780072_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qual

rl
Date of Visit: Arrival Time: 1 1&,.3V_j Departure Time: ,'�r� County: _);W,.:iiRegion: FTD
Farm Name: /,� �y,,,.�-��f--_ /��rjyi� Owner Email:
Owner Name: j Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 5?4e_1n ipi/ Phone:
Onsite Representative: ..� Integrator:
Certified Operator:�Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Current Design Current
Pop. Wet Pointry Capacity Pop'
La er
Nan -La er
h Design„ Current
attle it Capacity, Pop.
Wean to Finish
DairyCow
Wean to Feeder
DairyCalf
FFarrow
Feeder to Finish
��"
Design
D . P,oul Ga aci
Current
Po
DairyHeifer
to Wean
D Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
..Layers
j;
�,
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
'; :; f
Otlher =_
Turke sk
TurkeyPouets
I 10ther
'
"MMEN-,-.
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 FTNo ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes []'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
214.12015 Continued

' Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �lo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0- o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ET o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EJ-I io
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�J" ]�fo ❑ 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) ��>a'iZ/ u��-� ��'��"' >r:l� :C /�_ I,,,- "L
13. Soil Type(s): n D' yYL� u %tom
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ET o
❑ 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
[fr'�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q'<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�jNo
❑ NA
❑ NE
Required Records & Documents
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 �o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes C3 N
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii 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 [2-Ko
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []-7To ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes - Io
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 [3'�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El -No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems; over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [3'1`Jo ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
[:]Yes O No ❑ NA ❑ NE
❑ Yes Q'l1lo ❑ NA ❑ NE
❑ Yes 13-No
❑ Yes [D No
❑ Yes Q o
C��
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone: :3D3--ir/zS7
Date: el
21412015

.i6
Type of Visit: O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: f Arrival Time: ; p c7 Departure Time: County: zvJ.:5'k-- Region: p}.
r—
Farm Name: -2rt Owner Email:
Owner Name: �� /z� —moo Phone:
Mailing Address:
Physical Address:
Facility Contact: L{/r //� /?% Title: �Z c/ Phone:
Onsite Representative: Integrator:
Certified Operator: �y�,�- Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pap. Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish G
Dairy Heifer
Farrow to Wean
Design C►urrent
Dry Cow
Farrow to Feeder
D Pooutt ,
Ca aci Po _
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
--
Turkeys
Her, -
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes IQ No ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE.
❑ Yes
'12 No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Faciii Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes Cy -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ lg
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3,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 allo ❑ 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 allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J�a 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 q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes EaNo
❑ NA
❑ NE
maintenance or improvement?
l l _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [!gNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [�J,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes LkNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:)Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements [] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q 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 MNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RLNo
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
[DNA ❑NE
❑NA ❑NE
Page 2 of 3 214120I5 Continued

' Facility Number: - Date of Inspection: --/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ 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
Jallo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
IQ No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IQ No
❑ NA
ONE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
ja No
[DNA
0 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
K No
0 NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
(4No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Qj'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1�4_jVo
❑ NA
❑ NE
Camments(refer to gation #j aExplan anyYEnswers°and/or any addtttonal recommendations or m any other coments..
� .
Use drawutgs:of facihtytobetier ezplatn situat,o�s(use.additional pages _as necessary,) ,,"_
xw
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Phone:/O""DfST
Date:
21412015
Page 3 of 3

71 G -
Type of Visit: (Compliance Inspection Q Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: Awoutinc O Complaint Q Follow-up O Referral O Emergency C) Other O Denied Access
Date of Visit: Arrival Time: ; j o Departure Time: '3 County: Region: F7
Farm Name: Owner Email:
Owner Name: �,,z„ y TEL Phone:
Mailing Address:
Physical Address:
Facility Contact: Q,,.� e Title: Phone:
Onsite Representative: Scf Integrator:
Certified Operator: _ _ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current -
Design Current
Swine Capacity Pop.
We# PoWtry
Capacity
Pop.
@attle Capacity Pop.
Wean to Finish
I 11-ayer
I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
1
Dairy Heifer
Farrow to Wean
Design
Current =
Dry Cow
Farrow to Feeder
I) P,oW
Ca aei
PLo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other.
Turkey Poults
Other AOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes M\/ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Ins ection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ja 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
allo
❑ 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 JZI-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): �O�'t �L�'11rs/�lB�bz�r-rf ��jl7udfit ems,-r.5Y�.1
13. Soil Type(s): .4t,4,CA um_ Z pzr'/T-' --
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes �3 No
❑ Yes El No
❑ Yes E No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes S[ No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes fA No ❑ NA 0 NE
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-Yes No ❑ NA ❑ NE
136 Waste Application ❑ Weekly Freeboard P 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 instal and maintain a rain gauge? ❑ Yes [g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Callo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

• Facility Number: zJ11 - jDate of Inspection: -5'-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fZ] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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 �gNo ❑ 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 CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to
tias of facility to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[—]Yes (allo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
[::]Yes ® No
❑ Yes ELNo
❑ Yes ENo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone: ,22e-�,e 3 -_TTP-v
Date:=3`o�iG
21412014

(Type of Visit: eMompliance Inspection 0 Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'p U Departure Time: ' ! County: r dy Region:
Farm Name: aiv Owner Email:
Owner Name: Phone:
01
Mailing Address:
Physical Address:
Facility Contact:; /�:4.�+ �G J��tG�l� Title: Phone:
Onsite Representative: _ S ..,,t� Integrator: /I xO&I
Certified Operator:-0I Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
WAR_ Design Current Design Current
Design Current
Swine Capacity Pop. Wet Foultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
D ' Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Non -Dairy
D . F,©ul Ca aci P,o
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other. NO -Turkey Points
Other I 10ther
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 54-No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [] No
[:]Yes allo
❑ Yes 52 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facifl Number: 7&4r - Date of Inspection:
Waste Collection & Treatment
'. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-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 E3: 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
,K No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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
M,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t2l 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
C] Yes
L5,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes ER -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): el C A %
13. Soil Type(s): !
14. Do the receiving crops differ from those designated in the CA WMP?
[:]Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EE�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Qj�No
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[gNo
❑ 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. 0 Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections C9Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jZ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENO
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
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EO-No
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
S No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ENo
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�, No
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P�LNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
DNA ❑ 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 pales as necessary).
9,3
� y �
Reviewer/Inspector Name-
Reviewer/Inspector Signature.
Page 3 of 3
Phone: 2p tt --
Date: ?/ ::'� �kr�
21412011

3 I wt s M " M/!
Type of Visit: gKompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4rRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Zane et
Date of Visit: Arrival Time: � Departure Time: County: Region:
.r,
Farm Name: p Y1{tA( �B iZrr `L Owner Email:
`
Owner Name: 4 Phone:
Mailing Address:
Physical Address: �
Facility Contact: O t (64�x hL {[. /4*tTitle:
Onsite Representative: �1
Certified Operator: [�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: N9
Certification Number.:,
Certification Number:
Longitude:
Swine
Design Current Design � Current
Capacity Pop. Wet Poultry Capaty Pop.-
Cattle
Design current
Capacity Pop.
h
WeanjFd
La er
DairyCow
Weaner
-Layer
DairyCalf
Feedesh
Farroan
Farroder
10
Design Current
"F_T�Laycprsolu l . Ca a -I P,o ,
Dai Heifer
Cow
Non-DaFarroish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Other
Other
I urke s
Turkey Poults
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E915U NA ❑ NE
[-]Yes
[-]No
Fa-ITA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [::]No E3 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facie Number: - Date of lns ection• _
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
[C -W— ❑ NA ❑ NE
❑No S-N7C- ❑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
o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Cg ❑ 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
Ja ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Cjj-?Iro ❑ 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
9.? foo NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C3'i oo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®.Ko ❑ 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 j` ,�❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r'L�_ �✓'" v � �o4.s' CV r
13. Soil Type(s): 4 � f(_'6 G
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ENo
❑ NA
❑ NE
acres determination?
l7. 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
10
❑ NA
❑ NE
Re uired Records & Documents
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
1_B ""'
❑ 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
Q
❑ 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
Oo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
(—]Yes
Ug No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

r
Facility Number: 1.6- Date of Inspection:
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25_ is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ZN% ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C; tW [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ Yes � ❑ NA ❑ NE
[:]Yes [�J-i�o ❑ NA ❑ NE
[:]Yes Ca_Ne- ❑ NA ❑ NE
0 Yes GD.W ❑ NA ❑ NE
[:)Yes
[ -56
❑ Yes
[gMo-
❑ Yes
[�J a
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3

Mk s _SS 110
Type of Visit: (Wcom ante Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Comolaint O Follow-uD O Referral O Emergencv O Other O Denied Access
Date of Visit: rival Time: Departure Time: County: bt
Farm Name: a►R; R Owner Email:
Owner Name: Phone:
Mailing Address: �o ,3 �� �j /�G �% dt(J-61f�
Physical Address: � / �a'^GC 'WG p2 - 3
Regio�
Facility Contact: ('4 cff\� uccv'-L.� "Title: r� _ Phone;
Onsite Representative: << Integrator: 14
Certified Operator: Certification Number: /S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: I cp�—o 6
Longitude: l
Design Current
Design .Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
:'Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
;` _`
Da Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Poultry
Ca aci
" .l?o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[2 No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
❑ Yes
❑ No
e NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
2"'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
GZ6NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[0,1&o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IF
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

ON
Facili Number: - Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
io
❑ 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): J 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[E3 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
To
❑ 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
Eg"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Gg"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
[LyRo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EE o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ZXo
❑ 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): ce yV (,v04 5,b - �/�
/
13. Soil Type(s): C R
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ea'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[jj-l�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
021<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facili Number: - Date of Ins ection: o
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [8,Ne ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Lg1Vu ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
Q�o
[DNA
❑ NE
❑ Yes
�o
[DNA
❑ NE
❑ Yes
[D>o
❑ NA
❑ NE
[—]Yes [Zj'< ❑ NA ❑ NE
❑ Yes `Yf ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [ XO
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E'No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes F.-�No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EKO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer. to question ft Explain any YES answers and/or any additional recommendations or any other comments r
Use drawings of facility to better explain situations (use additional pages as necessary).
04(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 50-el q33_ _ `'
Date:
1/4 011

I ype of v Isa: qV t.ompnance inspection V vperauun review l.J structure r vatuanon U i ecnmcat Assistance
Reason for Visit: '® Routine O Complaint O Follow-up O Referral Q Emergency Q Other p Denied Access
Date of Visit: � 13 Z Arrival Time: •'d0 07►17 Departure Time: /� County: �A� Region: f%ic
Farm Name: jo „L �,7Q �A{L
Owner Name: —_Tom +1V & prE
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: To m Title: Phone:
Onsite Representative: Integrator: Y1UAjQAV �/QdSJ1l
Certified Operator: 76 WIMy 640 Ar- Certification Number: 1 gam
I -
Back-up Operator:
Location of Farm:
Latitude:
Certification number:
Longitude:
- Design Current Design Current
Swine - Capacity Pap. Wet Poultry Capacity Pop.
Design C►orient
C+aitle Capacity P.
Wean to Finish I ILayer I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish api
$7
Dairy Heifer
Farrow to Wean''
Design Current
Dry Cow
Farrow to Feeder
D , P,oul# _ ; :_ _Ca aci_ to ,
Non -Dairy
Farrow to Finish
I Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
PulletsI
Turkeys
I Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? [—]Yes E3 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
1/ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FF
Faciti Number: — - ;a I jDate of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
['gf4o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
eNA
❑ 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
[EfNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
E3*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 [/No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [TNo ❑ 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 fi2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
r%—),'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): r—Lugmup NA a1 SG 0 t CErRn 1.. F P,-} Soy
b t o^ S
_
13. Soil Type(s):�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EgKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D' 4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2rNo
❑ NA
D NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
BNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�rNo
❑ 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
EJ4Io
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[] Rainfall ❑Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E!fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
❑ No
L2rNA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - 'l `-t Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by thb permit? ❑ Yes [B"No ❑ 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 Q'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E]7 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E2" o ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [9"'No ❑ NA ❑ NE
❑ Yes C3fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes &a No
❑ Yes LZ No
[:]Yes allo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: IC. Date:
Page 3 of 3 2/4/2011

'IKS l!/g /// -to-
AMM
ty� b� i'' Division of Soil and R' ter Co`` — � FaCili Nu'`�' reservation
�. � Other -Agency
16
Type of Visit: JOrtompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &, outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: %l_j�� County: rSr Region:
Farm Name: Vnwl ti tn,ti _ Owner Email:
Owner Name: ^ I oryxr Li-i atJW P� Phone:
Mailing Address:
Physical Address:
.r,
Facility Contact: lcmevt Title: Phone:
Onsite Representative: OMYV1 Integrator:~ B
Certified Operator: Certification Number: 9204�0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Curren# Design Current
:Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Design Current
D , P,oultry Ca aci_ Po
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -Layers
Beef Feeder
Boars
Putlets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes to [] NA ❑ NE
❑ Yes []No
❑ Yes ❑ No
E rNA ❑ NE
G po<_1❑ NE
❑ Yes ❑ No LvJ "A ❑ NE
[—]Yes tDN ❑ NA ❑ NE
[—]Yes io ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Nu1nber: jDate of Inspection: !3Z. a,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No 216 ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in): 3Z
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FlXo'
❑ 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
'l_?'"o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E14��b
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
1Id'l<
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E jX ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vo ❑ 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 E3Application Outside of Approved Area
/
12. Crop TYpe(s). 9_ ". _ [ , 6� . &. ,jLj,4 5,2 f bll`.,
13. Soil Type(s): 1AU L��_L KrA-K LYf 16L . ! t, r l kJ
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [f, 'o
❑ Yes EK
❑ Yes iJ. K'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Eq4 o
❑ NA
❑ NE
❑ Yes io ❑ NA ❑ NE
[::]Yes Ea "'o ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [j Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and l " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fo ❑ NA/❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ KA ❑ NE
Page 2 of 3 21412011 Continued

Factlity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes N�0_
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
[:]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NEE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Q�1VE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L 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?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes cp�j< ❑ NA ❑ NE
❑ Yes �lo ❑ NA ❑ NE
❑ Yes I__I o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes B<o ❑ NA ❑ NE
❑ Yes ��o❑ NA ❑ NE
Comments (refer to question #,) Explain any°.YES answers`and/or hihy dditional recommendation's or'",any�ootl�teir comments.
Use drawings of facittty to better explain situations _Cure additional.,pagesW necessary):'
neg " Ft'­
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone:
Date:
21412011

ivisiion oW. WT_. X—_TN Nx f Water Quality
iFacility 1`inmber 7 �D -7O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
&I routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Z %- /O Arrival Time: Departure Time: ����� County: AZo 47 Psj Region:
Farm Name: 94.r-� FMyA,----- Owner Email:
Owner Name: J O�!� _�b.-ft6/c Phone:
Mailing Address:
Physical Address:
,A- o
Facility Contact: S7413-n/-e— Title: ©u�/^/r-Y Phone
/No:
Onsite Representative: Integrator:�vrn
Certified Operator: Operator Certification Number: % tg 20+ '
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: n 0 I [� Longitude: = o =
Design Current
Swine Capacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle CapacNMItyopulati
❑ Wean to Finish
❑ Wean to Feeder
110 Layer
_
��
❑ Dairy Cow
1110 Non -Layer
❑ Dairy Calf
Feeder to Finish
-3
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow.
❑ Non-Dai
❑ Layers
❑ Beef Stocker
Non -La ers ❑Pullets Beef Feeder
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PE]Boars
❑ Beef Brood Cot-
!Number of Structures:
El Turke s
❑ Turkey Poults
❑ Other
. tl
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
ETKA
❑ NE
❑ Yes
❑ No
E3 9A
❑ NE
[ -NA
El NE
❑ Yes
❑l No
Yes
Elr
I0� No
NA
❑ NE
❑ Yes
��o❑
D<o--
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ] —p
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z-7
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 L.9'No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes or co[:] NA ❑ NE
❑ Yes Ej<o ❑ 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? El Yes EKoo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require El Yes L1110 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L.j< ❑ NA ❑ NE
maintenance/improvement? '
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B ro ❑ 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 1
12. Croptype(s) elk life.. 6 r -LAC-4 - Z11-1110 n� Cevtv�ie�%
13. Soil type(s) /`{ U 64 k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes D,,N//o El NA ❑ NE
17. Does the facility lack adequate acreage for land application? El Yes ,E o El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Ltf
Yes '1Qo ❑ NA ❑ NE
Comments {refer to"questton I#) Explain any YES"answers and/or any recomm�enda#ions or any other comments.,
wtngsg4f facility to' better ex lain sttuahons (nse addthonal page ,,
Use dra�'
l
Reviewer/inspector Name ~' � "".
Phone: g/D.
G�
Reviewer/Inspector Signature:
Date: 13;e_ z7Z 010
Page 2 of 3 12128104 Continued

Facility Number: 7 —p Date of Inspection -2-7-4
Required Records & Documents El"
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3 o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes TNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t3No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N' oo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,E
L"J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ej No
ElNA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ef<
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_,
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,L_3<oo
L7No
❑ 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
,-,�
[575o
❑ 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
O'go—
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
,��
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElE Yes
,Blroo
No
❑ NA
❑ NE
Additional C6mide'66 and/or Drawings Us
Page 3 of 3 12128104

�ru1S
sion of Water Quality
Facility Number. %8 , 7 Z Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ~2y�-O�j Arrival Time: 9.150 Ate+ Departure Time: /�SSsa�•, County: !�a bCSdJ Region:
Farm Name: O:u:nnu ST�ti% �- r4VAA Owner Email:
Owner Name: I ;%Aw^W Phone:
—�j
Mailing Address:
Physical Address:
Facility Contact: I �`"`"""� S `J �-- Title: 49 `"3!`f S4� Phone No:
OnsiteRepresentative: 0JAM Integrator: Mq�_,R4y - Sr-oW1,J
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = ° = 6 0 6i
Design Current Design Current Design Current:
Swine Capacity Population,. Wet Poultry Capacity Population Cattle Capacity P�fRopulation.
❑ Wean to Finish
❑ Wean to Feeder
[PrFeeder to Finish
(O
0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
I❑ Layer
E]Non-Layei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
El NE
El Yes
ElL� No
[["NA
NA
❑ NE
I� NA
El NE
❑ Yes
No
❑Yes
�❑
LI No
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 78 _ 7Z
Date of Inspection `+�
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 01 No ,❑I NNA El NE
a. If yes, is waste level into the structural freeboard? El Yes El No L"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 dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ON. ❑ 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 �Dhr/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes LJ 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 Anolieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes '' No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) BtCM' .u_ (H&4 Coo -Al - Wkt e.a.f- !'oy&-Q Afs
13. Soil type(s) Iq u Cac�k, tX &I %re.hle
lot I
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
�,�
LI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MN.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3 No
❑ NA
❑ NE
1�ar-r n t� s `�Ye se.v> � e .•A�1 j ` ter; it �c �1e 4i', i �. fl s!? flea 11,4 w�
ReviewerllnspectarName iV-%3;4K� .i�eileJiS Phone: 9io.5�.3.3335d
Reviewer/Inspector Signature: gA kZAIIL� Date: -Z� 200g
Page 2 of 3 12128104 Continued

Facility Number: -7 g —% Z Date of Inspection'2S�-�
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 appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C! No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,❑]No E NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes dNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes , +ZNNo El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes B"NNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L'a No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes E No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑Yes
❑NA
El NE
❑ Yes
,L`7No
L7 No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
<o
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
BINo
❑ NA
❑ NE
12128104

R11f5 ,4re_Q( 7-03-08
ivision of Water Quality
Facility Number % 0 Division of Soil and Water Conservation
- J 7z 0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 166 _2 Arrival Time: I // :.3a Departure Time: County: �+ So^� Region:
Farm Name: E ti S4NC_ 1=aOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: toS Title: P41W-41- Phone No:
Onsite Representative: Integrator: _ /.4c. 0,c 45 dz A✓
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [_—] o [—] ' = " Longitude: = ° 0 ` 0 "
Swine
Wean to Finish
Wean to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design. Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I1. ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ NOD -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 No ❑ NA ❑ NE
❑ Yes
❑ No
LJ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
Cl NA
❑ NE
❑ Yes
❑ No
El Yes
"N�o
❑NA
El NE
El Yes
2 o
❑ NA
❑ NE
12128104 Continued

t
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes L7 No El NA ❑ NE
❑ Yes ❑ No B NA ❑ NE
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
E 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
Q 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?
El Yes
!� wo
❑ NA ❑ NE
8. Do any of the stuctures 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
El Yes
�,
L'1'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ 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) Co r,J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
��
NNo
❑ NA El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,L_'J,,
❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,I2No
o
ElNA ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
,B
L7 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Er&oo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ; ' • Phone: 1/0, g33.333-2_1
Reviewer/inspector Signature: Date: 'o, -Z- 3 — ZOB
12128104 Continued

Facility Number: 79 Date of Inspection -23 D
Required Records & Documents ,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ,ET, NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L— No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El 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 ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[��3 N//o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
,L7
LT No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1, oo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
El-�
,[-
l, two
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElE Yes
o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [f N ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�,�
is 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
El Yes
��/
L7 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NN.
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
El2 Yes
o
❑ NA
❑ NE
Additional Comments and/or
12128104

P) m q
7
r
® Division of Water Quality
Facility Number '� g �] Z . 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit B Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: . Vo w.. Departure Time: 3: Sir County.. Pabese'J Region: F'D
Farm Name: I h^ Sao e_ 47 Owner Email:
Owner Name: L . S4 c. Phone:
Mailing Address:
Physical Address:
Facility Contact: n +mow., 54t. N C- Title: Phone No:
Onsite Representative: 1-0 5404v <-- Integrator: /fu&44.4 r VQ,0AJ
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Elo = 1 = u Longitude: = ° = r = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
J❑ Layer
E1 Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cn;
Cattle Capacity-' Popu
QDajt Cow
❑ DairyCalf
❑ Dairy Heifer
Crary Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: I l l
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 M No ❑ NA ❑ NE ,
w
❑ Yes
® No
❑ NA
❑ NE `` s
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(9 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R9 No
❑ NA
❑ NE
12128104 Continued

L �
Facility Number: -7 — 7 Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [7No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes UNo ❑ 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?
t
❑ Yes
[� No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[51No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
`A No
❑ NA
❑ NE
/' 9
minaenance tmprovemeM.
11. Is there evidence of incorrect application? if yes, check the appropriate box below. Cl Yes $0 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) �3 ,. � .- G r._rs CHAP £ P. sue►- `) CP wkc"-J
. Soy
6 -e C'-.--S
—
13. Soil type(s) A, r_e c k. 9 v., i ei-71"1oc—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A 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
IT 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
(jNo
❑ 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):
Cool
Reviewer/inspector Name � i c j? �CtS Phone: V Q S�-� • 3334
Reviewer/Inspector Signature: Rt Date: 3 - Z S ` Z od-i
12128104 Continued

Facility Number: -7$ — ]Z Date of Inspection 3-28'd7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [VNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[jg No
❑ 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
[?9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
06 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
[8 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
[ffNo
❑ 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
[M 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
[XNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

a'
Type of Visit In Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z.-O 9'— U Arrival Time: Departure Time: County: r1 a itr►
Farm Name: ! �7,*r r c 5/_0AV �„ �clr,✓► Owner Email:
Owner Name: Sfraq/,�— Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 4fA4 c- Title: 0&8A&dr4,— Phone No:
Onsite Representative: , Is Al 6% L t__xl t. Integrator: %3vj`,-JA/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = i Longitude: [� ° = s
Design Current Design Current Design Current ...
Swine Capacity Population Wet Poultry Capacity Population Cattle .Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish (�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
Layers
Non-L,
Pullets
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ElOther
a. Was the conveyance man-made`?
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifer
El
Dry Cow
El
Non-Dairy
ElBeef
Stocker
ElBeef
Feeder
ElBeef
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? (Ifyes, 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
[� No
❑ Yes
17] No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
12128104 Continued

4
Facility Number: 7 S — -7 Z Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): , �1
Observed Freeboard (in):
❑ Yes [5INo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes '® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R1 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
[)a' No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) /7 e-J-01%��•L Aay t J6 -c Sou 6 «A,,_j
13. Soiltype(s) /��, t'_v. 11L �al.t.r�. TebIC --
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
[0 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
['No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tH No
❑ NA ❑ NE
eility;to bettereaplam sttnabons.(use aiilrtlonal
Reviewer/Inspector Name I KC,vG{-S • Phone: K/0'051 "/Sid/
Reviewer/lnspeetor Signature: e.,. rr Date: a - d —
12128104 Continued

Facility Number: 7 S — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ W1JP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
ElNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[K 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
[7No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
til No
❑ NA
❑ NE
12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O 0ther ❑ Denied Access
Facility Number Date of Visits b•! -o Tame:
..0 NNot erational O Below Threshold
BIxermitted Utertified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: S County: /l a 6 es at j Fie a
Owner Name: �.2 t - "—_ ..... _ .. PhoneNo.- 1/0- SI ?2 - SG 1-r
,Nfading Address: X sh oQ _ (1,4- c �i k _ 14n,� %an o� NL 8323
Facrfiity Contact: —.To Sion e- Title: Phone No:
Onsite Representative: f'+�i�c - _ , S e _ - - ._ Integrator: Ca r� o /% s �o e%S.Zet,_
Certified Operator: ToM��_ Sfon Operator Certification Number.
Location of Farm:
_IS
Stvrine ❑ Poultry E3 Cattle ❑ Home Latitude Longitude
�---.. ...... _ -
Swine _ ;rpo hap. Po®dtry: Po' Cattle °CnrrrJut
wean to Feeder ' Layer Dairy
er to Finish 39,3(o Nan -Layer Non -Dairy _
Farrow to Wean_:
Farrow to Feeder Other
Farrow to Finish - Tow -
Gilts
Boats, £ ti Totat'SSLW.
pkdaMes & Stream imparts
1. Is any discharge observed from any part of the operation? ❑ Yes M-I�o
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes 9N-0
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 0-M
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 EJ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [90
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --i— _ . -.
Freeboard (inches): 3 �'
12/l2103 ContUmed

Facili€y Number: — 7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes U'N"o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 21�0
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 B'g_o
8. Does any part of the waste management system other than waste structures require maintenanoelimprovement? ❑ Yes Q-mo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
21fo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
am
I . Is there evidence of over application? if yes, check the appropriate box below.
❑ Yes
❑lqo�
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
!"W 13g 7 14y 3/S
12. C �' _
� � Cor G��w
lo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
21' o
16. Is there a lack of adequate waste application equipment?
❑ Yes
EM
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Bf4o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
0090
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
eNo-
Air Quality representative immediately.
plee-se Ct M4070e, ! & Wade o n 60re Gre4 f /1;9 00 7,
Mit -MM I`�.
Reviewer/Ynspector Name _ -
Reviewer/Inspector Signature:
Date: 10 - l 9 - o
12112103 c.onunuea

Facility Number: 7 9 --Z,2 Date of inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Q-No
22. Does the ility fail to ha all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ , c ts, s, etc.)
❑
&WO
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
94o
❑ Writ *pp}ieation ❑•Fsee�- ❑ Weste sis ❑ Se'
9-9 7-2 3 11-30-> y. o ?- q-;, I.
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0-No'
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Mi<o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 o
28. Does facility require a follow-up visit by same agency?
❑ Yes
of o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0,4o
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) E34e's ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes GJ N-o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 8.,W
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 9wo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes g1<0
35. Does retard keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes EWO
12112103

Type of Visit m Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit m Routine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Imo: a 7 1 Time:
NNot rational Q Below Threshold
D Permitted D Certified © Conditionally Certified © Registered Date- Last Operated or Above Threshold:
Farm Name: Zy-4 I ,_. � & .. r. , County: -- - . 61je s a4 ., F?O
Owner Name: _ TQ S1on G Phone No: --- -91 a: - `-22 - . 9-4
Mailing Address: --'7-e2_ .A� 6,4w,c A —A&I _�...... _&2 W 1, M C( . A/ C-
Facility Contact: _ _ Title: Phone No:
Onsite Representative: Integrator.
Certified Operator: Operator Certification Number:
Location of Farm:
[}Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 44 Longitude •
Discbames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at~ ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gavrain?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — 1
Freeboard (inches): 2 d u
12112103 Continued

Facility Number: 7 - Date of inspection
X
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancer=provement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17- 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately-
;cots's s 9WW-Mny . _ orsayEot aQmments µ �
Use d�a Onzgs ai fa to,
be#ter" � (tee 1P ? c final Notes
�
Field
r
WRf� 1.qE
- H-r
ERevie:wer/Inspector
r r Name W µ .. W '— =' W g G :
a .�.F11rI .'y-ry.b.� ..x "8" x'a. „",:—,.ux... °' a,a,� s' �'" �......_
Signature: Date:
12/12M3 Condnued

Type of Visit (?rCom nce Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Foilow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of visit: - K o Time: 3.'dS
rO Not Operational 0 Below Threshold
0 Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ 0AU4u Jr ��- Fatr,�n County: RobeSnAI
Owner Name: 1 4m 4DN'• Phone No: 9 �' ZZ ' S F
G "
Mailing Address: O3 4S4 Do le cktiU'c i' P"I MC 2g393p
Facility Contact: 6"t'N L • S�rJ �-' Title: dWN<-� Phone No: 9f O -" Z—T�o1r3 /
OusiteRepresentative:-TovAwk L. S4DN e-- Integrator: CaV-V.6I rs
Certified Operator: I pwuu 4+ L 5h?+J e— Operator Certification Number:
Location of Farm:
om +L.c. Nor sf ,— of S211310 QPp'"wX, .5'": rs c_jcs-f 0-F i4S in►�c►-Sc�ilTan� c,ri
s2 113% :SAP wtS+ of [Z*'j .'C ; NL
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude 0 ' Du
Design . Current
Swine Cnnacity Ponutation
❑ Wean to Feeder
eeder to Finish
3 io
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagcions 0 Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Drains
----
Holdinonds / Solid Trap g Ps = ❑ No Liquid Waste Management S 'stem
Discharges & Stream lmnacts
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?
Wad Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes Q No
❑ Yes �o
ElE Yes No
ElYes
❑ Yes
ETONoo
2 No
❑ Yes
ffN,
❑ Yes
No
Structure G
Freeboard (inches): 23
05103101 Continued

Facility Number: "7 $ — 7 Z
Date of Inspection 4-15-03
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?
I I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes B<O
❑ Yes L9NO
❑ Yes E NNo/o
❑ Yes 2<0
❑ Yes 9<01
❑ Yes L'No
ElYes Ei o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
El Yes
,[TNo
oo
b) Does the facility need a wettable acre determination?
El yes
�L,.,i'
2<00
c) This facility is pended for a wettable acre determination?
❑ Yes
!moo
15. Does the receiving crop need improvement?
❑ Yes
2<
16. Is there a lack of adequate waste application equipment?
❑ Yes
B<
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Q'Po
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
lSNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
I_y'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5 o�
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
Milo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
El Yes
,�,�
LTI�o
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tw�o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
B,_�
25.
Wye any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,<O
�'No
JLV No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
EP lace any YES answers and/o�r,''an reeonarnendaos or an e01
Use draetter, ex taut kiWatlons a" addiLoaal a er as necessa ❑Field Copy Final Hotes
teCommeawn�tk
Reviewer/Inspector Name c �. 4 _ �1 � ' 't ._ " y#
Reviewer/Inspector Signature: Date: / S 0.3
05103101 Continued

Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit QPRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Virit: U� Time:
lint nneratinna] C) Ra
® Permitted ® Certified D Conditionally- Certified Q Registered Date Last Operated or above Threshold:
Farm Name: — S County:
Owner Name: Phone No: OD I Z,11 y 9L `aQ _
Mailing address: � C �, .4-< 0 �Y C.I•. v�C� P,(Q— __ ___ ll 3 r.� C_v�1. , iJ C/ a.? 3 1?3
Facility Contact: Title: n _rv» r-- _ Phone No:
Onsite Representative: Integrator: — cr,� nI`Q,(� S
Certified Operator: Operator Certification Number: 1 2 0 G
Location of Farm:
® Swine ❑Poultry ❑Cattle ❑Horse Latitude �� 0 Longitude
Design Current
Swine f anarifv Pannlatinn
❑ Wean to Feeder
Feeder to Finish 1
3 3
❑ Farrow to wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Ca acity Population Cattle Ca aciity Population
❑ Laver I I❑ Dairy
❑ Non -Laver I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharges 8 Stream IMR2cts
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 eal/min?
d. Does discharge bypass a lagoon system? (If ves, 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 8 reatrn nt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches):
OS/0 101
[PLNo
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
J�i No
❑ Yes
® No
❑ Yes
19 No
❑ Yes
allo
Structure 6
Continued

a
Facility Number: W-12 Date of Inspection f
5. Are there any immediate threats to the integrity of any of the structures observed? (ee/ trees, severe erosion, ❑ Yes 5 No
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 CR No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes E�l No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes (53 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes E4 No
Waste ApDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type RP[`vantJAAb, �+ � von , QY'VII-re'l n . S, C-1) rr J— L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 5 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired
Records & Documents
17"
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
E,No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[ANo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
V1 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes Z}No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes fA No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
... ........
@ouiments [refe-_ to=question #}. Explain aiiy°tYES an wets ani%ll ai} re'commendatlnns or any tithe m�e , (&
Use drawrngsi"of fsciltty to better ezplam situations ,(uaadtttonal pagesas necessary) [I Field Copy El Final Notes
Y _rrn')" GarJj t'. 8,bV-1" to pk'a �0 tFj, .
il
Reviewer/Inspector Name f 14,4-
Reviewer/Inspector Signature: Date:
v.vwiv■ t'"'"I Mru

[Facility Number: 2 Date of Inspecii4in
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application" (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
[I Yes El No
El Yes[ No
El Yes CR No
El Yes W No
E] Yes No
El Yes No
El Yes El No
Additional Comments 2ndlor:Drswings:—. 7:
05103101
05103101

N
Facilih Number
hate of Visit:
Tom'_ ime: � C)
10 Not OiDer2tional 0 Below Threshold
Permitted ©Certified
Farm Name: a,*M
Co d10 itionally Certified
© Registered
Date Last Operated A ove Threshold:
County: t�SQn�
Owner Name: _ l��yl
G'
Phone No:
Mailing Address:
Facility Contact: 4V6fj4P /— Title:
Onsite Representative: co-
Certified Operator:
Location of Farm:
Phone No:
Integrator: —~rDF if
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0. 0 K Longitude 0' 0' 0'
Di charges & Stream ImIlActs
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lap-oon ❑ Sprav 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 eat/min?
d. Does discharge bypass a lagoon system? (If ves, 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 I No
❑ Yes �txo
o
ElYes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Structure 6
ldentifier: 7
Frccboard (inches): 3
05103101 Continued

Facility Number: — L Date of Inspection s`�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes No
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNO
(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 F.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes rNo
o
11. Is there evidence of over app)ication? , p Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes
12. Croprrpe / r„-H /lrlhea7 / 5�ahers //ie�t/1?ud�Q
13. Do the receiving cropsdiffer with thosoesignatedin the Certified Animal Waste Management Pldn (CAWMP)? ❑ Yes ylNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
El Yes
*0
c) This facility is pended for a wettable acre determination?
❑ Yes
eNa
15.
Does the receiving crop need improvement?
❑ Yes
WNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU"P, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
tX
d04 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
M
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,2�NO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
pqNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question=#f) Eiipbsin any- reeommendattons or anv other comments: -
Lsse,drn�ngsWof facility to better eacplatn situations. (use additional pages_as aecessarvj� ❑ Final Notes I s
. ❑ Field Copv
,ZS SQin� a pPA-C� f vr- � �c�r.�r a c3 c� l� r'e B ��S% c� � p%•"c�7`� a�
(!%i�ICi(CJLt+l5r �vv;d /&
Reviewer/Inspector Name
ReviewerfInspector Signature: Date: -Zs -d Z-
05103101 y / Continued

Facility Number: — % Date of Inspection =0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
[IYes No
❑ Yes LNo
❑ Yes
❑ Yes
❑ Yes ❑ No
O5103101

Type of Visit f (tompliance Inspection O Operation Review O Lagoon Evaluation 1
Reason for Visit Sq Routine O Complaint. O Follow up O Emergency Notification Oder 1 ❑ Denied Access
Facility NumberczffD_Zr Date of Visit:=f� Time: r a
Q Not Operational Q Below Threshold
APerwitted 0 Certified U Conditionally Certified 13 Registered Date Last Operated o Above Threshold:
Farm Name: 1.. h'! 1._....................... County:...............
Owner Narne:....�1f ... .................... �r.. ... Phone No: ?�Z`. (Q .._ .. ... . . . ....1�� ......... .......... ..... .
Facility Contact: i . ..._... Q»t!-�!�i� .. ._.._...._ Title : ................................... Phone No: . .%.... ... ... ,� ` J A/ g
Mailing Address:.... �.5 /.// ! oo- ...1...r • ....io-ci.�t/on� .i n,t:.Onsite Representative:.........9P �►i i . Integrator:......-r l�•
....... /..
....... .. ... ..
Certified Operator:.,„,..... .. ...... ............................ Operator Certification Number: _-.....,._„•____.
Location of Farm:
❑ Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude Longitude �• �u
:Design.;
Current
Desigii Ctitrenit = Desigyii
' Cgriresit
5 _`- -'.. .Ca ci
Po elation' Poultry _
, ; := =Ca aci Po ulation7 ' . Cattle
Wean to Feeder
10 Layer
❑ DairyEnl
eeder to Finish
❑ Non -Layer I ❑ Non-Dai ry
- arrow to Wean
Farrow to Feeder -
Other
Farrow to Finish
TOW Deli& Ga Cl
Oa.b
Gilts
Boars
Tofal-SSLw -
r.. _
NVinber;otLagovns
Subsurface Drains Present
Lagoon Area
❑Spray Field Area'
olding
H Ponds I SolYd 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 No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes o
c. If discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Structure 2 Structure 3 Structure 4
❑ Yes /�Io
Structure 5 Structure 6
Identifier: ....................................
Freeboard (inches): 27
S/00
Continued on back

Facility Number: — 7E Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �INo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? -T
❑ Yes wo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes /� No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 000
Waste ROcation
10. Are there any buffers that need maintenance/improvement?
❑ Yes &No
11. Is there evident f over application? ❑ Excessive Ponding ❑ P ❑ Hydra is Overload
❑ Yes )4No
12. Crop type
13. Do the receiving crops differ with those desi ated in the Certified PXmal Waste M gement lan (CAWMP)?
❑ Yes QJ(No .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes o
c) This facility is pended for a wettable acre determination?
❑ Yes o
15. Does the receiving crop need improvement?
❑ Yes )<No
I \
16. Is there a lack of adequate waste application equipment?
❑ Yes 10
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
JKNo
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
AkNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
MrNo
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
fi4:No
Yi0f;3Wns'e.r• . t 14 00i 9 ire jnQted O(Wift 4bis.visit; Yo(� will rtec lye ti u> gr
correspondence. about this visit: ::......:::.......::......::. .
��. Need / 4 610; n s e' c.pp
Saws e (� ems- �,. ca►r-�+- ; ,C'� j
`-��� � -- �
4s 4 reu&s z ti jwtie,
rays es cl bf4e s.
Reviewer/Inspector Name J - �,,` 7
�:. -
Reviewer/Inspector Signature: Date: f 510p

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Kes
❑ 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
o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
z
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
1i0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
1
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
es
❑ No
5/00

�a
[3 Division of Soil :Operation
of Si)if�ind�materi Conservation ;V-,
% Uanie-L pe'cU6h`,,
J8 Divisi
on QU of W�tii C inpH ance,Inspection@t
if
Other Agency. Operation
14V Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number I i Date of Inspection wz� �7e � I 27E2��� � 'Time of Inspection / - fp 24 hr. (hh:mm)
H Permitted E3 Certified (3 Conditionally Certified [3 Registered H-3-77ot Operational Date Last Operated: ..........................
FarmName: ............ ................................................................ County: ........ ................ .......................
OwnerName: .......... la ............................................................. Phone No: ....... .....
Facility Contact: .......... ...... m� ......... Title:..a
............................... Phone No: ...................................................
Mailing Address: .......... f4 17 0. At...
.....u,
;r ....... /... .............. e .. ..... f ..........................
Onsite Representative:
............................... Integrator: •....... J��
........................ .... . . ................. ...... 11 .......... / .. .....
Certified Operator: ........... Z',z- ..... ........ 5_1.15'14ac ................................ Operator Certification Number: ..........................................
Location of Farm:
. . . . ..........................................
-----------------------
Latitude Longitude
-Design Current':': sign D Current Design Currefit
Tciipa6 ty - Po on
'Capacity Population..... Poultry- Population 'Catil, Capacity Populati
❑ Wean to Feeder JE1 Layer ❑ Dairy
Weeder to Finish ❑ Non -Layer LENon-Dairy E] Farrow to Wean
0 Other
E] Farrow to Feeder
El Farrow to Finish
'Total Design C ity-
❑ Gilts,
rl Boars
Total SSL
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? E] Yes ANO
Discharge originated at; El Lagoon 0 Spray Field El Other
0 C
a. If discharge is observed, was the conveyance inan-made? E]Yes J3 No
b. If discharge is observed, did it reach Water of the State'? (If yes. notify DWQ) C] Yes 0 No
c, If discharge is observed, what is the estimated flow in ualhnin'?
d. Does discharge bypass a lagoon system? (Ifycs, notify DWQ)
1�
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? 11 Spillway
E] Yes No
0 Yes No
0 Yes Jallo
0 Yes RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............. . . ............. ........................... ....... .............. 1. ............. ­1 .... ....... I .................... I ...... ............. 1­1 ..........
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe er()%iGn,
seepage, etc,)
[3 Yes 5LNo
Continued on back
3/23/99

Facility Number: 7,p— 72 Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Q No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ""5rYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes dn7drNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Analication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Pondingg ❑ PAN
❑ Yes
No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
&No
b) Does the facility need a wettable acre determination?
❑ Yes
X No
c) This -facility is pended for a wettable acre determination?
❑ Yes
RNo
15.
Does the receiving crop need improvement?
❑ Yes
19 No
16. Is there a lack of adequate waste application equipment? ❑ Yes ®'No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ,KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes Iwo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes_k�qo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes kNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'? / _
(ie/ discharge, freeboard problems, over application) ❑ Yes >No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes? No
El- yiolaiitiris:or deiiciertcies -were noted• diti;ing �his;visit; • Yoii wiiVt& iye 0 further: • : •
rorrespo deitce' ah6uf this :visit ..: .:....:.... .........................................
e drawings of fac>ltty to better explarn s�tuahons (use add>tional pages as necessary} t r = xZrr
--
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Facility Number: %a� — 7 Z Date of InLspection L 2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below kYes E] 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 eM No
28. 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)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
34. 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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes WNO
Additionaomrnents"an or rawings: ;:;
Or,�
i
V

is Routine O Com laint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
13 Permitted ❑ Certified © Conditionally Certified [3 Registered JE3 Not Operational I Date Last Operated .
/.ram �
Farm Name: ld"h'!�M .......1.... rL .-........ County :............... f +eS4.7.................................
..:.:.....:.:....... -
Owner Name: (7.(!!'1.F1W� • -P . Phone No: l
--•- 1/...........
Facility Contact: ................... t- ............ Title: .. Phone No:
'k,iailing Address: .....................................
OnsiteRepresentative:............................................._............................. ........................ Integrator:......................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude 0 • =` =11
=_ Design
Swine Ca sett ;Po
;Current
Wation
❑ Wean to Feeder
eeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEI
❑ Boars
Longitude �• �� C��:
.�, .....Design Curreiit'
Poultry._ Capacity -Po ulation - Cattle
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non-1
EI Other
Total Design Capac
Total SSL:
_ DeSjgn � � Currenf
`� Ca ac>< Po- ulation
iry
,,�
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 ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 27/, .........................................................................
S. Are there any imm tot Teats [o a int grity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
4--i
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PCNo
Structure 6
❑ Yes [:]No
Continued on back

x xp Ii�V]SIO��of Sorl and Water;:Conservahon Opera�on Reviewer
r r x
Dtnston of Sod and Wafer -Conservation Comphance ][nspectton�
10 Routine 0 Complaint
0 Follow-up of DWQ inspection 0 Follow-up of DSWC review AVOther
Facility Number
Date of Inspection
Time of Inspection
� 24 hr. (hh:mm)
Q Permitted © Certified
0 Conditionally Certified 0 Registered
JE3 Not Operational
Date Last Operated:
Farm Name: ....jp.
..
County:
be.....s...a.......................
T
Owner Name /.
..........� ,,:
Phone No:
Facility Contact: ...:..I........ ............................................................
...............................................................
... Title: .
Phone No: ...................................................
MailingAddress: ............................................................................ ........................................ .............................................
i
`-� ......Onsite Representative:{........ Integrator:................ /�„ A.,
5
..... rye a..... d'r}
...............................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =' =, 14 Longitude 0 • =' 44
Design : - Current
Swine Capacity- Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current _ Design Current
Poultry Capacity: Population Cattle _ - ,Ca aci Po 0 ulatio.n -
❑ Layer I❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design: Capacity= -
Total 'SSLW-
71 Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Dischar_Zes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (I1• 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
IdCntif;er: �� //
Freeboard (inches) : ....................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
5_ Are there any im diate thre s to e integrity of any of the structures observed? (iel trees, severe erosion,
r�
seepage, etc.)
3/23/99 2,2
❑ Yes ❑ No
Continued on back

Information contained in this database is from non agency sources and is considered unconfirmed
Farm Number
Farm Name
Owner First Name
Owner Last Name
Source
Breached
Depopulated
Overflowed
LQ Issue
PermissionToPump
Inundated
Flooded
Pumping Equipment
Comments
Farm Emergency Call Form
178
ommy Stone Farm
ommy
15tone
p Reporting p Compiain
I-Fornmy Stone
Inches
Date 12-1-2000
Time
Call Number 1698
Plan Due Date Date Plan Date Freeboar
(7 equals blank) Received Level OK
O Yes O No
Freeboard Lagoon'!
- -
p Yes p O
Freeboard Lagoonl
.
p Yes p o
p Yes p o
Freeboard Lagoon3
p Yes p No
Freeboard Lagoon4
U
.
O es p O
Freeboard Lagoons
p Yes O No
Freeboard Lagoon6
p Yes
nessage_on-wic.e..mail ..... 11 it

Information contained in this database is from non agency sources and is considered unconfirmed.
Farm Emergency Call Form
Farm Number 78 —
Farm Name ommy Stone Farm
Owner Frist Name ommy
Owner Last Name Stone
OO Reporting O Complaint
Source ommy Stone
Date
-1-2000
Time
Call Number
98
Breached
O Yes O NO I
Freeboard Level 1 18
Depopulated
O Yes ONO I
Freeboard Level 2
Overflowed
O Yes O No
Freeboard Level 3
LQ Issue
O Yes ONO
PermissionToPump
O Yes ONO
Freeboard Level 4
Inudated
O Yes O No
Freeboard Level 5
Flooded
O Yes ONO
Freeboard Level 6
Pumping Equipment
O Yes O No
CommentsEntered..b.y-- e-ff-enr--Bro.wn........ ------------------------------------- ---- ----------------------------.................................................
.............................................................................................................................................................................................................................�
AT.............................................

a --k bi i� t-SA W4&W! tWC6n rvrsion of Soel aced
p�ration
Water nserviaiii)n'- Complidin"cie I
ti
pspe9TOTIti
D�v�seon of Water c eAnspection Quality o�rnplian'
V-7
ration Review 4
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-t=f DSIVC review 0 Other
Facility Number Date of Inspection 12 9
I I - I I Time of Inspection 24 hr. (hhmm)
APermitted 0 Certified 13 Conditionally Certified 0 Registered 113 Not Operational Date Last Operated: . .........................
Farm Name:
Countv: k^ ...............................
L5)
Owner Name:
....... Phone No: .............. ......................
y ('-'37 . ........... Title: ........... .. ............................. Facilit Contact: ........ O.Z ....................... Phone No
Mail in- Address:........ ke.Lo C
...... ?23 ...... ....... M ............................ .. .. ..
"'T ..... * ........ * ................. * ...... ........................
Onsite Representative: new- . ................................................................ IntetTrator: ........... C. c;- r r-O // I-S
....................................... .........................
Certified Operator:..... ............... . . ................................. Operator Certification Number:..........................................
Location of Farm: I
..................... * ----------- ------- III -I -I --------- ..........
Latitude Longitude
Design Current
Swine Capacity Population
D Wean to Feeder
❑ Feeder to Finish
'3 -3A
❑ Farrow to Wean
E] Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
I[] Layer [] Dairy
10 Non -Layer 1E] Non -Dairy
JE1 Other
Total Design Capacity 3q -3 If,/
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present �agoon Area ❑ Spray �Field Area
Holding Ponds /Solid Traps FEI No Liquid Waste Management System
Discharges & Stream "in jac
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated av [:] Lagoon El Spray Field E] Other
a. If discharge is observed, was the conveyance man-made?
1). II" discharge is observed, did it reach: [] Surface Waters E] Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min'?C, Z7
d. Does discharge bypass a lagoon system?
C-
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2
Identifier: ;_.7 It
Frechoard (inches): ........ ................ .......... .......... ...... ....
1/6/99
Structury 3 Structure 4 Structure 5
................................................................ .............................
El Yes JZ No
E] Yes 9 No
No
ii
❑ Yes No
❑ Yes ONO
❑ Yes�No
El Yes A'NO
Structure 6
..... I ..........................
Continued on back

Facility Number: 7 Date of Inspection .
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, gauped markers with required top of dike, maximum and minimum
liquid level elevation markings? 4
Waste Application
10. Are there any buffers that need maintenance/improvement?
Z -F
❑ Yes
Ur"io
❑ Yes
O[No
❑ Yes
M No
❑ Yes
P5 No
❑ Yes
ONo
❑ Yes
[gNo
11. Is there evidence of over application? ❑ Ponding Nitrogen
12. Crop type.�f'i►.tyGSQ ........Q..T t`-...........�!l!` 2�.........•.•....•........
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible 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?
NA.vialations:or. deficiericies.were rioted riurin ttiis:visit:. You will.rereive nor further ....
cofresporidehee: about; this visit... .. ... . _ . .... . . . • . • . • . •
❑ Yes j4No
❑ Yes 00
❑ Yes .Wo
❑ Yes ;t No
❑ Yes WTo
❑ Yes X No
❑ Yes Ij No
❑ Yes ONo
❑ Yes XNo
❑ Yes VfNo
❑ Yes fi�No
❑ Yes g No
❑ Yes 4No
Comments:(refer tii question #): Explain any YES answers and/or any=recommendations or any -other comiiterits., -`
Use drawings of.facility to better explain' situations. (use additional pekes as necessary)-'.' _ r ` _ , .
Q44rd 10-7 49
)1117 SO 011
�r� S�r; e�-'f`ivtCtES '�j �.•�C� �S1�1�(%Sly �r�s� U't- Q� S,
C>fl`CLJi
Reviewer/Inspector Name 1A �n.. ,YGC�i
Reviewer/Inspector Signature: A "; z' _Hy�&-i-,! — Date: _G--[S JC,2 I116/99

[3 Division of Soil and Water Conservation [3Other Agency
53 Division of Water Quality
I• Routine O Complaint Q Follow-up of DNVO inspection O Follow-up of DSWC review ' O Other
Dale of Inspection
Facility Number -jTime of Inspection 24 hr. (hh:mm)
13 Registered —C-�eer�tified [3 Applied for Permit Permitted 0 Not O erational Date Last Operated:
Farm Name: �—�- jam. �ct�'rvt Countv:........... r4�f..S' ..................................
Owner Name: ..............1. u .... ................. � 1101t. .............. _ Phone No:....................... �0 c S6 I...........
....�
Facility Contact . ................ ...Rr;. ...........qin�.. Title:.............................. Phone No:
67 1
Mailing Address; .......... ..... ... 1...........& ... ......... .i•�QW �G ........ ...ao.
........... ... ........................
OnsiteRepresentative: ............. 7O*A........ L...04-1 ✓........................ Integrator: .......... v+cilrY�pf..��5....... .�.`.�'..5�...�C
Certified Operator ,............... ....�..frMtvk L- S-I(Vn ................ Operator Certification Number ..........................................
Location of Farm:
Latitude '41
b w, tiDesrgn ?` YC4i
Swine NCapacityn P.onr
❑ Wean to Feeder
Feeder to Finish
3
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Longitude 0• �� ���
'Currentxi�
_ _
❑ Layer
'' ❑ Non -Lay,
R �e
❑ Other
MIN©
V jj! r 4nt
tpulationR
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P(No
2. Is any discharge observed from any part of the operation? ❑ Yes 01 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes ONo
❑ Yes XNo
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes .0 No
❑ Yes JxNo
❑ Yes XNo
Continued on hack

Facility Numher.
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (1—igoons.11olding binds. Flush Pits ete.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
Freeboard (ft): .............St. �..............
Structtre 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures'?
1. Is erosion, or any other threats to the integrity of any of the structures observed'?
Structure 5
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)
t
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 WIMP, or r noff entering waters of the Stat . notify DWQ)
15. Crop type .... .......... �e -----....................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW.MP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Its there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certirte I or Penuitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes 9(No
❑ Yes PQ No
Structure 6
❑ Yes 0 No
Yes ❑ No
XYes ❑ No
❑ Yes (� ♦i'o
❑ Yes ANo
..........................................
❑ Yes
No
❑ Yes
XNo
❑ Yes
XNo
❑ Yes
CXNo
❑ Yes
No
❑ Yes
No
❑ Yes
P(No
0 No.violations or deficiencies were note'd-during this. visit.-.Yoit.will receive no further
Oeresporidence ah"out this. visit:• : -
❑ Yes 'X No
❑ Yes VNo
❑ Yes No
0
Comments (refer to question`#): Explain any -YES answers and/or any recommendations or an .other comrnent&, M -
y ..
Use drawings of faciiity to better`explain situations Luse add'sfic►nal. pages as necctiurv) £�
A7. T&W UU0 ra do &ruta� CkjW.Jo s
Maur ohr u'l�.d.�•(o �5'
7/25/97
N
. _ . -:
Reviewer/Inspector Name ? y � Fk
Reviewer/Inspector Signature: ti ajma L� �1 r Date: a�

of
Facility NumberE=—C= j
Farm Status: Q�+
pera�on-� evict
iierationite echo;
0 Follow-up of DSWC review 0 Other
Date of Inspection S 7�
lime of Inspection : !lD
Use 24 hr. time
ITotal Time (in horn) Spent onReview
or Inspection (includes travel and processing) �.-...1+
Farm Name: r-11M t -S�o h �'SCounty: Ro b eS a ,n
Owner Name:..1 w+ &1u S- f --p r C Phone No: /P `{ 1 Z
Mailing Address: 7o3 145i,ra)P--C'-kLwic-k- )U, R1,-nj,_NC, Z$i33
Onsite Representative. Integrator. CQ r ro f S
Certified Operator. ^l Operatoor Certification Number. 206
Location of Farm:
Latitude 0 G Longitude • uS «
10 Not Operational Date Last Operated:
Type of Operation and Design Capacity
' r�s ;„f3a,FQ'""""s °k"fa �'�n�s`a,✓' ,� ti..rA^,' a.}s`e-��`L'9;.a
SwieNtmbere �'�-�Ponite]!N it�mher CatHe n�Nttmber�"
Ift
Wean t0 Feeder
Feeder to Finish Non- Beef �Y
Farrow to Weans
Farrow t6 Feeder
',�w����" ....+�'•.:.�, - ,�� ' =ram .
Farrow to Finish 13 Other Type of Lrvestocic 1
111R,g
'umber of Lagoons! Holding Ponds ' ` Subsurface Drains Present'
-- '- spray Fuld Area Lagoon Area
1. Are there any buffets that need maintenancelfmpmvement?
2 Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surfi= Water? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in galhoin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is them evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State. other than firm a discharge?
S. Does any part of the waste management system (other than bgoonwbolding ponds) require
maintennowmsprvvement?
Q Yes No
❑ Yes No
E3 Yes No
El Yes $6146
a Yes10
E3 Yes *No
E3 YesNo
� Yes �No
Coiraed ore back

6. L facility not in compliance with any applicable setback rritoria? ❑ Yes *10
7. Did the facility fail to have a eertif ed operator in msponzlle charge Cif inspection after if IM? ❑ Yes lZkIo
L Are there lagoons or storage ponds on site which need to be property closed?
troetores (LaeoOns and/or HoldInj_EonS s
9. Is Unwb ul freeboard leas than adequate?
Freeboard (R): ' Lagoon 1 Lagoon 2
10. Is seepage observed from any of the staucum?
IAgooa 3
11. h emsion, or any other threats to the integrity of any of the strictures observed?
12. Do any of the strucum need ?
(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 strucam lack adquke markers to identify start and stop pumping levels?
M'aste Apptimtlon
14. Is there physical evidence of over application?
.(If in excess of , or runoff entering waters of the State, DWQ)
�
IS �f M IAa
p
❑ Yes �No
Yes ANo
lago= 4
o Yes j4No
❑ Yes *0
0 Yes ANo
❑ Yes o
13 Yes I(No-
16. Do the active crops differ with those designated in the Waste Manageeat Plan? ' �' E3 Yes 0 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ,g(No
18. Does the cover crop need improvement? E3 Yes ANo
19. Is there a lack of available irrigation equipment? ❑ Yes o
or Certified jacHititt O 1
20.. Does the fatality fail to have a copy of the Animal Waste Management Plan readily aysalable? E3 Yes No
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes No
22. Does rzcotd keeping need improve cent? ❑ Yes )!fNo
23. Does facility require a follow-up visit by same agency? 0 Yes ONo
24. Did Revicv cdi ispector fail to discuss reviewfmspecdon with owner or operator in change? ❑ Yes gNo
CatYimeats (refer to quesda7n # F.icglaan arty YES answers and/oraity recoauneud_a�ons'or aag'r routaieats.`� r
Usedis of facil to better 1su3 szEous use additional es as a
C�i'1►1 (OOi5 500dr Jr' Dhe 15 J01.
►aq 'tr i hqs k5 s"IeAc .
Reviewer/iuspector Name
Reviwer/inspector Signature: (11 Ante: w5-7-3-9 7
c= WVWVn of K ester Ouality. Water Ouall& Secdom Facilkv Assent Unit 11/14/96

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Tommy Stone
903 Ashpole Church Rd.
Rowland, NC 28383
Dear Mr. Stone:
M?WA
EDF=HMF;Z
DIVISION OF WATER QUALITY
June 2, 1997
SUBJECT: Annual Compliance Inspection
Tommy Stone (P&S) Farm
Registration Nos. 78-72
Robeson County
On May 23, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
inspected the subject swine facility. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided and
observations made during the inspection that the facility was in compliance with 15A NCAC 2H,
Part.0217 at the time of the inspection. Please refer to the comments section on the rear of the
inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for a
minimum of 250 hogs must have a certified waste management plan on or before December 31,
1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and Water
have specialist available to assist you with upgrading of existing facilities and certification.
If You have any questions concerning this matter, please call John Hasty at [phone].
Sincerely,
(21,4�
ohn C. Hasty, Jr.
Environmental Specialist
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. NRCS
Wachovia Building, Suite 714. Fayetteville � FAX [phone]
North Carolina 28301-5043 NfM� An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

s
P
dd d d floo n
NE.
t
k

6]hftCMYnot is onempiiaaoe with sw seibact esimeda? . M Ya jg�o `
7. Did the bm-My W to bm a codfied op mww In nqNaOle dMP (if MAW VIAM V Ya 10
!� Are dms lagoons or storage ponds on dfa which need b be peoQetiy oloeed? _ 13 Ya 1Jo
anftL f
9. Is sttnettuW it- A u wd Im adegme? Oyu �No
Fiexboard (!tk_ Lagoon 2 Lap= 3 Lyooa 4
10. Is seepage observed Elam `sssaeha o -
11. L etoaioM, ar any cdha ftP I so tie integrity cfsy. of the strvcum +obs vied?
12. Do any of the am== need
nihswance-
(If any of gneWons 9-12 was answered ya, and the dtu d n paeee an
Immediate public bealtia or nvkwumeotal threat, notify DWQ)
r-
.a Do any of the ammm hack sdgoke marIs to idao * start and stop pmzpiag levels?
RIM ste A9OlicatiDn
X b then pbysics] evidence of aver applieadon?
_(Vim excen of . ar tuaoff entering waters of the State, ' DWQ)
crop�
10. Do the sedw crops differ with those designated in the AukWWsste MaaaV=t= Plan?
17. Don the facility have a lack of adegoate arrratge for lead sppiicnon?
IL Does the cover emp need dent?
19. h there a lack ofwndUble krigation egWpme d?
Eor CeMrsed Fa ffi t &
20.. Does the facMV sail to have a copy of the Anima] waste Msuagemm Plea ready svaume?
21. Doet dm amity fad to comply with the Aaims Wale Maaagemew PLa in say wW
22- Don te; w keeping need h p vvcc= ?
23. Does faciiiry re�quim a inclose -up vna by same
?4. Did ectot fad 10 discx�s seview!%spectivn with owner ar opemar ion charge?
13 Yea JqNo
-13 Yes *40
13 Ya ANo
13 Yes 13 No
13 Yes *b
13 Yes AND
13 Ya *0
Mes No
13 Yu No
© Yes )�No
13 Ya ONo
1] Ya gNo
Cauur�eats {r+cfer t0 questEoa #�: rF.�piaia say YIrS sns9vas iadlarasy. �ecomroi�eQdatso� a� nay ci. � �� r-
r- .. .. . :� Fir-,. �e r,-� • . �. �-r4 _ -
viertWlQ$5 OtfiCfty C7C�at ttitliat;0lti.,R
rarM locks 5oo4 . M r 54o>,e I s JoY5 tur +kIKg:9 D5+0 ticks scc-nr4cd.
Reviewer/lnspemr Natue
RmfwwAaspector Signature:
cc &Wsion of Hkeer Qrathy, Warer Quality Swdoa, Facility .ls.ess+Ra t
Date: 5-z3-9 7_

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Tommy Stone
Tommy Stone Farm
Rt 2 Box 150-B
Rowland NC 28383
SUBJECT: Operator In Charge Designation
Facility: Tammy Stone Farm
Facility ID#: 78-72
Robeson County
Dear Mr. Stone:
RCVS®
NOV 19 1996`
FArETI TE a iLLE
REG. Or"TICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91033-0026.
Sincerely,
A. Preston Howard, Jr., P. tar
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, 4
Raleigh, North Carolina 27611-7687 v An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 = 5M recycled/10% post -consumer paper

r = State of North Carolina Elm
Department of Environment,
Health and Natural Resources • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 5, 1995
Mr. Tommy Stone
P & S Farm
Rt. 2, Box 150-B
Rowland, NC 28383
SUBJECT: Compliance Inspection
Robeson County
Dear Mr. Stone:
On October 19, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part .0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
F Ro
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Acfion Employer 5096 recycled/ 10% post -consumer paper

f
Site Requires Immediate Attention: NO
Fsct7ity No. 7 F-�7Z
DIVISION OF FNVIR0NMFNTAL MANAGEMENT
AND AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: /O - / 9 . 1995
Farm Name/Owner: f .5 �o��r ye —
Mailing Addrrsr Ratc z 13ox /SO :8_� h'ow/u.�d
County: Ro•'as n/
Tntegtstor:. Ca rro ! 1 's_ - f-a o d Phone:
On Site Representative:, _ 7—g m Ar v S �✓ e- - Phone:J
Physical AddressJLocation: ::vo ,t.'k-S W s/
10J *2Z -
So- //3&
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: _ 31?36 Number of Animals on Site: .3.S00
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: • Longitude: • •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es or No Actual Freeboard: a_FL Inches
Was any seepage observed from the 1
Is adequate land available for spray?
Crop(s) being utilized• Ca�asfc
I? Yes oi( Was any erosion observed? Yes or®
No Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin '?(_ or No
100 Feet from Welh? (&or No
Is the animal waste stockpiler! within 100 Feet of USGS Blue Line Stream? Yes or(�p
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(s)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes w(JO If Yes, Please Explain.
Does the facility maintain adequate waste management recor s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?(War No
Additional Comments:
inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.