310148_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: !�(,f j Jr�� Arrival Time: Departure Time: 5© County: l i1 Region:)
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1 Title:
Onsite Representative: I
Certified Operator: >1 I t
Phone:
Phone:
Integrator:
Certification Number: 1 1 I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pap.
Layer Dairy Cow
Wean to Feeder
I
INon-Layer I El
Dairy Calf
Feeder to Finish
`�,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr P,oul , Ca aci. $o
Dry Cow
Non -Dairy
Farrow to Finish
Lavers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
JJJLJOther
Turkeys
Turkey Poults
I
I =
0
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 y No ❑ NA ❑ NE
❑ Yes [—]No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Yes ❑ No
❑ Yes No
❑ Yes
%%% No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /NO
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No
Identifier:
❑NA ONE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 U-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ 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 VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s).
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Renuired Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
0
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes No
❑ Yes No
0 Yes�No
❑ Yes 12'1Qo
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JE]"N'o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _[:�6 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IfnMiWNumber: _ I Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [;R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JE]"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 Signature:
Page 3 of 3
❑ Yes P�'o ❑ NA ❑ NE
❑ YesoNo ❑ NA ❑ NE
❑ Yes T( 4o ❑ NA ❑ NE
❑Yes O"" ❑NA ❑NE
❑ Yes.EyNo
❑ Yes�o
❑ Yes �Ko
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Date:
21412015

Type of Visit: (D C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: bUACZ�J Region:
Farm Name' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: yy Title:
Onsite Representative: CJ J W.n-czcm.yi,<W
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
Wean to Feeder
01 11-ayer
Nan-L:
Feeder to Finish
reN
Farrow to Wean
Farrow to Feeder
Farrow to Finish Gilts
Boars
Turkey
Poults
Other
Phone:
Phone:
Integrator:
Certification Number: 19 1 Qa0
Certification Number:
Discharaes 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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes VN,0
0 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes i o ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facili Number: 157 Date of Inspection:
Waste Collection & Treatment
4.'ds storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure rr1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LAC71 Y i ( J 21
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
UU
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[y�No ❑ NA ❑ NE
❑ No 0 NA ❑ NE
Structure 6
❑ Yes IZ4No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El Yes [No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff] NJ ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes �o ❑ NA ❑ NE
Re uired 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. 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 ❑ 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 21412015 Continued

Favili Number: - Date of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ Ndo 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 io ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes [/No ❑ NA ❑ NE
❑Yes ❑N ❑NA ❑NE
❑Yes eNo
0 ❑NA ❑NE
Yes ❑ NA ONE
Comments (refer to question #):"Explain any YES answers and/or any additional recommendations or any other. comments.
Use drawines of facilitv to better explain situations (use additional naves as necessarv).
�6
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:l Ili] l 1 1 L —
Date: i 12 ai
15

1
Type of Visit: tMo�outince
e Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: * Arrival Time: Departure Time: 93 County: Po p'ir-, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ®Ql,C h ly'"I.A
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number: �3 6
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
C*urOR'rent;;Design=..Cur:rent
Pop.
Cattle Capacih Pop.
r[
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La er
Non -La er
D . Plouit ,
Layers
Design
C•_a acit
Current
Pao
DairyCow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other MOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes 6"No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili . Number: - Date of Inspection: 17S j 0 IL(,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ 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): 39 39 3
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.)
No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [/�
❑ 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 environment 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 Jam-' � -
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fN
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
eNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 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):
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[7No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EKO
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate Coverage & Permit
Yes
No
NA
NE
of readily available?
❑
I rJ
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ 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 I" 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 21412015 Continued

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

11
Type of Visit.. 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ST&Oelo W Integrator:
Phone:
Certified Operator: Certification Number: (7 l21
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er I I
JNon-Layer I I
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I
Feeder to Finish
MDesign Current
D . P,o_ul Ca act Rio ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 17-40 [DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ❑ o
❑ Yes Vo
❑ Yes �No
❑NA []NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facili Number: i - Date of Inspection: S
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C I 'vo�j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 V_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2No ❑ 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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesV
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 0 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ s No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
7No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff <No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑Yes
to
❑ 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
Fj"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 YNo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
El Yes
WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
LA `Vo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
❑ Yes
21/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ Vo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
�No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Reviewer/Inspector Signatur
J�
zia ors

Type of Visit: UCo pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Q�outine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: O 0 County: JuVC=r,� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: `Title:
OnsiteRepresentative: STEQB 0� IAMU_±Arns6r�
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number: �l
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design ... Current
Swine Gapacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I
ILayer
I
Cow
Wean to Feeder
I
jNon-Layer
I
Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
_%'72,
Design Current
Di. P.ault . C►_a aci P,o
Dai Heifer
DT
ry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ 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 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 ❑ o ❑ NA ❑ NE
[:]Yes 90 ❑ NA ❑ NE
[—]Yes WNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 31 - ffl Date of lns ection: (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
It
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: %-A C,ftjj j (Kc'" 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a5 ag
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes E% 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 environment 1 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 ENo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E? o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IL_l No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ez�Lj o
❑ 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 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 214120x I Continued

Facili Number: - Date of Inspection: aglly
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
2-5. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes WNo ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6No ❑ 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?
❑ Yes
[�f`No
❑ NA
❑ NE
❑ Yes
]n No
❑ NA
❑ NE
0 Yes
[21/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Ef�No ❑ NA ❑ NE
[—]Yes F(10 ❑ NA ❑ NE
[]Yes F�J`No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations fuse additional cages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91�1 C
Date: �. a
21412011

Type of Visit: Co Hance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Countyb Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 4S—r 6 P W &J y(kZA AJS&) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
A
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pap.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Layer
Da' Calf
Feeder to Finish
Design Current
Il , l;oul Ca aci P,o ,
Layers
Da' Heifer
Dry Cow
Non -Da'
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑YesWNqq
❑ 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

Facilitv Number: ]Date of Inspection: 1 �C
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ( LA 64Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ag
5. Are there any immediate threats to the integrity of any of the structures observed? E_y_eS1ZN o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes2No ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L�f<o ❑ NA F] 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 �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�JlNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
20
❑ 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
6No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
N
EZo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: jDate of Inspection—: 1113
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ 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 VrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ko
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
eNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[._�Wo
❑ 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
[!rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:)Yes
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any"other comments. " e.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon YN6 — J&
l 1
Date:
2 4/201l

Type of Visit: Q 7Rputine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
is Reason for Vit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: /?I -D
Certification Number:
Longitude:
Design Current
Swine C►apacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cat#le
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oula aci P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Otherjjj
Turke s
Turkey Poults
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ 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 DWQ)
❑ Yes
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
No ❑ NA
[] NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2'] Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !G/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes CZ/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 environmenta 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 174o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
.�N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
Ld No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Yes No
❑ Yes L.-"o
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [211` o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑NA ❑NE

Facili Number:A I - I Q K Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNc❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C2"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[ ] Yes To ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes [ 1Vo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑ NA
❑ YesZN9
❑NA
❑ Yes ❑ NA
❑ NE
❑ NE
❑ NE
iComments (refer to question # ): Explain any YES answers. and/or any additional recommendations or any other comments "
UseDdrawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7
21412011

FaCtlty Number' Q Drvtston of Soil and`Water Conservatton
J ..,
=Other A
Type of Visit ;Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: `Title: Phone No:
Onsite Representative: TLI/E1� { al_ ["runs/) Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = f ❑ Longitude: ❑ ° = ,
➢esign Cut
. Swine ,.� Ca aci Po ul
m P� ,tY P.
£" ❑ Wean to Finish
❑ Wean to Feeder
W Feeder to Finish I SC22 1 a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
►Other � ,��'"
Des:gn Current Des�tg`nCurrent;
��WetPoultry w..Cauacitvf'Pooulatton Cattle m Cau citvPopolation .
lL Non -Layer
1
1
Dry;Poiiltry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood {
Numbi?r<af;:
Discharees & Stream Impacts
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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
E,] NNo
1-1NA1-1
NE
2. Is there evidence of a past discharge from any part of the operation?
[:1 Yes
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
?No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Faclity Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
IdentiCs�yJ C 8 Identifier: _ sQ?/V v
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(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
environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
2/No Igo ❑ 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
C 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
2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 ,B N<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [o [3NA ❑ NE
ElYes No ❑ NA ❑ NE
Comments refer to question # : Ex lain an YES answers and/or an'q recommendations or an other comments
9 P Y Y Y
Use drawm s.of fac►ti to better ex lain situations use^addittonal a es as neeessa �� TM .
g.. tY P ( P g �3)• s
ZIL/ aExio,w4 Far:,Lo
`
Reviewer/Inspector Name
Phone: ) -'
Reviewer/Inspector Signature:
Date: a -
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
lr]✓ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CJ 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
P<o
❑ 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings: . ,
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visjt/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j3 D Arrival Time: Departure Time: County: Region: j
Farm Name: '�' .IL/— A4 "'/1114 _" . rc Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: � ��� Integrator• /_>1
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = « longitude: 0 ° = ' = «
Design C•urrept
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
10 Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
gf No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
g(No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

,tFacility Number: � �� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ONo ❑ NA ❑ NE
❑ Yes eNo ❑ 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
.ZrNo ❑ 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
UrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EfNo ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ZI 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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t2. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
21No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
C3 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P10
❑ NA
❑ NE
Comments (refer to question#): Explain:. any YES answers and/or any recommendations orXany other comments ,. m
Use:drawings'pf facilitrto:better explain;situativns. (use additioiial,pa`ges as necessary) x ,;
a
Reviewer/Inspector Name
- 3 ,a Phone: d
Reviewer/Inspector Signature:
Dater 6
12128104 Continued

Facility Number: Date of Inspection t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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? (iel 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?
lv 1fi _�
-710 y
�/94
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
J� No
❑ NA
❑ NE
❑ Yes
Jam-' No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
J2 No
❑ NA
❑ NE
❑ Yes [;'No ❑ NA ❑ NE
❑ Yes �2No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
12fNo
❑ NA
❑ NE
12/28/04

40 Division of Water Quality
Facility Number D Division of Soil and Water Conservation
Agency
Type of Visit ,C.,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4EI/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1612
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
ArrivalTime:Tiim�e:: Q�� Departure Time: County:
lL_ ?czzL Owner Email:
Phone:
Facility Contact: `` Title: Phone No:
Onsite Representative: 15-f11P/1 l�l S Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Region: t%✓r�% -
Latitude: I--] c 0 f = Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer r
❑ Non -Layer
i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Populattour
❑
Dairy Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [�J'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�INo
❑ Yes
QNo
❑ NA
❑ NE
❑ Yes
P�No
❑ NA
❑ NE
12128104 Continued

+ FacilitrNumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑'No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
3No
❑ NA ❑ NE
Stru�ture l 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
L3 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
O-No
[:1 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
'P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PhNo
❑ 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
EfNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
jr] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PrNo
❑ 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): r'r y
- ��I�i'►'t Ga ,f �/-ca. C C c� ,5 v°- o•r r c./ ,.
J �
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 12'No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�INo.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;]-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[No
El NA
El 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
�jNo
❑ 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
�3No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Additionatcomments and/or.Drawings:'
A�
Page 3 of 3 12/2VO4

Division of Water Quality
Facility Number Y Q Divlsion of Soil and Water. Conservation
— — - Q Other Agency
Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitk)rRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��f} Q Departure Time: County: Region:
IF
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: /P/hone No:
Onsite Representative: Integrator: L� i
Certified Operator: Operator Certification umber:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o = ' 0 Longitude: = ° 0 C = w
Design Current Design.. Current..
ine
Capacity Population Wet Poultry Capacity Population
Wean to Finish
❑ Layer
Wean to Feeder
, ❑ Non -La er
'Feeder to Finish
72
1
Farrow to Wean
Dry Poultry
Farrow to Feeder
❑ La ers
Farrow to Finish
Gilts ❑ Non-L
❑ Pullets
ter•
❑ Turkey Poults
Other - ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
-- a. Was the conveyance man-made?
` Design Current'`
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes FZINo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ NA
❑ NE
❑ Yes E No
❑ NA
❑ NE
12128104 Continued

3 /6
Facility Number: — Date Inspection r
of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,El"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 y�fo
❑ 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 P`No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes jZfNo
❑ 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 VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes LE(No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes � No
El NA
El 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):
Reviewer/inspector Name { (/ k't_ 1-67" [ Phone: �j
Reviewer/Inspector Signature: / Date:
Pale 2 of 3 1212404 Continued

Facility Number: 3 -,%y Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes <. ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�i'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fait 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
PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
',Q No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Jallo
❑ 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 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
CjNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
VOW
v � / / �- Cd%61S
Page 3 of 3 I2/28/04

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: m Arrival Time: �% O Q Departure Time: County: !h Region:
Farm Name: J7-C�%7 ��t� fC/f/!i�iL► Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative. / /olxs3Y1
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator• r
Operator Certification dumber:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = 1. Longitude: = ° = 6 = H
Destgn Current,. Design, urrent C9
acitDesign -, Current
Swine ' "Capy Pipulatioii ' `Wef Paultty° 'CAP city PopulaEi n ' Cattle n Capacity Population
❑ Wean to Finish
❑ La er
❑Non -La et
El Daia Cow
ElWean to Feeder
❑ Dairy Calf
Feeder to Finish
6 S-0
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
El Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ TurkeyPoults
❑ Other Number of Structures:
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J2"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D"NO
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
l'No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

racility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19'
Observed Freeboard (in): a Y
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 El -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? [:1 Yes ] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes DNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes -21 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
/ONo
❑ 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
0 No
❑ NA
❑ NE
refer wqueshon-,#j .°!
- j Grp /.s /`T Yoac-K A aloy° A Ca�'kO°S /2,oG d- 0rCh ll�
ReviewerAnspector Name IA P � Phone:
- d
Reviewer/Inspector Signature: Date: D oZS' 0�
12128104 Continued

!Facility Number: 3 Date of Inspection R�0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C34o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ..®"No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,EYNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes J:allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
_QNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�+10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DIN o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J'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
P*o
El 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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ICJ No
❑ NA
❑ NE
Addiiioual.Comments and/or Drawings:
12128104

(Type of Visit 0 Co hpliance Inspection O Operation Review O Lagoon Evaluation .1
Reason for Visit m Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ® Time: I==
Q Not Operational Q Below Threshold
Permitted dCerfffied , `3 Conditionally Certified 0 Registered Date Last Operated or Abovee,�eshold ..........................
Farm Name: ..... 7 ! li -1d ... i �rL fJ 0 County: JtR1Jy
OwnerName :........ ..._................ ........... :.......... ...................................... ............... _........ ....... Phone No:......................................................................................
MailingAddress :........................................•.•--- ......................
Facility Contact: . ................................_.-...... ................... Title.......-..-------•---- Phone No:
Onsite Representative:...�.%� f f+Z 1�13 ( 1� Integrator: p ..........
Certified Operator: .. ..... . ............. . .......................... .. . ................ . .... . . ................ .......... Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • ` 66 Longitude • S 44
;
Desk`
-
Current Desrg Current _ — Dcstgn Current
Swine Ca I'oultr3' aci Po"ulation"�CatRle,
aci _:Po iron _ _ �._CaT :Cameo ulatton
Wean to Feeder
❑ Layer ❑Dairy
15reeder to Finish U612
.0
3(.-7-2— ❑Non -Layer ' ❑ Non-Dairy
._
Farrow to Wean
Other
s Farrow to Feeder
Ij Farrow to Finish
_
3
_ 3 Total Design Capac>It3'Zlz
Gilts
Boarsz,..
f -_v. 4
s- F '.:- +�- �'TQ�-LW >ai
..,._. . ._- -
,.z ., a
_ ..:.-.. _.-, _- � ....,?- _ .ram_ - . �• ._<_ -
Number of Lagoons
,
An
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2�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) E] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [3/No
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 ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .... ................................_............... �.
Freeboard (inches): 211 Z 5
12112103 Continued

Facility Number: -- $ Date of Inspection 2 D
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
C4
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?
❑ Yes
Nq
8. Does any part of the waste management system other than waste structures require maintenanceJimprovement?
❑ Yes
,BN
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
L o
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
LJ NI11.
is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
E No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type MUMNSL,G-r (CO SC=A.w tJCA (C,) SGO GSLj
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
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes
❑ es
Yes
❑ Yes
❑ Yes 2NO
❑ Yes L0<0o
❑ Yes r3leo
❑ Yes o
Comments {re€er,ti► quest<on #) Ezplatn a y YFS:ansvv67-
eis and/or arty recommendations or any oLnercommentK4
`.Use draivt of fa to better' sztgations ase additsonai es as necessa ���- s �- ngs sty explain ( Pag r]') ❑Field Cop ❑Final Notes ��
L `#-.. -V.«P.-
^,3:, i.�� '� %�in«�
.;: g � ).[" �j'� v F •-' L`"SY j. a'- .D"� _i,°^�y."� e"�"- .« 6 E -e ie�— �. _�_.
13� Waco WEED C0&J1 R ol, 3.t'1 F'EC S
3 5) O E(,o -46 drjj47C.Cf A" yu zTXh L AF rCA-
[,J P►S A wwv-, a o r^cNT racl 6C- 2Yr. V4AC(.,) API' `�0 0.9
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: &L24fY
V
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documenti
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 6 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes To
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ElYes w
26. Fail to notify regional DWQ of emergency situations as required by General Permit? ro_
(ie/ discharge, freeboard problems, over application) ElYes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes ��O_
28. Does facility require a follow-up visit by same agency? ❑ Yes 13<0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes l O
NI PDES Permitted. Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) j1Yes ❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes N
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ es No
35. Does record keeping for NPDES required forms need im�Zpection
meat? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

�` �,� ¢.,:� �' 7 ���� �; Dtvtston of Soil andWater Conservation ,� � F
fiY + Q Other Agency �. ~ k 6..
Type of Visit GXompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
j Facility Number Hate of Visit_ Time: ,Z �'1 Printed on: 7/21/2000
I
Q Not Operational Q Below Threshold
Ej Permitted 19 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ....................
Farm Name: ......... .�?.� gyg ..........�'.IG.IA0.1 ..n......... ae ......................... Countv:
Owner Name: ....... !ti ►�1 a`�! Phone No:
Facility Contact:
Mailing address:
Title: .................
Phone No:
Onsite Representative:..__.,_ ........ ....... Integrator:........., % u✓ .
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C7• 4 Gi Longitude ' & cc
DeA6
die Capaci
Wean to -Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Poultry
- ❑ Layer
Design Current
Ca aci .Population Cattle
Dairy
❑ Non -Layer
Non -Dairy
❑ Other
Total Design Capacity
Total SSLWI I
_non [*n
nn
❑-
F��
❑
10 Subsurface Drains Present I❑ Lagoon Area I❑ Spray field Area V
No Liquid Waste Management System �x
L
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ElYes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes [INo
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. Dees discharge bypass a lagoon systent? (If yes, notify DWQ) ElYes ❑ No
2. Is there evidence of past discharge from any part of the operation? ElYes JK 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 ElYes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: ._._........................................................................................
Freeboard (inches): 20 2�
5100 Continued on back

)Facility Number: 3 — 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? ❑ Yes UNo
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 maintenancelimprovement? ❑ Yes ZI No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type &cAJAAqr r Q rm r W4 �n411 1 61 awffeme
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 I.No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiuia iQnjs :e def e�encie wire hOfj - during 4tis:AWit; - You vQ •teegiye 00 Cu;thtr
:. correspondence: about this visit` ...::.::::.:........::::::::.....::
❑ Yes [S No.
❑ Yes W No
❑ Yes [& No
❑ Yes ® No
❑ Yes 0 No
❑ Yes tg No
❑ Yes 13 No
❑ Yes 0 No
❑ Yes 13 No
❑ Yes ® No
❑ Yes ,® No
❑ Yes. 19 No

Facility Number: I -- fl f 1 Date of Inspection ) $ Printed
on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
® No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not Iocated near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
IN No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
M No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
M No
[Adoition*-omments an orDrawings:.
J
5100

Facility Number 3 J Date of Inspection 2 00
Time of Inspection j t{ 3 p 124 hr. (hh:mm)
13 Permitted E3 Certified © Conditionally Certified (] Registered r] Not Operational I Date Last Operated:
• ....................
Farm Name: �Lten I,,)x}].i�ctrhs'�....�r County:.... T1-1/.iZQ.1
..i...........................................................
Owner Name: '
S ..7 ...Z..-C......................... ............................ Phone No:...........................-.....-.-..--...........-..........................
Facility Contact: .............. ..... Title Phone No -
Mailing Address:
Onsite Representative: S-.lteYy.. .:.��i.��^t.sd'� r� Se,...cn�l�r�i�?+tr�integrator: M V" % r►til
...- ,-.-. -...--..-...............
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
1 �^•► � 1 � £ask of �
c_ F'Ok-- •, ',r Ie%-_4ed a•. fQa+'f�, s;
Latitude �• 0` �
.Design , _ , Current'.
Swine Capacity: Population
❑ Wean to Feeder
3r%/
21 Feeder to Finish
3 2
549�.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
...........I
Longitude =• =, =LC
Design ., Destgn;: "Cuieent' Current"'
Poultry Capacity Po elation Cattle :Ca aci `: Po ulat,on
❑ Layer V. ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design; Capacity.
Total SSLW
_ Number of Lagoons W.r r ❑ Subsurface Drains Present ❑Lagoon Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El 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?
Spray Field Area �.
Y r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I 2—
Freeboard (inches): 21 30
❑ Yes $l No
❑ Yes ® No
❑ Yes ® No
n A
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes IN No
Structure 6
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes IN No
Continued on back

Facility -Number: 3 j — f 48 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 ® No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?' ❑ Yes No
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 Eg No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JS No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ff No
12. Crop type--5u+1O111cY 4n►1V a raskcc i,i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EJNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes JRNo
c) This facility is pended for a wettable acre determination? ❑ Yes 54No
15. Does the receiving crop need improvement?
E Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ENNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
[I Yes
ONo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[$ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
29 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
19 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
�' O-yiola(Wris.'oe deficit?ncies mere noted• dirririg this:visit; • YoUI. mjH1-reeeiye iio (urther: -
correspondence. about. this visit:
Comments,"(refer to questions#) Explain any YF,S answers and/or any recommendations orFany'otEiEer,commentsryx
LTse drawin;,rs of faciltty'vto;)ietter_explai isituations (use iddltsonal pages as=necessary)
15, L_,)"", ,emave a e - �^Ct55eS �fO", �e,M0dC., rets4vre ah �;e- 6"C_k�
q. (,Jock )OL./ev, fotleoh ICV615 4a s4ap 'Pumpmp %c✓cI a►?qI/ �iva;/,ql/de d'�P'
4c. 6ve Ao,,)c gvti�l'�6�c rev fosS;6la by ,''�canGs.
ector Name r.,
p _ • Sf_on�g.11 �rx'1��h� s
Reviewer/Inspector Signature Date:
Reviewer/Ins �� L1op ^

Facifrity Number: 3 r — qg
Date of itispection OlJ
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
0 Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
®'No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
N No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
.9 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
M No
32.
l
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
® Yes
❑ No
ditional omments an or rawings_ 7-_ - - �
L11
3/23/99

Facility Number 3 Date of Inspection L ) Z
Time of Inspection 1 D 24 hr. (hh:mm)
® Permitted © Certified © Conditionally Certified Q Registered 113 Not O erational Date Last Operated:
Farm Name:
�¢,� County:.......h ... n
.........---��a4-n..---�i.�..�.� ..!�.a�'!:isay'.L......a�'.'".:.'................. �..!.........................._.........._ .......................
Owner Name: ........... � V_ DLe't.. ...... W t d I fct �fO)l Phone No:......................................:................................................
t.... . ----- ..............................................................
Facility Contact: ................................._............................................ Title:..................... .......... Phone No:
Mailing Address: ......... ..... ..........
Onsite Representative: "r h CN v t 1 � Integrator:.. ,,,,,,,,, ' ,,, h► r .t
...#°................................q............................I.................�.... k.... '........1.... ..... ..............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
r................ .......................................................................................... ...............
......................................................................�
Latitude �_ Longitude • �_ �'_
.: Design Current Design, Current, - ` Design Current _
Sivene Ca acity Po ulation' Poult _ _. -.
r'y Cii icity . Populatioir - ' Cattle' -Ca acity Po ulation -'
❑ Wean to Feeder ❑ Layer f ❑ Dairy
§gFeeder to Finish 3X'72 S ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean r
❑
El Farrow to Feeder =' Other
❑ Farrow to Finish x
Total Design Capacity
❑ Gilts, ;
❑ Boars - Total SSLW
Number of -Lagoons �; [] Subsurface Drains Present ❑Lagoon Spray Field Area
Area 1
- Holdrng Ponds /Solid Traps ❑ No Lequid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 01A Ow
(jw
Freeboard (inches). .........2. ............ I. _ TI.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes Cd No
❑ Yes J0 No
❑ Yes 9 No
hlr,
❑ Yes Eg No
❑ Yes No
❑ Yes gNo
❑ Yes El No
Structure 6
❑ Yes No
Continued on back
3/23/99

Facility Number: 31tqLf Date ul' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 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 10 No
Waste ADolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes .V No
11.
Is there evidence of over application? ❑ Excessive Ponding PAN
❑ Yes,,
59 No
12.
r❑
Crop type - Sy mom« AA,%Vq r1 �;,14¢i �tt►j �_�ervw� VC.'t�( 'o-1-OI Q ySk'z'q1j
Grq in
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo .
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
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 readily available?
❑ Yes
JZ 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
EN No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss reviewlinspection 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
0.1 Div yiolatiotis;oi itefc. . . . .mere potted diet.. �his;v. . . ;You wit. receive �iti ]further.. .
: - comes• oxide * ' e: ab' k this visit. : ::: :
Contriaents ('refer to queshi►n #) Explatn:any YES answers andlor any recommendations onany other comments
Use :drawings of facility to'better explain situations {jese additional.pages as necessary) t ,�
r �� 1 I r i M9G G G 0 f i ILGt 4 a So " j 4e-< �•
- App1 4a>- CM01 Icy 'P?an wr}-�, 4eZ4n1Ca� ��eLl�el� is Ly
Dec a� b a Y r
Keep 6.41AI, q�AIC15 ul.nd8r- 60n4e'01
lg9Oons/ 1"L1 4"k5e!s- 1 L
✓ ,,1 e" x S iT e, is I ti ge O G[ c. ed
Reviewer/Inspector Name v.
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: 3t — J Lt
Date of Inspection II 3 qI
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
2 Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,l No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
[:]Yes
IffNo
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
f 9.No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
29 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
C9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
Additional, onnmorents an ravings:
3/23/99

❑ Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Routine 0 Cum faint 0 Follow-u of DW ins cction O Follow-up of DSWC review 0 Other
Date of Inspection I--107gE -t
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered 13 Certified AApplied for Permit © Permitted JE3 Not O eratinnal 1 Date Last Operated:
Farm Name: --"--.------... ........... Ok-JU.i.0ux+wn........................................... County: ........ i}[qAn..... ............................... .......................
Owner Name: ........................ 17:[(,j1"r.......... .�:.............. ................: Phone No: ..��%a�..��.�a-`�-��-..........................................
Facility Contact:
Title: ................................................................ Phone No:............... ....................................
��
MaitingAddress: ........... �!....C�.... ?�c..................................................................... .........t ��ll�....!4..�.N`.....---..................... ..?n.4.......
Onsite Representative: ................... 1 .........G�i �. �.i G ysa...�Or.................... Integrator: ............. M..Vx,l...................................................
Certified Operator: .................. . Ut! 11jA4t..,.UN.................... Operator Certification Number,.......................
Location of Farm:
n. -.na ...........szD.�.....a ...... ... ` °1 �.....i�...S...tr► }-1L�s ......ex-s........ 4A..... 1...L........................................................................................
... .................................. -"-....--.....-"---..............-----" -- .-"-------.... ..... .
Latitude 0' 0' 0" Longitude in =' 11
s Design -Current
F
Design Current p Design ""Current
Somme, Ca acit -Po illation
Y P
Pouitr Ca acit Po "ulation Cattle acitPo Mahan
Y P Y P_ C p Y P_
., R
: ❑Layer ❑ Dairy
❑Wean to Feeder
Feeder to Finish
El Non -Layer ❑ Non -Dairy
- X�
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other a 3,Ar
Farrow to Finish
y
Total Design Opacity F
u
❑ Gilts
SS T i LW
Ota
❑ Boars
Nwnber"of Lagt>ains % Hildtng Ponds'
�Z� ❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
❑ No Liquid Waste Management System
s
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes �No
2. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes km No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes N No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facilitx Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holdii g Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ............�:3 ..........—
................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Structure 5
❑ Yes 0 No
❑ Yes P3 No
Structure 6
❑ Yes P No
❑ Yes (3 No
12. Do any of the structures need maintenance/improvement? ❑ Yes [9 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop ........... S^t ,V..... . . W-Ir t ....Lnk coal.......'... 6�mua6..............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes E3 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
M No
18.
Does the receiving crop need improvement?
❑ Yes
fa No
19.
Is there a Iack of available waste application equipment?
❑ Yes
PqNo
20.
Does facility require a follow-up visit by same agency?
M Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JN No
22.
Does record keeping need improvement?
d Yes
�4 No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
P9 Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
P Yes
❑ No
[]- No. violationsor. deficiencies:were-itotied-during this:visit:- You4_ill recei�e�no-ftiritier-:
com)M es ehce about this:visit" :
-As� e' cvoTO;c"gar. 4 n; ev' iv, At tck Z`� '� 43 or,
reS�e CAI- v[[e. j . (1 '� .� 16s fa c 9 31 3� 1 �S�a L 7 2-`f . —tk t s
'Sv��y�G.[tCd �iYav►. `�- G0!'Y� S�ont# ; � � 1 +(!W ivi,t Gfro� .
6 r mvdo- "{" S Mc 1 �;YP1 n
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ¢{A.&-�, j I Date:

141 Routine O Complaint O Follow-up of DW ins ection. O Follow-ue of DSWC review O Other
Date of Inspection
Facility Number � i'-E-
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
09 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: . ...... .................. ............ . ...... . ...... . ..... . . .... . ..... _.`.....
1_....... .........
Farm Name: : ' i.�kkI....County:
Land Owner Name: S,Vh. " ........... Phone No: .......
91fl
Facility Conctact:.................................................................................. Title: ................... .... _....... ..___ Phone No:
Mailing Address: L:.I.L.:.......�Q. ._.. ....._.............. ...�...... .............
__...._ ..., .....�1�Q...
Onsite Representative:.... �..�L.d( `.................. .._ Integrator:
Certified Operator: 5 ...P_A, O....t..LG�n4 -------------- Operator Certification Number: �.`.��. ...... .... .,
Location of Farm:
Latitude • 4 OO u Longitude s ©1 ©14
Type of Operation and Design Capacity.
` « .z
�De51gnCurrent -Design Currents 'Design ,Current
,. —�a"
Swiae>Poultry„ �Ca "aa l?O "ulatian Cattle . rCa aci 'Po Mahon
- n Ca aci , ' Po" elation:
❑ Wean to Feeder ❑❑ D
Feeder to Finish 4I❑ Non -Layer ❑ Non -Da'
Favw to Wean �'-'901
;
Farrow to Feeder Total DeS1gnCapac>i
.10 Farrow to Finish:
s
.n.-__aa--.r.,wxm_�:wa.......:.w.--y..'.w'u. ...... ... .. ..,... ._.. � t _,c 'lam �'�f1�JV� ,.i➢Fn
Other
Number of Lagoons¢fHolding Ponds - ❑ Subsurface Drams Present
�' ` 3 t ' ❑ L ❑Spray Field Area agoon Area .
?`.M.
eneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
R Yes ❑ No
❑ Yes &No
[:]Yes ®`No
❑ Yes El No
❑ Yes
®No
❑ Yes
allo
❑ Yes -
KNo
® Yes
❑ No
Continued on back

FacilityMember:... 3._1_
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JR No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
SNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
JqNo
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RLNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
IffNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E'No
12. Do any of the structures need maintenance/improvement?
®.Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
J.No
Waste AuDlicatiou
14. Is there physical evidence of over application? ❑ Yes .9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. yu► �� (i r� x�u ....i^��!!!. _.. xt �a tts�s .S w+-L^^ r"r..�t ' L'w`'wt T
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes gNo
17. Does the facility have'a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r Cedfied Flicilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24, Does record keeping need improvement?
❑ Yes KNo
91 Yes ❑ No
❑ Yes B-No
❑ Yes 9LNo
❑ Yes ®.No
❑ Yes 9 No
❑ Yes EQ No
® Yes ❑ No
Comcnents�{refer to'questionEzplam any YES answers and/or any recommendations'or any othecamments n
Use diaw2ngs; of facility tv �etter explain s�tuat2ons' {use additional pages as necessary) x•F .� � �- T � ,�.� � �;
`
O w� ' S , Da y t_
C k MJc C k Q.g S �+n?�o1+-sue p a i-d io v t in er
Q
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w-a 0_� .
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�clse +" -�w,tie de bred 1es Wow P-,,,,t S
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24 . rae. f Gv r- rA.,, t S t-q M . A t
ID
Reviewer/Inspector Name r `
Reviewer/Inspector Signature: Date: 7 1 "f
cc: Division of Water Oualitv. Water Oualitv Section. Facility Assessment Unit 4130/97
?h
VOL

•
•
OPERATIONS BRANCH - WQ Fax :[phone] Jul 20 ' 95 9 :11 P. 03/17
Site Requires Ym►nediate Atteiition
Facility Number.
SM VISITATION RECORD
DATE: `� - �� _ ► 1995
Owner. Gn Farm Nance: � --
County: ��
Agent Visiting Site: R<)Yh F. -ke-v,,A, _ S i• Phone: `3L�- &-?•��
Operator: Phone:
On Site Representative:.., _ — . Phone: _
Physical Address: _ CM I Iti Cr
3L
Mailing Address:
Type of Operation: Swine Poultry Cattle.
Design Capacity: I K' 3,e _ Number of Animals on Site: d 2
Latitude, Longitude: °
Type of Inspection: Ground ,�` Aerial., `
Circle Yes or No
Does the Animal Waste. Lagoon have sufficient freeboard of 1 Foot Y 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or Actual Freeboard: Feet Inches
For faciLties with more than one lagoon, please address the other lagoons' freeboard under the
cornrnents section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application.? Yes yr N'o Is the cover crop adequate? Yes or No

Site Requires Immediate Attention:
Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: - 9—,3 , 1995
Time: I
Farm Name/Owner:--
Mailing Address: 170 (6D)( 2 q& Koo �47 5 V 112 P C- z B 3 49 _ -
County: rio n l /1
Integrator. KU r_yh g� Phone:
On Site Representative: Phone: 29(a -0"nO
Physical Address/Location: -40 mo l i 2 e)c i G rrO5 5 NC I
114b ;?.L5p- 0 Ie�y
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3%- Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �� `�(v ' �3.3" Longitude: _°' S3�" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) 0orNo Actual Freeboard: 2- Ft. 0 Inches
Was any seepage observed from the iagoon(s)? Yes oo Was any erosion observed? Yes o No
• Is adequate land available for spray? es r No Is the cover crop adequate? 06T No
Crop(s) being utilized: 130r M of �4 1 II et
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or do
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific a7eae with cover crop)? YesoLLAdditional Comments: ��5 2 e- h 2nC� (.yti Pam, 1'K?k5 Of
-eOW- li),-K (1<42e i ` hP kM40 nnA;nr. 79•krd11
49 L k . (4a L. -
Inspector Name
AARL
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9-3 , 1995
Time: Z .
Farm Name/Owner: 6"eve Wil i l 2m cn For j'r1 Pon c Z
Mailing Address: � e n-2n SVJ I-e Z IF -5 4�I
County:
Integrator- r[ or 1
On Site Representative:
Physical Address/Location: -4 D hDl r 2 ex I+ t
ort tb n5 tea I l I i _0*rX'M 1Zj_ C51� 195(r;
Type of Operation: Swine Poultry Cattle
Phone:
Phone: Z9'(P-0770
U -3 - 5 K)G i i
�f'(--
F4--
Design Capacity: 1%72 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ° 5(v ' %.F" Longitude: -I-? ° S1 ' %.I 9" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Fe
r No Actual Freeboard: �,' Ft. _v Inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erosion observed? Yes ors)
Is adequate land available for spray? e r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: rm
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch; flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
0 L,'A41' - -
2
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERRTIORS' BPRPICH - WQ Fax:[phone]'3
Ruq 1 '95 10:28 P.04/1�-,
Si[, Rcqui cs Lrnr:.,cdiatt
r a4ili-1' Nulnbrfr: -
O` ntr ; 77���—'� O ff _ Farm! Nturle:
Agent ��lslurl� �lt�:
Or! Sire keplesrnta[i'Ve —
FilVsit:a.i Adores;: c1y`� �-►
r f
Ma11.ing A,,,dir-SS:
Tvi e of C]-pttatinn: S .� ire V i ciritx : .-._�
Y, -
Design ign CnPji3citY: 3-6 i�Tlli:fver Qt .%S!1!^1a1-- Oi, Sir�:
LouZiLude:
Type of NspecTion: Grouec.1
0 Circle `Tres or Nu
Does ti;c Ani.un? Wasta Lagoon Have of 3 Fact . 25 24 hoLlf s:«rm CVCI,'.
(approxinlately 1 Foor + 7 inches) Y(:s o; (S� Actual,�rcr€�u .r[]: _^u Fee: _ In"'1:rs
FOi' iaCi1i1iC-$ WiTh mac-. than onf: Iii-Don, piease address tht; i t]'1Ci ]sa(:Orla• Er=AbQ-nUd under 6--
Co1Tinicnt5 section.
Wa's aril obseve rd frpm the YPs pr No IVaS these ,I on of .l?e dam.`: i'e5 nr N,
Is z&quacu land ava.ilabio for land application", Yes or Nc 1-1 {hil co, -- crop adec ate? "YC or ` rr
Additln[nal Co ;-,,menu,- S3r{.-�•- 1 _�lfi: -T
5 'n'r �ti:i�"
C t'1� _
_' '' t
j pa - tG (9 !:'j ] J JJ�1r1
3%r W i��'3iitra; �:w ". c'[lf ✓