
Coinments ftefer�to question # ) Explain any :YES snsw,erstandlor�an : recommendations of an Pother com ments:.; }
°t Y
t = ash• a
e d
Use4ia,.«OitngssM factllty to`better explain situat ons.,,(use additionaltpages as necessary,) ❑ Field Copy ❑ Final Notes
�.�u.-'v°.t
moo, =»:i a.. '.:d:«atama: Lx '::•. -
1( 4dd 7'D 1&f d44-e �kt MA,t/l 40 ,'4W Aeld ►ZCttnO &61014) te*.
r�
Reviewer/Inspector Name :.: .k ' J
Reviewer/Inspector Signature: Date: Z
O5103101 or d Continued

Facility Number:1 — Date of Inspection
Odra Issues*
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M 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 P'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? O.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes I? No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j1No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes '1Po

Type of Visit &Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint. O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: ® Timer
O Not O erational Below Threshold
EOermitted 0 Certified 0 Conditionally Certified [r Registered Date Last Operated or Above Threshold: .................
Farm Name: 01 n.-AD ...... rA.D,1lan.5.....1.. y..Z.�..3... .. � .... County: .... D.i..O.l .i<-1. t..............................................
Owner Name:.i: .1. k C.l ?-1 ...... ..Qt..1M=6C QLO.S........................... Phone No; .�.�i......�..�.�'..... �.fca.l�...................
Facility Contact: Qkr2,^.Z>...... V t:A.".'C.S................... Title:. .t�................. Phone No:
MailingAddress:... .s. ?.x.. ... ..... 9t.J..(............ ...... a.............. ..................................................
Onsite Representative: ... .1,Z�?.......... .L,,„.................................Integrator:.„1,,,y..l�,.(�..t-}..
.....................................
Certified Operator:..,0.ra„&X>....... 17t.A.JrC _'� ................................................... Operator Certification Number: .... 1.Qj.Q. ,�..........
Location of Farm:
�t�-o�.,, t r►-r�ta-S �LTf pry 4-tt�J Y 4 t X d Lp c-A l� ta-or4 D , C—O 3 , 0
D 11 (D L__ D G V7'^ �M "C hT l`s-'kn Cr L j Or-)
('Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ®' ®, =" Longitude • 4 ©64
Design ;. Current
;` 1]esign
Current Design Carrentj i,
.r i.
Swine lafioa
Ca ace Po u
attie
Poultry. Ca act Po ulation C Car cf `.'',Po elation ;
Dt Wean to Feeder
❑ Layer
❑ Dairyry
❑ Feeder to Finish
❑Non -Layer
- ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design' "Capacity, , p
❑ Gilts
❑Boars
:.
-To;al'SSLW`
F` Number'of Lagoons Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ,y
Holding Ponds I Solli&Traps ❑ No Liquid Waste Management System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation? ❑ Yes fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes E(No
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ) ❑ Yes RNo
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EqNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EkNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'MNo-
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
ldcnti fie r: ......... 3.7....................... dr.0 .................. ............ 3. 0.........................................................4R.....................................................
Freeboard (inches):
5/00 Continued on buck

Facility plumber: — Date of Inspection
5. Are therb any immediate threats to the integrity of any of the structures observed? (ie/ 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? ❑Yes RNo
(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 gNo
8, Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9190
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes RNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes E�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
,kNo
c) This facility is pended for a wettable acre determination?
❑ Yes
5kNo
15. Does the receiving crop need improvement?
❑ Yes
JZNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
)�No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
qNo
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
5kNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Cl Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
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
ANo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[lo
iNQ.*i0r, t00AS'0 ile00600 wire PQteo• ilt< 609 Nsm4t; • Yoo wlli-t ewo 00 fu>� thO
cor'resAo>ndence about this visit:
�'t�-G�t3 O/•�-ta-D c� �S �Xc��.c..�cJ� �--�T � r� �t� ��-G-O� n S.
ta-DS
L/-%, 5T � ���-5-�c�ot�a--ds o Y
UJ "x.11—IC— l or) S-T` 1-7- U GTE D
Reviewer/Inspector Name t G
' .'' r " � � ,P :x! i ,try �.. • t
Reviewer/Inspector Signature: [__jj+ /�-_-Q� i',j A Qn Date: j 7 l , n! 5/00

Facility Number- �3 4 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 ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes UNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
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? 'cs ❑ No
J'A4ditional Commentsan or° ra ngs
A61
5/00

�p � r• � I � l J Y r.`i41 '� � � a -03'i' .p ,�i 41
"� .: �• k Vlsron of Winer U.- alIty a �1,1 , ,I �s�, ,F- :., •� �'( �r'' �
:t• : Y - i -
QD>tvtslon of soil and�Water Conservstton
' y Other 5 sYr 1 f� 'jt k: r
0 Agency,
t r F
_,
w
�;
r,p x
�
r:
I, ''], -,}. .,. t%...
! ,:. - - . ..;:} F:.. LY
:.i• _ f. '.:G' [-ace..._
%.ie- w 2 u ... s_.i it�,1.F-'pw�.r.;1,'
Type of Visit
ompiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit
t�outine O Complaint Q Follow up O Emergency Notification O Other
0 Denied Access
Facility Number Date of Visit: ®�jnc: ® Printed on: 7/21/2000
Q Not O erational Q Below Threshold
M-frermitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .................
Farm Name:.O.U.t...... C,..r4.:1M1..P.........�i��-'i!!r>`.�......�.t.2.,t�}d S County:....�.U..P.L....,LM............................................
Owner Name:.....i i< .1 . ..L-tY .k,2-!>..........lau..�-- ......... Phone No:..q............ _2'OS............ a.(0_0Q.........
�=i°t t�V1
Facility Contact: .Q..1 ,c t?........ -t: 1..4--1: S.................ritle:..�ln..e�., ..ifk-'�t7...�...... Phone No:
Mailing Address:.......��....�..c.....�3..C?......a...1.h........... ....................................=..�11�.�
Onsite Representative:....Qkrh �...........::1`f 6ti1...................................... Integrator:.....'lrl..C....L3�C...:.j'................................
Certified Operator: .... ...............................................,• Operator Certification Number:,••„
Location of Farm:
t l 1 ViLA) Y 4 t x 4 t---r> .era c� ' t-aOA'zo , Cr<0 3 , C) +�
'IAA t L_�C. o n o �o c t -t' t� t-i -Ta� C:� -t_ S h t
. ci -q L
n4wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ®' ®i Longitude �• �� 1
Design Current
�wu�e Capacity ro ulation
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 I JE1 Non -Dairy
❑ Other
Total Design Capacity I tn. 4 nn
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Laron Area 10 Spray Fieid Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance IT1 m-rnade?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II• discharge is observed. what is the estimated Ilow 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
StI•ucturc I Structure 2 Structure z Structure 4 Structure 5
Idcntificr:...•........"...................•..a.•.....................� ...................................................... `T •r..................
❑ Yes A0
❑ Yes ["No
❑ Yes [I0
❑ Yes No
❑ Yes ,[�\10
El Yes o
❑ Yes �No
Structure 6
Freeboard (inches):
5100 Continued on back

Faci-ity Number: — Date of Inspection
Printed on: 7/21/2000
5. Are there`any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 ;440
(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 Pio
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Mo
Waste A Upiication
10. Are there any buffers that need maintenance/improvement? ❑ Yes f�(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Flo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes o
b) Does the facility need a wettable acre determination? ❑ Yes D440
c)'This facility is pended for a wettable acre determination? ❑ Yes �No
15. Does the receiving crop need improvement? ❑ Yes 9N0 .
16. Is there a lack of adequate waste application equipment?
Cl Yes
N10
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
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
JR�No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Cl Yes
R' 0
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ro
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
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
WNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesE]Yo
o yiolaiitjris or deficiencies mere noted dµring �his;visit= • Y:oir Will•reerrKit d6 lui-ther ;
comes oiicience.abatit.this:visit_ . ... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
;A .. ..
Use drawings of facility to better explain situations. (use additional pages as necessary):
W � t 1"l Crt�—��4-Z` �j H- �►� U l`a=C7 Hr `r n C.—L n
W L [_L— _V C:_t7 n L-t O CJ S '� _S C_la�C, S jj
13 Y t h 0 t-1 O P n <,- t—) A— L "t C. -- tQ Cam--5 r) .
wr
Reviewer/Inspector Name
Reviewer/Inspector Signature: I—Z A v r _A.4 _ �� a , , n Date: LO " _SZ , 5100

Facility Number: — 1 Date of inspection i 0,7� . Printed on: 7/21/2000
Odor Issues f
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hplow `rYes ❑ 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 � TO
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 4No
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 peimanent/temporary cover? ❑ Yes No
Additional U omments an orDrawings:
AL
r3 � f`7h_LO V � Ct�- � p - L= tzp �.�.� 1.-�l�c ��-C� � [•7--� V �
LD f� -14^ C Lac, C-;z— ©tom p S
L Vtr�t-
( L--->-(v L S )
5/00

Division of Soil and Water;'t
Division of Soft aildEWaterl
d , )UKDivision of Water Quality,
13,Other Agency-, pe" 9t i
aan Operation Review
, � r,
]o" 6mpliance'InSpecdon I1 En
[ce ,Inspectloli-
i s r a I r 4
if l S R ^z.
Routine O Complaint Q Follow-up of DWQ inspection 0 Follow-up of DSWC review Q Other
Facility Number Date of Inspection Gjrl
lime or lnspectiou r-� 24 hr. (hh:mm)
Permitted Certified Conditionally Certified ©RegisteredILI Not Operational I Date Last Operated: ..........................
-3 A t-% D S
Farm N. .trl?.....C.4.. i.L�..�.t!'tl '.3!Y...15... :...4. 2. County:.........C?.i..J..l?.h i..].....................................
Owner Name: - Phone No: Ci 'Z
-1'�......i�3..1. �. t-�-l�-Q.�..� ,t_5 ................. 1. .,� ... ` t.........3 Via. ?.Q............
Facility Contact: Q.C�,.,4,v. D......t� •1....�.�............... Title: �V!�\ .f'1.R.G-. .it�r.�.... Phone No: ..� Q... Z �1... .....29 .4
Mailing Address: ...0..0.......e..1...fGt.................................... ....�.c.?A.L..L...�4.G r''��1 t.<-.r........... ZZE3.1-k-GG
Onsite Representative: .�t..A�,.1�.......1`t: .l.... �................. Intci,ritor �il1�L.L.. .. C ..E-Y..`................................
Certified Operator:.,....,,,................................................ Operator Certification Number:.12, .............
Location of Farm:
-A- ....HL_tJ-.Y... -..4....x:..... s.=rD.......0 ..P........ .. t .... Gx-f...�........�.� �1...�n...1 L..�. 5.....O..�...................................... A,
1...... ......
�1?..... 171-0.r
Latitude IA A �1•{ Lonuitude �f�:• Fr%a P1 �44 S�` ,1
Design Current Design'' Current ' Design Current
Swine Capacity Population '"Poieltry`.: i Ca achy. Po"elation Cattle Capacity Po elation' o:
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ' ❑Non -Layer I I I ICINon-Dairy
❑ Farrow to Wean
x,
���.
❑ � Farrow to Feeder ❑Other .k
❑ Farrow to Finish
❑ Gilts, r
Total o6igi "60146V
❑ Boars , ,- „i. Total:SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ppnds /, Solid Traps ❑ No Liquid Waste Management System
Discharge- & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes *0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes J<No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes IMNo
c. if discharge is observed, what is the estimated flow in gal/thin?
d. Dues discharge bypass a lagoon system? (I1:yes, notify DWQ) ❑ Yes `$No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes '11PNNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ` P To
Waste Collection & Treatment \\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes `�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): rr ......I ..................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes-)R:LNo
seepage, etc.)
3/23/99 Continued on back

F .•
Facility Number:• — Date of inspection
�-y
'19
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes `<No
& Does any part of the waste management system other than waste structures require maintenahce/improvement?
❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes VNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 5j(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes S] No
12. Crop typckZX 3naV
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes $�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes $<No
b) Does the facility need a wettable acre determination?
El Yes %K
c) This facility is pended for a wettable acre determination?
❑ Yes RNo
15. Does the receiving crop need improvement?
❑ Yes VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes Wo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
19. 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 S�10
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes KNo
21..Did the facility fail to have a actively certified operator in charge?
❑ Yes RfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes WO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 9No
24. Does facility require a follow-up visit by same agency?
❑ Yes KNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Wo
Vo yi. afioris;or dl ficiencies •►ire jnpted• ooimg �his'visit' • Y:oit< wiii-teeoiye ijo• fufthor • ' '
• ....• oricience: a�atit: this visit.: • ' ' • . • ' - • • . • • • • ' • ' • • • • • .• • •
Commentsl(refet; to questionE#) °+Explayn any YES�answferssanid/or any recominendataons�}ofr4any,other comments
Use drawings of facility, to better explaiin situations (use addettonal pages as necessary) ' MR
_7-,'\ G t l�- LTY W A-5 e i�t� - o h�+� T� D r� r, t�
•
_)AN A- r,.,A, v- b +`-OO V_-5 C�,-00 D la�c� ka- rJ
t--i C,- WAS 4>CG5L'V-nT
Reviewer/Ins ector Name i r " t 04
Reviewer/Inspector Signature: Date: L-7 l G, Q g
3/23/99

Facility Number: 3 — 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 152rY.. ❑ 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 gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J7�(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
itiona omments an or rawings `;
.. _ C. ? if' -� _i -. E. ,. � I 7t �. r y, h 4
A.1
3/23/99

3 ❑ Division of Soil and Water Conservation ❑ Other Agency
IX
Division of Water Quality"
Routine 0 Complaint 0 Follow-u ' of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection i IS 24 hr. (hh:mm)
13 Registered'P Certified © Applied for Permit' © Permitted 113 Not Opera Date Last Operated:
Farm Name, % tliam 3 'd S County: ?.[%C`..............................................................
OwnerName:.......................�.�.1(........r:Y.S7t>1................................................. Phone No:.....e�.ia.�........................................................,...........
Facility Contact: .................. ao...,.:(Vus............................ Title: ....... mna�ef................................... Phone No: �.�.14�.3.���.�,�........
MailingAddress:.......... .a.....i ......... &L......... ....:.. ........ .. .................1U 1-Nn .......................................... .Z.V.��.......
Onsite Representative:........ �.Ll�t�.........&...4tS....... ... Integrator:....... .Ut......................................................
Certified Operator;,. �il!4�V1. �� ..:......CT(14.� ...................................... Operator Certification Number;.. ...............................
Location of Farm:
ak,.... SRc.�..%.6 r s.........Wc .... a........ 1:n,;:U.5.......... ......... lq4..,........................................................... I................
... ......... .. .... ..... e
Latitude �•Longitude' EX]• 4 4-1 44
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
iNo
2. Is any discharge observed from any part of the operation?
❑ Yes
Ej No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
1p No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
l�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require)
Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
q No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
M No
7/25/97
Continued on back

Facility Number: _7
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures_(Lagoons,Eiolding Ponds, Flush fits, etc.l
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �......................................................................................................,�..............................................,...................................
Freeboard ft .
10. Is seepage observed from any of the structures'? ❑ Yes "N"o
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 1P No
12. Do any of the structures need maintenance/intl)rovement?
(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 Slate, notify DWQ)
15. Crop type ............................ ..Y..1?4.�A.,.............................. s,ft.. .............................................................
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'?
Yeti
❑ No
❑ Yes
No
❑ Yes
. J9. No
❑ Yes
N No
❑ Yes
® No
0 No violations or deficiencies were noted during this. visit. .You will receive no further
correspondence about this;visit:- ;
0 Yes No
❑ Yes No
❑ Yes {g] No
❑ Yes [ No
Yes ❑ No
❑ Yes A No
[.Yes ❑ No
a Yes ❑ No
C6i6bients:(iefer to question #): Explain any YES answers and/or atiy re'comm'endationsor an"y"other `c"omimeiiis w �-
Use drawings of fitciltty to better explain sttuatiiins. v(use additional pages as,necessary):.
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fur aons s � bQ tree ! +e E
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7/25/97

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