310862_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual
II

e
Type of visit: tc!:�Fuompftance inspection V Vperatton fcevtew V atructure Evaluation V ' ecdnical Assistance I
Reason for Visit: (DIko'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /LAL�J Arrival Time: ; 7 Departure Time: C%; County: �� .-L Region: W?_0
Farm Name: t1a"t e e- Owner Email:
Owner Name: I)ai l e r Phone:
Mailing Address:
Physical Address:
Facility Contact: Zr o Yt L_ j�() /1 Title: Phone:
Onsite Representative: ,'ir6r_� Integrator: 14�
Certified Operator: Certification Number: '1f�IK3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity op.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Ca Pjacim op.
DairyCow
Wean to Feeder
er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Q7
jLae
Design Current
lt , Ca aci Pao ,
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
ers
Poults
Beef Feeder
Boars
Beef Brood Cow
Other
Discharges and Stream IMDacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Callo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Jallo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

' Facility Number: - tr Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fKL No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): — % �-
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ 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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L4 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): �!//yJls�ec U�l�S �YSG{G
13. Soil Type(s): }j 0,7-1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L�,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 'Yes UgCo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes _U No ❑ NA ❑ NE
❑ Yes M[ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes g No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;V!�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. 9—Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard /J�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 ER[No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:3�o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [a 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[—]Yes CkNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA 0 NE
❑ Yes � No ❑ NA [:3 NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: _ Date:
Page 3 of 3 21412015

I•
type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , 3 _dU Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine C►apacity Pop.
Wean to Finish
I
Design Current
Wet Poultry C•apaeity Pop.
Layer I
Cattle
Dairy Cow
Design Current
Capaciiy Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D . P,oultr, Ca aci P,o ,
Layers
Dry Cow
Non-Daity
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Outer
Other
I
Turkeys
Turkey Poults
10ther
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes J21INo ❑ NA ❑ NE
❑ Yes J!fNo ❑ NA [] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes EJNo
❑ 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
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 11
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Date of Ins ection: Jr 7R
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? ❑ YesNo ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
OCit!7
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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
❑ NA
❑ NE
waste management or closure plan?
IV
%
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
nj 1 No
T�i'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
f
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes V1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes V 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 EfNo
❑ 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 ZI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes PNo
❑ 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 E!T 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 JCJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:�fi0 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of Ins ection: Y
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes E],No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E;�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 J:2-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Lallo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes�To
❑ 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
0 NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
,gNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �lo
❑ 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
.12-No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes j ],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 Ljl�o
❑ NA
❑ NE
Comments (refer to;question'#): Egplain`any YES.answers andliir„any-additional recommendations,or;any:other comments. -
Use drawings of facility to better explain situations (use additional pages as necessary):
re C look- 5acd
tr e cc r S S T>-jb1r) A sr I +►•-vv,7
5-erUt, ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
a�d1�
Phone: W � 73?_._;�
Date: l Z Z "1 ,G
214/ 015

Type of Visit: .4a'Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (aWoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 1&,yt L p SCL�' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Finish
7Feeder
Design
Capacity
Current Design C+urrent
Pop. Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
DairyCow
Current
Pop.
Feeder
Non -La er
DairyCalf
o Finish
DairyHeifer
Farrow to Wean
MEtesign Current
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Dr, PlouIt , C►a acit Plo ,
Layers
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes ETNo ❑ NA ❑ NE
❑ Yes •Eff No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
ZNo
❑ 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
0No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
r;;rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facifi Number: -6211 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes T/�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2'1�o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;2-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 RTNo
❑ 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 �lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ENo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �❑E 'gVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes
❑ NA
. ❑ NE
';2'No
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;2�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 j2no ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? []Yes L21ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 'C2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
r�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F,11�0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:J-1Go
❑ 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 CalTo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6No. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C�No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 1,1- Date of -inspection: { t
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
C2'1Vo ❑ NA NE
❑ No [] NA NE
❑ Yes.,;]
-No
NA
NE
[:]Yes
PNo
NA
NE
[:]Yes
P.No
NA
NE
❑ Yes L2rl4o NA NE
Yes ErNo ❑ NA ❑ NE
❑ Yes C;�`No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes [!rNo 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 L] 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).
/'Y) c s.y,a/ <S1Q4-;6 e su-11� {` o`o% y
Co l-clt Surr/4-AL;) 4s 5" Or' ex j
4
I;r,Ak
P1"4*_
®G 'sS1L le
Reviewer/Inspector Name: 1 "�V(ti bj�. f Phone:
Reviewer/Inspector Signature: _ _ i��--� Date: l
Page 3 of 3 614

Type of Visit: 0. of pliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 2Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: A Arrival Time:[/ 0.a yAeparture Time: County:_RVIe—Region:
/
Farm Name: (1WP C J A-0 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: s4k il / JQ Ir
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design C•urreat
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
C*attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Dairy Heifer
Feeder to Finish
Design Current
D , P.o_ultr, -a aci P,o ,
Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 0 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
ZrNo
❑ 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
0 No
❑ NA
❑,NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

FaciliNumber: raj - DateofIns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes EfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
&. Do any of the structures lack adequate markers as required by the permit?
❑ Yes] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes E5No
❑ NA
❑ NE
maintenance or improvement?
Waste A1212lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Vf No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes P"No
TTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Xf No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VrNo
❑ NA
❑ NE
Re uired 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 PrNo
❑ 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 71 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number; - Date of Inspection: O /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YestLa"No ❑ NA ❑ NE
95. s
the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑"No 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes L�rNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes L2fNo ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VI 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 Signature: AL� Date: O 11V
Page 3 of 3 2/ 22014

,1j
Facility Number
vision of «'ater. Quality
0 Divi.sinn of Sorl atiiI'Water
0 Other -Agency ,
Type of Visit fircompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )2_1110utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I % Arrival Time: r parture Time: County:
� U iv
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: bna^_dLL0 L_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = n Longitude: 0
Design :Current ~Design, G'urrent�,.
Swine Capacity -- :Population Wet=Poultry Capacity ,.P.opulation Cattl
❑
❑
vision of «'ater. Quality
0 Divi.sinn of Sorl atiiI'Water
0 Other -Agency ,
Type of Visit fircompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )2_1110utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I % Arrival Time: r parture Time: County:
� U iv
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: bna^_dLL0 L_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = n Longitude: 0
Design :Current ~Design, G'urrent�,.
Swine Capacity -- :Population Wet=Poultry Capacity ,.P.opulation Cattl
❑
❑
Wean to Finish
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
I�er.
Other
77-7
❑ La er
❑ Non -Layer
l ITT
outry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-DaiEy
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)?
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 irnpacfs to,the Watei s'of the State
Motherthan'.froni a discharge?, ;
Page l of .3 ,,;; ;
❑ Yes /,,No ❑ NA ❑ NE
❑ Yes / 5 No
❑ NA
❑ NE
❑ Yes ,ErNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes EI—No
❑ Yes L_I No
❑ NA
❑ NE
❑ Yes G<o
❑ 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? ❑ Yes A'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:�-Ido ❑ NA ❑ NE
Stru2re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;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 g No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2]rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑. PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 46No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
/in
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JZ'_jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �!fNo
❑ 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 0No ❑ 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 el o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /(
24. Did the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes [�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P
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 to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑NA ❑NE
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes F
o ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P?No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2-No ❑ 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 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). .
Kea. Y.
- 31< 7// Z_ "19-IS-0
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: `
Date:
Page 3 of 3 21412011

. _ lsion of Water Quahty ffi
Facihty.:Number Q D�vEstop of Soil and=Water Conservation ° a
Q Other AgencyY
Type of Visit ..'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Tecical Assistance
Reason for Visit �jakououtine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: LLs/�//� Arrival Time: Departure Time: County: Region:
Farm Name: N� _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Y erj6.&- ' .4 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = = I = Longitude: [--I o = , =
Design Current - - Design Current " Design-.�-�: current
,. Swtne x Capacity: Population m' Wet Pohltry ,Capacity Population' attle pty
N vv�
ro Ca Popitlatioin
❑ Wean to Finish FL,
a er ❑ Dai Cow❑ Wean to Feeder Non -Layer v ❑ Dairy Calf
❑ Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean a "" ❑ D Cow
MmDry Poultry
❑Farrow to Feeder
N D'
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
on- ai
❑ Beef Stocker
Q ❑ Beef Feeder
❑ Beef Brood C
Discharses & 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 P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
2 o
El Yes
, No
❑ NA
❑ NE
❑ Yes jZNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — ' Date of Inspection t!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ 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
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo [DNA ❑ 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 �3_No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes la 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ YNo El NA ❑ NE
maintenance/improvement? r
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
gNo
❑ 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?
❑ YesNo
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ 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):;
IReviewer/Inspector Name Phone:
Reviewerlinspector Signature: 4f—-Date:mr
Page 2 of 3
L�
Continued

FacHity.Number: — Date of Inspection 1R
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ;J-No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes'P'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes [P'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ONo
❑ 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 ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes VNo
❑ NA
❑ NE
AdditYonaL_,_ C
Comments and/or-Drawings:..:r
V
,
/A v'
+
Ji/v
o 7 Z
.? `'' /�� o •�6
p r
doll
'° G�,SC�
i���ay.- G✓4f � G- �-c. `� 1 � s �'-� .�C/r-P_ ��Kr+e
6�
�S(arQ -4/ke �c�c ✓ �.r4J fly r
Page 3 of 3 12128104

IType of Visit ,C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit •rJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: Region:
Fee Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative &6r:kkz i/PZ 6-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 t = " Longitude: = o = 4 = «
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Laver
I
❑ Dairy Cow
❑ Wean to Feeder 10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
LaEl
El
Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Pullets
El Beef Feeder
❑ Beef Brood Co
El Boars
0-Turkeys
OtherW10 Turkey Poults
❑ Other JE1 Other I I
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 2 of 3
❑ Yes 7No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
[:1 NE
❑ Yes
F] No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes LXNo
[I NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[I Yes �o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Ye�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
❑ NA
❑ NE
through a waste management or closure plan?
,R<o
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 ,21�o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J! No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El,,
Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PKo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ]�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,:, o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yeso
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Jal o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes .ET"l'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _EjVo ❑ NA
❑ NE
' lie
�or
isp . 0"-Zq-7
3vC/ -&5
Reviewer/Inspector Name j - Phone:
Reviewer/Inspector Signature: Date:
Pnoo 2 nF 4 121TV0Continued

Facility Number: 3 — Date of ]inspection v
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W UP ❑ Checklists ❑ Design El Mans El Other
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
Q6.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
ElNA
ElNE
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�TNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5(No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RrNo
❑ 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
[Z�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VrNo
❑ 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I[ -I No
❑ NA
❑ NE
Additional Cgmments and/or DraWmgs
. ,...,. _..§-,..�-a•a�.. .ar =� :..,� - �.mre- ..-: ,�r :,.ro "� s_'a�, ., L'. ate:
A-1 AL
u5CCI /i/a
' PLC Gar/I 4ee4.1 k je'
A/ I-e C_ C4
fit ", 91a r ..7 J V ,v2C16A4Vn
Page 3 of 3 12128104

A�/
o I/- 0 - 0 c)o 9
JQ4H9vision of Water Quality
Facility, Number 0 Division of Soil and Water Conservation
0 Other. Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % Departure Time: County: Region: ——fJ
Farm Name: _J,�
Owner Name: ,
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: %%���� /,' // / / Title: Phone o:
Onsite Representative:, _�w (�t/P/�A Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 ❑ g Longitude: = ° = f
Design Current Design Current Design " Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
I❑ Wcan to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Cilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
.❑ No
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,allo
❑ NA
❑ NE
❑ Yes
Po
❑ 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? ❑ Yes gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J'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 oNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes u No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑•No
❑ NA
❑ NE
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)
ill ro t�CG:'! . PIS A*6
I r-e.-,< O'cil- 3St� — d067-e71
Reviewer/Inspector Name - -� - -� Phone:
Reviewer/Inspector Signature: Date: 7 Q
Page 2 of 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
[:]Rainfall ❑ Stocking ❑ Crop Yield 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No ❑ NA ❑ NE
VrYes jNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
UrYes ❑ No ❑ NA ❑ NE
❑ Waste Transfers El �nnual Certification
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 1Zf No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
lzfyes ❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes )Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes Eallo
❑ 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
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
.
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(0 No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
Ju
�a14 beP� LjCf mi��Pc
aS� co/ell
Q� fcr>r1 aS �oS�l Xe l-
he u ss,nc4/ a�r�✓cc�/ %c L �i�P
/0 /VO (UG ar S I_eZ!l--S4r_o� a-7
,LI)IIiy 011'e,
�GS.SG�
t Nee4 9�
/ _c 1-5
.5' ti✓
�re✓Ls �Q Jpp i�5
�oU.7 ����/` WCrS1� GhC�•�/S./.
'2 002- r. J oo I// 2 o G 4 c� Laos
Ca �� d607 A14�
12128104

Type of Visit 70utine
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: F Arrival Time: Departure Timer County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 13rwf l
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
10 Wean to Finish_
❑ Wean to Feeder
Feeder to Finish b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other— — -
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [ o [=.
= Longitude: 0 o =,
=
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 16 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes }J No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
12.128104 Continued

Facility Number: 31 — Date of Inspection } a
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 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3I
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 D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [VIVO ❑ NA ❑ NE
❑ Yes ErNo ❑ 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 [2 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D,Vo ❑ 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-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,,,��
10_ Are there any required buffers, setbacks, or compliance alternatives that need El Yes D No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) --•-13 C zm �b C7 Y' ? i' D — ---
13. Soil type(s) __. w4 A16j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ErN"o' ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
❑'go
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ETNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment? El Yes
No
❑ NA
❑ NE
�3
Comments (refer to yuesttoa!#) �E�plarn any YEScansweispap ,, or any recommiendattops or arty*other�comments
_ -. - - - ; 0 } . _.ater, x• �'' "
Use drawtngs ofU&1jtS to better explain situations. (use addshonal°pages as necessary) .� ''s
'�.'�-%_,fa�w�� a- x¢' - � ? _ w- -a ?.. wi �.�n r34:. t. i✓/J' � ��^. :t a'f.,s s... r.BPK ,..La��s-r.._vra
/�+� 6f3TRsh% C- rTFx(, 0i W 64C-24G6 &'It ?6"n.24- Ryo A1pfiE(l ,
c,� O a7 /►/ IW''a v �A 6 ro�tJ ,OE f >Cl�ar►n 56 r i,
1--I-t'D {-r�rLrw G7voD (tea A
/�vZaI— n/P A
Reviewer/Inspector Name ��_.`. � � � �� , �, Phone: hp -M �s
Reviewer/Inspector Signature:
Date:

Facility Number: Date of Inspection
Required Records & Documents
7 9. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW readily available? If yes, check ❑Yes El No ❑ NA El NE
the appropirate box.
❑ WUP El Checklists Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard dwaste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking La/crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
'' No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
E❑j/NA
A
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
,�
DNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2Noo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
fJ NA
❑ NE
Other Issues ,�/^
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes l� No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LKo
❑ 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
91 o
❑ 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
El Yes
CI 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?
ElYes
�J N
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
12128104

Type of Visit 10Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number !/
Date of Visit: O Tune:
r "Not Operational C Below Threshold
Permitted [3 Certified 0 Conditionally Certified [3 Registered Date Last Operatof or Above Threshold:
Farm Name: ...11 ! i El " ..:..IIL2/rL...._.. _ __. County: r.G/.. . . .......... .. ._
OwnerName: ........... . . . 0 . . .......... ..... ........................................ Phone No:.......................................................................................
MailingAddress: ....................................................................... .............�_ .�.._
Facilitv Contact: ... _. Title:.. _ . _._ ... Phone No:
Onsite Representative: ,•,�L+J - -- t"' Integrator:
_.._...........�.� ..... _ ....... ........................... �_.........
Certified Operator: ........ ..................................•... ..................... ................................ Operator Certification Number:
Location of Farm:
i
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• �' �'�
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
- t 'Current' _
Poultry <.Capacity 7P4vu1ation . Catt
`]E] Non -Laver I I 1" 1CI Non -Dairy I
Other
' ._
Numiser
r twAnldne¢ Fends % Doha Tranc`=
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes O'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )n No
❑ Yes J.
❑ Yes z No
Structure 6
Identifier: ...... ............... -- .. _ .. _ ._.... �....__. �.
Freeboard (inches):
12112103
Continued

r Facili,y Number: 51 Date of Inspection TI/
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
0 yes 9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes ZNo
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 maintenancelimprovement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance./improvement?
❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes eNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ,d No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ONo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated id the Certified Animal Waste Management Plan (CAVWMP)?
❑ 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
I5. Does the receiving crop need improvement?
❑ Yes ,VfNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]yes ONo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 1ZNo
Air Quality representative immediately.
Conuneitts (infer t6 ques3ron{#) ExplarnauyYFS answeasEaml/o�w s commesidatzons or any other comments:_ _ W
M�-
sUse diarvtngs bf f RaiIitylto better expla ntsttnat�ons ,;,(use: RM ;<enal�pages as necess$ry) Field Copy ❑ Final Notes
'". =-_ � .. -
(J �//7G 5�� (`jSL�✓gyp .�n/ LJ•g���� �LvcJ '!�PrP�T"�/vaT
�Lc.oc.✓ GtJR57,� �`l��At/ �.r LrJA��'�PccJ,4�/, /!%flT�j�te� �i C.!/�i'� �E
e�vev;e- Co c Ao 6-41t)4,�&
ReviewerAnspector Name �� ...
Reviewer/Inspector Signature: Date:
I2112103 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application XFreeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N�'PDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
31 Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
OYes ❑ No
0 Yes ❑ No
)21 Yes ❑ No
❑ Yes 0 No
❑ Yes XNo
❑ Yes PfNo
❑ Yes 10"'No
❑ Yes 0 No
❑ Yes 9No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

AR-18-2004 03:43 AM
��
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Date
Rainfall Lagoon Level.
Animal Populetion .
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29
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AR-18-2004 03:45 AM
Month
.Year
......,.- ... __ .-
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Rainfall.
; , LegocR Level
Animal Population
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3
1
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4 - r
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5 '
6
7 p
10
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14
18 7'.
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20 •� _. .�" .
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26
LINO
27 -
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28
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yo
29
30
Month Y ...
e=-
"' 'Date Rainfall - , Lagoon Level Animal Po 2 "
pula#lon Q

7- - Date -"
Rainfall
! , Lagoon Level
Animal P opulation
2
an
3 �:�'L _a
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5
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Q

AR-18-20B4 03:43 AM
`d t
11
9

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ©Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 S62 Date of Visit: 4/11/2U©2 Time: loam
NNot Operational O Below Threshold
Permitted M Certified El Conditionally Certified E3 Registered Date Last Operated or Above Threshold . ............
Farm Name: ....................... ..... County: Dupliu...
..................................................
Y .IRQ.........
Owner Name. Vanee...................................... Rasdea ........................................................ Phone No: QLl3. 2,9;3-42�3..{H�..�2 - 22Q.{ � ix�u.............
Mailing Address: 43in.E.N.C.14......... ............................................................................... 8rulayffie.BC ...................................................... 185.18 .............
FacilityContact:............................................................................... Title:........................... ........... Phone No:
Onsite Representative: Ownex...................
Certified Operator: B.xi;m L.................................. Mich
Location of Farm:
................................. Integrator: Murphy..Eaxnily..Farm&.....................................
..................... Operator Certification Number:.X X$ .............................
East of Beulaville. South side of Hwy 24 approx. 1.2 miles East of SR 1715. Just past 2 body shops on the North side of 24.
this farm is second site on farm path.
® Swine El Poultry ❑Cattle ❑Horse Latitude 34 "F 54 ' 27 " Longitude 77 * 41 ' 0944
❑ Wean to Feeder
M Feeder to Finish
2392
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream impacts
1. Is any discharge observed from any part of the'operation? ❑ Yes M 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)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
[J Yes M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................1................................................. ........
Freeboard(inches): ..3.4...............................................................................................................................................................................................

Facility Number: 31-862 Date of Inspection 4/11/2002
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?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes 0 No
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? [j 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency? '
j� Yes []No
(] Yes N No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes N No
❑ Yes No
❑ Yes No
❑ Yes No
0 Yes S.No
❑ Yes S No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
15 Fields 4 & 5 look better but still need some follow up. Farmer plans on continuing plan to improve.
Field # 1 is being re -disked and re -planted.
Rest of farm and records are in good shape.
Reviewer/Inspector Name Gal::tetre.
Reviewer/Inspector Signature: Date:

O5103101 Continued
Facility Number: 31-862 Date of Inspection 4/11/2002
Odor issues
26. Does the discharge pipe from the confuiement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 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 IN No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [j Yes ® No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? [] Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0 No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes M No
i

' -.- _ - � w `::` Q Dtv�s�on of Soai and Water Conserrakt[on
OO#hsr Agencg Y =�
Type of Visit ,ZCompliance Inspection O Operation Review Q Lagoon Evaluation j
Reason for Visit Routine O Complaint. Q Fonow up O Emergency Notlication O Other ❑ Denied Access I
Facility Number 2 Date of Visit:
13 Permitted 0 ,Certified 13 ConditionaBy Certified 13 Registered
Farm Name: v .
Owner Name: ............ ....... .}C ''fir(7......I d
� 11 Time: t S(->
Not Operational O Below Threshold
Date Last Operated or Above Threshold: „
PhoneNo: .................................................................. .... ».„..»W.
FacilityContact:............................................................................... Title: .................................................... Phone No:............................... .................
MailingAddress:..........................................................................
Onsite Representative: xN �1 eA "t C 16 ` Integrator:
Certified Operator: ................................................... ............... ..„.......................................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 fig Longitude • 6 «
Design Current ' .:.. Design Y Currenf` Design Curreat
Sivtne •+ Ca aci Po elation = : Poul Ca aci, .Po ulstion Cattle Ca cs . Po elation . -_,
try
❑ Wean to Feeder ❑Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer 1 10 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other _
❑ Farrow to Finish ToUd Design Capacity
ILJGilts
❑ Boars Total SSLW
.;:Nu I mbeiof Lagoons '' f ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Poeds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes )21INo
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes )2rNo
c, If discharge is observed, what is the estimated flow in gal/min? q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes j TNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes /P'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes jp�No
Waste Collection & 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: ................... ....
Freeboard (inches): �1
5/00 Continued on back

Facility Number: 7 �-- 7 Z Date of Inspection P p'I 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 ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �"%To
(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 E�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level !
elevation markings? ❑ Yes J2(No
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type le �'�"t ilO�ct f'exzr.
13. Do the receiving crops differ with those designated in tie Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
viblatidris er deficiencies ve�re noted diWkid this;visit; • Y;oti will-f eeeiye Rio Curther • ; ;
coriresporicience: abuuti this visit . • . • .......
❑ Yes 27'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.PrYes ❑ No
❑ Yes JZNo
❑ Yes )?fNo
�8'�Ces ❑ No
'ErYes ❑ No
❑ Yes -2fNo
❑ Yes ONO
❑ Yes ,�No
❑ Yes ,EfNo
❑ Yes ,dNo
/Yes ❑ No
�Q- Akc—,'t ;"IscG� jo o�J-6 ckcdd;-qs- A.
6e +a Use eA O(cj+CX.k l,'M41=n 6, 6 da7s
oOaff i >' r-c4l i v L, 2JeAr� J 0 kt --T- is f ri Cad J6 W_soe- C11C--'X'f,
.�`�-r OG�•o�o� Slv.rn, i oh s-;�q.ir cJ�czi.'L '�-�t�.r t�''. �r� sic
0 e^ r s -2 >21 wi'g ;,re + eokc • ja of 4 d e s �i�c.�+� o �G Ave �►C1 L
�� a -e,' cct: 1 mot^ evr_'t4s t,. e i ,'►-IGorf0- s %e u't d ZtE�*'+qW
Reviewer/Inspector Name 4t S K s
+'.
c �Gx< fix 7,
Reviewer/Inspector Signature: J Date: ! IWe1 5100

Facility Number.. Date of lfrspection ► Lr�
odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid leve[ of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,WNO
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 f"R
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ErNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9-No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional.Comments .;and/or Drawrngs: W. ,
15 . Ne-eGI i ew f ('0116- ber y., 04c4 nVx boa r+ 6r t�'7 rats} q LJ
AL
�C sc"/P 1 S GJ r',o"Clvd u� e
2� A . W�a� f/Ja t'LG{ IS t n pGi'� d l�� � J �- t 4. n, p per v-s. j Ir. s
[, c/ GtipG f ✓!eG'4OC( LZICGO�C�+rtG +C) correm }7IQ✓t - i"'IOC �,t` ccr."+S
sr � be w, ie +0 Wa4e p'["
A eld --o Vcw6 j/Jd'vpor o�cv-" 1-4 ctelQegrS 4kc,4,
j l `� Ltc�1 ec iM cc e �,rc,y+'. l,L7L1�-eo-i 7- ' be S v/e -fO - e (v&,,�
vVe�6 blr, etcIV5 CAes;qI

O Drvision of Soil and WaterConservatton Operation Review '`w �., �';
«% ionod=Water, Conservation Compliance Lispection� = ;
a �Davrsaan of Water Quality
Otleer Agency= Operahon.Reveew
1d&Routine O Comnlaint O Follow-un of DWO inspection O Follow-un of DSWC review O Other - 1
I Facility Number I
Date of Inspection
Time of Inspection
(permitted 0 Certified [:] Conditionally Certified 0 Registered 11
FarmName: ........�... 5`a.............................................................................
Owner Name. ...................
Facility Contact:
Title:.......
24 hr. (hh:mm)
qot Operational J Date Last Operated:
t
County:........
...1..................................................
PhoneNo:.....................i................... ................................................
PhoneNo:... ................................................
MailingAddress: ..................................................................................................................... .................................:.................................................. ..........................
L
Onsite Representative:._.....,,, �-�......................... -............................................. Integrator:...... ►r
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude ' 1 64 Longitude 0 ° 44
Design Current Design Current _ :Design= Current
aci Po u - Ca _ ..
.Swine � - 'Ca" ' lation Poultry Ca achy �Popula`tion -Cattle _ - achy "l?o ulatioin
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish a3 ❑ Non -Layer ❑ Non -Dairy -
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total'Desigll':CapaCity
❑ Gilts
❑ Boars Total"SSLW''
Number of Lagoons M ❑ Subsurface Drains Present ©Lagoon Area ❑ Spray Field Area
Holding Ponds] Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway -
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes DNo
❑ Yes D4No
Structure 6
Identifier: J
Freeboard (inches): ............. S I. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [(lo
seepage, etc.)
3/23/99 Continued on back

FacilitytNumber: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?'
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence f ve Zlication? ❑ Excessive Ponding ❑ PAN
12. Crop type r p r Sal
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ief irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
o.* tidrisbir- idcirdwroled• 00ritg tbis;visit; • Yott *ill-teeeve fii fuith&o.::uorroridence: abouthivisit: . ......... .:
❑ Yes �<No
❑ Yes KNo
❑ Yes Dj'No
❑ Yes [_No
❑ Yes XNo
❑ Yes P(No
❑ Yes kNo
❑ Yes WO
b(Yes ❑ No
❑ Yes ❑ No
XYcs ❑ No
❑ Yes j<No
❑ Yes XNo
KYes ❑ No
19Yes ❑ No
❑ Yes KNo
❑ Yes t<No
[:]Yes 5rNo
❑ Yes X No
❑ Yes �(No
XYes ❑ No
Comments (refer to:question #): Explain any YES answers anrUor any recommendattons or:any other comments
L1se drawings of facility to better,eatplain sttuations (use addrhonal pages as :necessary)
U . . _ -
"� � ~ e �-�' r } �ci S �C QS� c�CJL1 . i�•,�'"\ � �dG� t��
v
Reviewer/Inspector Name
Reviewer/Inspector Signature: ��� Date:-a.�,.j

Facipty Number:? =0.-- Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
Yes
❑ 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
WNo
28.
Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
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
[ INo
'1
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
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNO
'Additional.-jUonaments and/or Drawinev1>-,r4
- -
10
W \ A �U'T,

wj
Division of Soil and Water°Conservation -Operation Review' -
ar (] Division of Soil anii Water Conservation _Coiripliance Inspect,on° x g �r
^ : , VDivision of Water Quality Congpliaace Inspection s-
j].Other Agency Operation Review, - t
Routine O Comulaint O Follow-up of
' Facility Number 3 a I
Follow-un of DSWC review O Other
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
'Permitted 0 Certified E3 Conditionally Certified 13 Registered 113 Not O erationa) Date Last Operated:
FarmName: ...... '"` e. -----�Q .......................... Count ��....... .................. I...... .............. .........
Owner Name: ............. Phone No:
...................... ............._._................._.......................
Facility Contact: �!' �� ..W.. `1 ...................Title:...... L-:'� _Q'.'.......... ......... Phone No:......l..lU. .`
MailingAddress :..............................._:.. .......................................................................................................... ........:....
r{] YYLL .....` ..
Onsite Representative:.,•)a...._.. - `-�, Integrator: b..,. .......
Certified Operator: ............................................. ..... ............................................................. Operator Certification Number:
Location of Farm: .
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _
Latitude • �� Longitude • �° �=
Design Current y Design
Swine = . ^ ;:Poiilt - Curi ent Cattle Design Current
Capacity Population ry Ca achy= Population Capacity Populatiod
❑ Wean to Feeder IMayer ❑ Dairy
Feeder to Finish 3 a ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other =
❑ Farrow to Finish
Total Destgn Capacity
❑
Gilts,
� -
-' ❑Boars - Total SSLW
,Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
r
Holding- ;Ponds /Solid .Traps - ' ❑ Na Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes IgNo
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 'p'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Pio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P 'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches): ............................................................................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.) .
❑ Yes R No
Continued on back
3/23/99

Facility Number: 3 — Date of Inspection
6. •Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
& Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I L Is there evidence of over appligation? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes KNo
VYes ❑ No
❑ Yes 9No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes igNo
i 5
13. Do the receiving crops If er with those designated in the Certified Animal Waste Management Plan (CAWMP)? es ❑ 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1$. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N6-• olatioris:oi- Mciencies wtere noted. il&ing ]this -visit'. Yoir Will•i-&OW iit? fufthe�
,corres{ 6fideitce' about: this :visit. • . • . • . • . • . • : • : • . • : • : • :
JR(Yes ❑ No
❑ Yes R No
❑ Yes q No
❑ Yes V No
XYes ❑.No
❑ Yes 14 No
❑ Yes L&
❑ Yes 9No
❑ Yes 0 No
❑ Yes NJ No
❑ Yes kLNo
Comments (re%r to.questi(in #) Explain any YES answvers arid/or any recoiiiinendations "or any. other comments -=
_:.
Use drawings.of facility to better explain- situations (use i ddibonal pages as neeessary)ry
�`rv—o'er 1__P_Q< 11C�
54�)
1-3
9,
�2�� GIB Fc�-�Q CAS rl
3/23/99

k4'

Facility Number: S6} I)ate 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 ❑ 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 Wo
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 )�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? XYes [:]No
_ ._Mona omments an or _rawtngs:
--... ....... r .
•
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
�j Division of Water Quality
,MV A
Routine 0 Cotn laiut 0 Follow-u of DW ins ection 0 Follow-u of DSWC review 0 Other
Date of lnspection y{
Facility Number - ?j, ,
Time of Inspection i �• 24 hr. (hh:mm)
Registered Certified [3 Applied for Permit © Permitted [3 Not Operational—Operational-1 Date Last Operated:
Farm Name: .......V.trx Q +:. J1Z1......... FGc . County
t' n �r-....................................................... ........D.4-a......................................... .
OwnerName:...................V 1e, ...........1...'..�. - ....lr �lPd................................................ Phone No. ..... �ti�R� �^�$.-!;�.-�7�...........................................
Facility Contact: .............. ]IiG . W.ct F ................ Title........, 'Me 4�4. .. ........... Phone No: '' 1 .�1.�� ....................
Mailing Address: .t.....Fi.C.r............ .. z..A........................................Dlri��iti.1..1.1`1if'........................................ ..2...... .....
Onsite Representative:........ ...... W£.LCr ...... lntegratcsr:.....
lgvf................................
Certified Operator.............................................%............................._.:....I........................... Operator Certifica1tio1n Number:...... i.. ..�. ............
Location of Farm:
....U...an .... �o . .:... .;~.. af.... , ......sai .... C"..E.Q f .... S.R .1-Al s.......................... ............................................................................
..................................... I .......................... ................. ... .. ...
Latitude Longitude �• �° ���
Design Cu
in " Eanacifv FPan
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars .
a36d--
Number of LaQaons Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
I❑ No Liquid Waste
p.
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, whafis the estimated flow in -al/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 91 No
❑ Yes EP No
❑ Yes M No
❑ Yes [P No
❑ Yes 0 No
❑ Yes 10 No
❑ Yes 1OQ No
Vj Yes ER No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
V►MMJV
❑ Yes P No
Continued on back

Facility Number: Z
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
Structures (Lagoons.11olding Ponds, Flush Pits, etc.}
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: .......... N. .............. .......(i.� t?...............
Freeboard (#t): ........... Z..s .......
.........
..........
............................................................................................................................................................................
10. Is seepage observed from any of the structures'? ❑ Yes [2 No
11.
Is erasion, or any other threats to the integrity of any of the structures observed?
❑Yes
No
12.
Do any of the structures need maintenance/improvement'?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) '
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
10 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...............-................... 1an�..... Imil............................... .......................................................................................`.......
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')'?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
53 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
F] No
25.
Were any additional problems noted which cause noncompliance of the Permit"'
❑ Yes
A No
0 No.violations or deficiencies. were noted during this: visit.- Nou 4ill receive no further
correspondence about this'.visit.: :
Comments.(refer to question #I): ;Explain any 'V answers and/or any reconimenda[ions or`any`other comments.
Use drawings of facility to better'explain situations. (use.additional pages as necessary
00
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18' • mat, or-o ,rows ` `aei m4" re .cll
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•I
S fl2�oi:S �.L�S S�nwit�t ]fc1� Tta� S�l({i- 7/25/97
w
Reviewer/] n spector Name fhMW
Reviewer/Inspector Signature: Date:

0 DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
JQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSI C review O Other
Date of Inspection 7
Facility Number { -e2�
Time of Inspection t p 24 hr. (hh:mm)
Total Tinte fin fraction of hours
Farm Status: ft Registered ❑ Applied for Permit (ex: L25 for l hr 15 ntin)) Spent on Revieix
❑ Certified ❑ Permitted or Inspection (includes travel and processing)
hjNot O eratian�al`� Date Last Operated: ................................................................................................................................................
�W/.1 x... Q County
Farm Name:......... � { ....p ...... r ............................................................. ��1:�................... ................ .......................
Owner Name: ........ .V.oAa...... L�ctSpp�ll'!n}.....�.......................................................... I'hone No:..������-W.A354................................... .......
Facility Contact: ....... ......LaRS i ....... Jr ........... Title: Phone No: ,L••g AN-1-947r?.Y.............
it7airrngAddress: .....q33.1....... Eu ....N�.... [Sl ....2,`t.......:................................. ..... atl:i�tj& ......................................... ...?$S ......
Ii.
Onsite Representative:.....,�;�,.n.....N. I.1441........................................................... Integrator:........," .............................
Certified Operator: ........ $.fiw......... w............................................................... Operator Certification Number:.... 'Al...........................
1,ocation of Farm:
.31.0114.... .......... mV..... ......... v vi.�..,.... xs....... 19..rnti.i4....... an...cciskfj.........................................I..
ki
............. ............. .. ........ .......... .. ....I........... 1.................. ...................
Latitude ©• ®' Z.'1 GG Longitude ©• ©' ®"
Type of Operation ; Design ,.` Current > Design Current = Design Current
'Swine Capacity :Population F Poultry Capactty, Population Cattle Capacity : Population
❑ Wean to Feeder
[,Feeder to Finish'
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Namber_of-Lagoons /:Holding Ponds, ❑ Subsurface Drains Present ❑Lagoon Area I[] Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 93 No
2. Is any discharge observed from any part of the operation? ❑ Yes X No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IS No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes r No
c. If discharge is observed. what is theestimated flow in eat/min'? Nth
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) El Yes MNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes �Vo
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?
4/30/97 Continued on back

r
®
r..

Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 K&O Structure 2 old Stricture 3 Structure 4
..........T,�................... ................. �P ..................................................... .......... I ....... I ........... ..
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes [A No
❑ Yes F No
1A Yes ❑ No
❑ Yes WNo
Structure z Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ (.6,06 l.1............. M.............................................................. ........ .................... I ............... ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. ' Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes CO No
Yes ❑ No
Yes ❑ No
❑ Yes [I No
❑ Yes [p No
❑ Yes [&No
❑ Yes gKNo
t' Yes ❑ No
❑ Yes No
93 Yes ❑ No
❑ Yes 1KNo
❑ Yes ❑ No
❑ Yes ❑ No
`o Yes ❑ No
Comments_(refej t 4tiesttan #)mm xp any YE5 answers and/or any ecammendahons or. any other cflmments '
of y %
Lise drav►tings f'acrlrty to better explain sttuattdns (use a ddttidnalFpagesas necessary) .
:u ,.. a ... _. ,.
X-%z, 6MI&, "u's or. 4, law 6- wo, l of � wtw lour 4uUd lac t to 4
.
Gaol � mcde . &,w wt&% We- rfuokd.
S. 01) [ark, rk, should lac- Glosed o A.
)t. c \ J%AJ %e I(ed -
z4. s ►� sfw+ � � V ask- ��'Ir� � ���, �. u�� �i � � O� <w4o
4WO Le 4pJ4,i,,, Ovor-Ned �-WU 16& J) -(ID&k.
w,- _ „mot `
Reviewer/inspector Name : k : L. .o
Reviewer/Inspector Signature: Date: QJ�r I47
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit
4/30/97