310338_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua!

vrsion of Water Resources
Facility Number � - 3 � OO Division of Soil and Water Conservation
sQ Wither Agency
type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
2eason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O 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: drr 4,01
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design Current
C►apacity Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
Feeder
Non -Layer
Dal Calf
Finish
2Ycf�
250�
D. P,oultr.
Layers
Design Current
Gs aci P,o
DairyHeifer
D Cow
Wean
o Feeder
o Finish
pGilts
Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes QNq/� NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number; - Date of Inspection: /2 Z S
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EjWC_❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 UfNo ❑ 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 EJ'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ 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 eNo ❑ 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
❑ ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
IJ "' ❑ 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
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yesg�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 21417015 Continued

Facili Number: -'3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Jo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E: tt ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ AB ❑ 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? ❑ Yes hio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ "N" o_ ❑ NA ONE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Gainments (refer to'question #) aExpWn any` YES answers and/or any.additional recommendations�or:.:any other comrnentiL
e +
Use drawings of racility,'to' better explain situations (use ac ditional `palzes as necessary).
❑ Yes �No' ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Q/1V0 ❑ NA ❑ NE
C, -r! 4Ce<5 n^ 'C' 1r--- _� /�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes � ❑ NA ❑ NE
Phone: j� i 919 3 ell
Date: / Z S
21412015

Type of Visit: G Co lance Inspection 0 Operation Review. 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up Q Referral Q Emergency O Other 0 Denied Access
Date of Visit: /G Arrival Time: Departure Time: O County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: 29 2- 3�
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
ELa
Wet Poultry
er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
to Feeder
Non -Layer
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
2 YV jr -2
Dr, P,oultt�
Layers
Design
Ca aci_
Current
P,q ,
D Cow
Non -Dairy
Beef Stocker
Gilts
HTurkeys
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili .Number: - 33 Date of Inspection: l Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):``
Observed Freeboard (in): J t�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EErNb ❑ 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 Q26❑ 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 F-1-No ❑ NA
71
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�-No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑-N- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [,_jNe- ❑ 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 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C]—No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes &No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes rNo❑
NA
❑ NE
Page 2 of 3 21412015 Continued

Eacili,Number: - 3 Date of inspection: Z
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
e` off
❑ 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
❑ 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
Ea-Ro
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[] o_
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
F
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�'No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U 1Vo
[DNA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to, question#.): Explain any"VES.agswers and/or any additional recommendations or any other, comments.,
Use drawings of facility..to-better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: V" ` C �(" - -4 r/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: jig 7 %7 Q
Date:
214120151

(Type of Visit: (3Com . ce Inspection O Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access iI
Date of Visit: Zn Arrival Time: l Departure Time: 4 0 -1 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 0 r
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: ? o 2 3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity= Pop.
Dairy Cow
can to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
2
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,ault . Ca aci P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
D NA
D NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 2T✓ /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑"I o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): 3
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?
Structure 5 Structure 6
❑ Yes D-N-o— ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ "K ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EfNo ❑ 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 No
❑ 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?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ NA ❑ NE
❑ Yes F!�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑Yes u 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 [j No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E:J�qo
❑ 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: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-1q0 ❑ 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 0 f" oo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3No ❑ NA ❑ NE
❑ Yes ENO [ ] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes l_J No ❑ NA ❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
E_L>kir.
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: Compliance Inspection U Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: VRoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: ( ! Arrival Time: Departure Time: ® County: L!/✓ Region:
Farm Name: & AA1 � �N/�/ F� �- p'� Owner Email:
Owner Name: Q::.{L1 AN YLE NNE Phone:
Mailing Address: ]� FS QA "_iZZ�d ?I lylc ``Y! L c XA/C C/),0V.S7 _` SQD
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: gig! J '4 t'V i zs
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
,%
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C►apacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Design Current
Capacity Pop. Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Non -La er
I
Ell Dairy Calf
Feeder to Finish y
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . P,oult ,
Layers
Design Current Dry Cow
Ga aci P,o P. Non -Dairy
I Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
No
C] NA
❑ NE
2. Is there evidence of a past discharge from any park of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: -7Dr jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
A
❑NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any 'immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 XNo, ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 V 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 X 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): M,4HAw)c VJ L.,4,y % O/1f �:�r iToa
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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/of operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists 0Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application E] Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers 0 Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and I " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

I±acility.Number: "S j - 733A 1
I Date of Inspection: fr/ 4 IV
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 to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues �[
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I XI No ❑ NA ❑ NE
and report mortality rates that were higher than normal? TTT"`
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 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) X
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers.and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
co)311y ).)0
�l WIu I.o'dk
5", ¢ fie i /0040-
of a� �
SLV'oc,C_
�.5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214.12014

type of Visit: Veompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
[lesson for Visit: QlRoutine O Complaint O Follow-up 0 Referral O Emergency O Other .0 Denied Access
Date of Visit: Arrival Time: Departure Time:LEI County: Region: �✓ ,—
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: Y`� �aa col
_ � Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
L
JNon-Laycr
Dairy Calf
Feeder to Finish
I
Design FPS
D F loutt . C•_a aCi P,.
o
11-avers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharp,es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes in No
❑ Yes ;2rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: jDate of Inspection: 1 — -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P3'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
til
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 9 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
to
❑ Yes wrNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes 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 A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V0 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?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ONO ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
VI 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
V3 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:)Yes
4] No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
12 No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facifi Number: s IDate of Inspection: — —{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VI No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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
0 No
❑ NA
❑ NE
❑ Yes
VT No
❑ NA
❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes �ff No
❑ Yes No
❑ Yes No
❑ Yes P] No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: jyj 9
Page 3 of 3 21412011

type of Visit:
Compliance Inspection 0
Operation Review Q Structure Evaluation
O Technical Assistance
Iteason for Visit:
Routine Q Complaint
O Follow-up ( Referral O Emergency
O Other 0 Denied Access
Date of Visit: j / Arrival Time: J tv Departure Time:r County: 1��L4IV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (f+q 1J - k(�G/V(YED L\
Certified Operator: &U A
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
13
1i
ertification Number:
Certification Number:
Longitude:
a aQ 3y
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer I
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Design Current
D , $Quit . Ca aci $o
Layers
I
Daia Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
I Beef Stocker
Gilts
Non -Layers
I
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
I
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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection. /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �.
Observed Freeboard (in): --
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 1$
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? ❑ Yes I , No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)t2No
T'����
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 14
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes M No ❑ NA ❑ NE
maintenance or improvement? 77�(No
-
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n\❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): �e� �E� C1' 1 L�4EAT SK CC"
13. Soil Type(s): I Q()') jQLA_'5C Bi 4/V TOA/ d RC— G J/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
j No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YestNo
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
OWUP El Checklists Q Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ElWaste Analysis 0 Soil Analysis ❑ caste Transfers Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections Ej Monthly and 1" Rainfall Inspections [d] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 1 - _3 Date of Inspection: $ !(o /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'ANo ❑ 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 0
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [—]No XNA ❑ 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? 'A
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. 19
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) 19
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
UCommentsre (refer to question #):Explain anYany-additionalanawers an or
ree. yo}m� en�d�a�trions or any oth=er c. omments
bdrawings of facility toetter explain situatconss(use additional. i esas ioecessa M r.
t9ffLf//a
91 all'a
mblii
u(3a-A ►14N CAI
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
�� Q.v7'ti07
Date: O./% b L/oC
21412011

Type of Visit: 01,compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:© County: �t1 L!/1/ Region:
Farm Name:l �N �N ��u oC _ Owner Email:
Owner Name: 1 J 1 t�r%±i i� Phone: 9 )y _9q g -- R 32 `y
Mailing Address: I � � i N K_ 111 L L. , / Y C_ Q O S_V —'� SG0
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: LAC %Af LC&,VN6 pt� Integrator:
Certified Operator: below L FNNF b Certification Number: t0001 `1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
C►apacity
Current
Pvp.
Design C+arrant
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D , P,oult .
Layers
Non -Layers
Design
Ca aci
Current
P,a
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Boars Pullets
Qthe
Other
Turke s
ey Poults
Other
Discharj%es and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number: `3 t - -3 Date of Inspection: j f
ste 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )J No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 7TTT��
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? 19
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes /XNo ❑ 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? A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, a c.)
❑ 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): SC C e C A 5 (S CoQ l/'.V H c_ 4 !
13. Soil Type(s): 16PA tt 1M WIC NLAN7CAt Fr_-)L (--5 'T6 fC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �4te Transfers ❑ Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: —3 1 - i3 $ Date of Inspection:
24. bid 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No )6 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 ONo
❑ Yes �No
❑ Yes N(No
❑ Yes 'No
❑ Yes I
❑ Yes No
❑ Yes Vo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments '
Use: drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V.Q
Date:
2/4a011

IM
IType of Visit 0,mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit:
Farm Name:
Owner Name
Mailing Addi
Physical Address:
re Time: County:
Region:
Owner Email: !gyp� Phone: d`� r'
kRg-C NC Dg5�Za-_4s06
Facility Contact: Title: Phone No:
Onsite Representative: 1J' A AI C—NNE D
Certified Operator: 1-,(ZA A N
Back-up Operator:
Integrator:
at
Operator COM ication Number: « 3T
Back-up Certification Number:
Location of Farm: Latitude: = o = ' Q W Longitude: = o = 1 1:1 u
Design Current
Design Curren#
Swine
t Poultry CapatyPopulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DI Cow
❑ Wean to Feeder
I j ❑ Non -Layer I
❑ Dairy Calf
Feeder to Finish
El Dairy Heifer
Farrow to Wean
�* y`Dry`P ultry'`
El Dry Cow
❑ Farrow to Feeder
,�z,« .
j
❑ Non -Dairy
❑ Farrow to Finish
La ers
El Beef Stocker
❑ Gilts
ElBeef Feeder
q El Boars
El Beef Brood Co
Other
❑ Other
i
Plumber of Structures:
❑
El Non -Layers
El Pullets
El Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
[__1 NA
❑ NE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
[I Yes
❑ No
❑ NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[-INA❑
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
[I NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

FacUity Number: 31 — 33
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes A No ❑ NA ❑ NE
El Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ .Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) S S��c_CO LA—)"6 -T SQ C."
13. Soil type(s) 1�Au119R�cAoyxyy F�qss-r /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes V No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No El [I NE
18. Is there a lack of properly operating waste application equipment? [3 Yes No ❑ NA ❑ NE
wE.
Comments (refer to question #) Explain anv YES answers and/or*anyrecommendattons orany other comments
Use drawn s of facility taM'b.
ettelain s�tnahons (uddidonalr ex pagesas n�e�cessary) #x
Reviewer/inspector Name /� rQ S' ` �� Phone:
Reviewer/Inspector Signature: Date: [�
Page 2 of 3 12128104 Continued

FaMity Number: —33 Date of Inspection [1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 VPLJp ❑ Checklists ❑ Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ jWaste Transfers ❑ P�inual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield ❑' 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ❑ No V NA ❑ NE
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes\ No
❑ NA ❑ NE
El NA El NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 3 of 3 12,128104

Divrsion of LMFacilityNYMbW
�O D�v�sion of SoW
0 r,Agency�
Othe .,.__ .ems
Type of Visit J&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ 19�U9 Arrival Time: I b9 Departure Time: County: Region:
Farm Name: (; � �( Owner Email: np�?
OwnerName• AN E)MG Phone: 91�d 1a—HQ�I
Mailing Address: %S19 S Aoy �1�� �t_! NC, co�S"3d—�S�
Physical Address:
Facility Contact: Title:
Onsite Representative: RiZIReq eAX E
Certified Operator: � � Y_r= Wr=
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: (Q(3a3y _
Back-up Certification Number:
Location of Farm: Latitude: = c 0 6 = i! Longitude: = o = A = it
-
Design Current: De
Swine
Capacth' 'Population
Wet.Poultry, �;Ca
:, ❑Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
jQLV4Rj
❑ Farrow to Wean
1)ry Poultry'
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Other
❑ Other f .,
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cow
Calf
U Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
w
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'4No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104
Continued

Facility Number: _jj —�j3g
Date of Inspection �q
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: (A 600N
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
[--IN E
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the.situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
( No
❑ NA
❑ NE
maintenance or improvement?
J 1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
[INE
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.)
, 1
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ElApplication Outside of Area
12.
Crop type(s) SRe{ZLl1 J
C'
13.
Soil type(s) TO Ma H A W <
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
KNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
X No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
S§.Zjo ❑ NA
❑ NE
oExpain. anyYw.
any: recomiuendation06r_-nmmehlComments"(refertoquesti`lEado
Use drawings of,facility to better explain situations. (use additional pages as necessary)"`
. .�-
m
W.A.
Vcd G 9 / Q
3JA/6 9 9. 74-
ReviewerlInspector Name Phone: 9/0 r1% Uq 4
Rev iewer/Inspector Signature: Date: g j/Qg
12128104 Continued

Facility Number: j 33 $ Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo []NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. 0 WUp ❑ Checklists Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑Aste Transfers ❑,Almual Certification
El Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
IqNo
❑ NA
❑ NE
❑ Yes
JkNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
JkNo
❑ N
❑ NE
❑ Yes
No
eM'
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes V No
❑ Yes vy No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
,V
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawin
O '3�i.+_�.+k.=�
12128104

'Aa Division of Water Quality
ac�� Number O Division of Soil and Water Conservation
O Other Agency
Typ of Visit-.OrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit s>Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
bate of Visit: a Arrival Time: : l Departure Time: County:
r
Farm Name: 5 h n Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: _2
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region:
Latitude: = o = 6 Longitude: = ° =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
-�T� ❑ aver
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �..
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
'..
❑ Yes�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
12128104 Continued

a
Fac li Number: 3 — Date of Inspection
Waste CAction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
�W.o Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
' Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes F,�f No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J�TNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑-No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes /,ETNo ❑ 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 J21,io ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 ''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 ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes L2*No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes '�Ko
❑ NA
❑ NE
Comments (refer to question #): Explain. any YES answers and/or any recommendations or any other,comments A ,
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewerllnspector Name Phone:
Reviewer/Inspector Signature: A Date: v7 7
Page 2 of 3 12128104 Continued

\1
Facili}y. Number: 31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2 No ❑ NA ❑ NE
`—,P-'20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�2'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[21110
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)2rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
JZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
14
//,3 /o 1,9
/// grog ,.y
12/28/04

r
O'Division of Water Quality
acil�ty Number h �, 0 Division of Soil. and Water Conservation
0 Other Agency
Type of Visit compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit )D-Routine O Complaint O Follow up O Referral O Emergency �0 Other ❑ Denied Access
Date of Visit: 3 G Arrival Time: O Departure Time: County: l�< /h Region:
Farm Name: JOhAXPIA ere% Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1,4. din
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
y�J Phone No:
Integrator• Al._42
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 [= Longitude: = o = 6 =
Design Cu, rrentw Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish i ❑ Layer
❑ Wean to Feeder k . ❑ Non -Layer
® Feeder to Finish �j Q pEl Farrow Farrow to Wean Dry Poultry
❑Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
:,Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current -
Cattle Capacity Population'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes Z No
❑ NA
❑ NE
❑ Yes -[:!fNo
❑ NA
❑ NE
12/2"4 Continued

Facility Number: — 3" Date of inspection
*0 %
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;2 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 J'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes .2rNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? []Yes -0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CT 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 -EI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes _(:I.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J2 No ElNA ❑ NE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground y❑ 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
J"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
-ErNo
❑ 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
Pxo
E
❑ 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):
y
Reviewer/inspector Name T �_, 1� T Phone:
Reviewer/Inspector Signature: Date:
Paoe 2 of? 1 M d Continued

Facility Number: Date of Inspection
"Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EVNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ETNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
-B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑-NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2^No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ 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
Po
❑ 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
qNo
❑ 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
❑ No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Qf Compliance Inspection. 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Cr,' Arrival Time: -DDe'parture Time: County: Region:
Farm Name: iq YI h� Ttz C" 44 4n Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: hone No:
r
Onsite Representative: rla
� ! rat Inte rator: �r
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= O = = 1i Longitude: = o = 4 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other- ---
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: Eji
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1,_�'Vo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
ONE
El Yes El No
❑ Yes -flNo
❑ NA
❑ NE
❑ Yes P",o
❑ NA
❑ NE
12128104 Continued

Facility Number: —? -3j Date of Inspection 2*ay-
4Waste,Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�'N o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;a 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 , TNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes ,0,Ro ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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)'//�l./JGrCl /G ! l , rfJ7/_r.�� W), ! here / 1, S& ,
13. Soil type(s) ff//frVUi,
14.
/ r -
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
J2Tlo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
ErNo
❑ 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
)2rNo
❑ NA
❑ NE
Reviewer/inspector Name Phone: 91,�
Reviewer/Inspector Signature: Date: 7
I2128104 Continued

Facility Number:_ — Date of Inspection
Iteguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 ETNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,TNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ONA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J:;►No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J:�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L�jNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
2rNTo
❑ 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
�ZNo
❑ 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 ,ZNo
❑ NA
❑ NE
12128104

I7ype of Visit OrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit {.Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit: (o O Tune:
Facility Number 3 3 _
O Not Operational O Below Threshold
© Permitted E3 Certified 13 Conditionally
/Certified 0 Registered Date Last OperZ-1
ted or Above Threshold:
Farm Name: ..S.,r.l.C2.4n, rtr} .. f.••.(.... �I t!1 ....._............» ...._. County: � .» .......
OwnerName: .../.............................................................................. Phone No: ............. .............. .......... ..._............................. ......... ».
Mailing Address:
Facility Contact: _...
... .._.....
-- - Title: _ .........
»..... Phone No:
Onsite Representative:,
t_.,F.» __...._..._..
. f�
Integrator: _._ . »......----------
Certified Operator: .............. . .... . .................... . . . .... . . .. . . . . . .... . .... . .... . ........ . . . . ....... . ...
Operator Certification Number:.»...... _....... » ..._.....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • d 46 Longitude ` 6 «
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Flo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUniin?
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 X?<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2<o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 12gro
Suvctu�e 1 .Structure 2 Structure 3 .Structure 4 Structure 5 Structure 6
Identifier: .........�...../.......�... ............... .......� ..--- ............... ........... ..... . . . ...........................
Freeboard (inches):
12112103 Continued

FacUity.Namber: 3— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I L Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type
13. Do the receiving crops differ with Wosd designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes D-Nb
❑ Yes ZNo
❑ Yes *ETNo
❑ Yes OVo
❑ Yes J2,So
❑ Yes I'No
❑ Yes D.No
❑ Copper and/or Zinc
r SG�G��-see
Management Plan (CAWNVIP)? ❑ Yes 014
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 C3'No
❑ Yes J'No
❑ Yes PNo
❑ Yes 21,90
❑ Yes Zof�o
❑ Yes La"No
❑ Yes kmo
❑ Yes P No
❑ Yes [I No
Comments}(refer to queshoni #} �E�tplmn any YF.S=answe aaadlor any recoxnmeadatrons or any otliertirom_ments._ B
Use dravvrngs of fac�ily to Bette e�acplar s t a�taans: {ase ad oaa l pages nec�sssry) ❑ Field Cop ❑ Final Notes .
wm . n ,..
1-2PGS0 665-e e,) e, e- dl
y s
fiver-Ql , �s 1 s
-- c 6 r-df ,Ptea- vl-
Revrewer/inspector Name
Reviewer/Inspector Signature: Date:
12112103 ` Continued

Facilit,-Number: — Date of Inspection O
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,INO
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 j 2 + o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ 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 ,0'No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;2*90
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J 2I 0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P-No
28. Does facility require a follow-up visit by same agency? ❑ Yes PTo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [�Ko
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
QJA
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit: 3 Z Time: '--
Not O era 'onai Q Below Threshold
Permitted © Certified © Conditionally Certified ❑ Registered .Date Last Operated Above Threshold:
Farm Name: � b nNv Fu'�'rA �iO4 County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: /� Title: ``Phone No:
OnsiteRepresentative: &I1N Integrator: /rfur�ny
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • " Longitude ' 01 0�
Design Current Design Currents Design Current
Swme:�:Ca. acitv:. PaalattOn
Poultry A•W' .Ca a' d6 .-Po ulation .•x Gattie . __. _. _-uCa achy. Po nlatwn
W ❑ Wean to FeederI 1- ElLa Layer Da
is rt
' `" Non -Dairy
Feeder to Finish � � ❑Non -Layer ,;,-
_ ❑ Farrow to Wean
❑ Farrow to Feeder Other
_... i - =
ElFarrow to Finish Total Design C>pacttyw
❑ Gilts
El Boars Total'SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area tz
�Holdintftnds J SoWi`�Traps �## ' ❑ i No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9LNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PgNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 19NO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes %No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I Yes K[No
(If any of questions 4-6was 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 5.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KLNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9-No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes & No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes I.NO
12. Crop type LAVAU A HAU tL-1AVVe -Urn . =`t l/Pe_,'* eA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N 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
KLNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
'& No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Z] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
nNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
glNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
$LNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9(lNo
No violations or deficiencies were noted during this visit, You will receive no further correspondence about this visit.
'Comments (refer to, quesdon #): -Ezplain:ann YES;answers and/orany reconinienda6ons or anyother-comments:
.Use dra;6 s of facility to hitter explain sitnattons(use addtt,anat pages as necessary)❑ Field Conv ❑Final Notes
+ %Fe i`a�e r-r , L.,iflG li��/`P /`A.
"Ay �rrr�r�- A4r v-'4Oa/41 '& '04e__
iK!✓G� �i'xri ,� �F C d t� !CO /G
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: EZZE
05103101
Continued

Facility Number: j — Date of inspection i
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P 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 44No
28. is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �kNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [�T'N0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes k9"140
Additional Comments and/or DraWinks
O5103101

x 'Dr�ision of Water eery. .
Qe
- obivision of,Soil and Water Conservation;'
Q;Other Agency
(Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit JKRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
3 33
E3 Permitted © Certified © Conditionally Certified © Registered
Farm Name: o n v -e
h .. ki fl ►`► ...... ..............................................................
.......r.......
Owner Name: O h nn�
.....................I.................-......................-...-.-.-............
Facility Contact:
Title:
VS D Time: 9: S Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County..... .............
Phone No:
Phone No:
MailingAddress: ...........................................................•.t...d....h.................................................................................................................................�..f...
nr �Gle�-n1^ �VOnsite Re resentative: ----...............................
............
t........................ Integrator:....-
Certified Operator:
Location'of Farm:
Operator Certification Number: ..........................................
,QfSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Deiign Current Design Current Design -: Carreat -
Svvf PotCatleCa acPo eaton Ca aci :..Po elation.
Wean to Feeder ❑ Layer I 1 ❑ Dairy
AM!Feeder to Finish 2 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder i ❑ Other
'`t s Farrow to Finish Tdal Design, cipaeity,
Gilts
Boars Total SSLW .
Member of Lagoons ❑ Subsurface Drains Present IFO lagnon 10 spray Field Area
Ponds ! Sohd = Traps: ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b- If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: ................. .....................................................................................................................
Freeboard (inches): q Z
sroo
Structure 5
❑ Yes 040
❑ Yes &No
❑ Yes ONo
;I to,
[:]Yes 9No
❑ Yes ,� No
❑ Yes No
❑ Yes PNo
Structure 6
Continued on back

Facility.Number: Date of Inspection 2 CJ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P�No
.'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )eNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding'OP,„AN ❑ Hydraulic Overload
12. Crop type 'Er-P►-,XldA P�if � �►Ww f 4o -,I I i/" 4 ee I�j, (3¢zt 6'� J 5`v"� i1 6r,!�:, ,,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMF
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio-Aolatttons:o�- de#icie'noes were noted- during this.visit; • Yoit Will Kcr iio further: • . .
correspondence. about this .visit.
❑ Yes 0 No
❑ Yes JUNO
❑ Yes ,EI No
❑ Yes ff No
Yes ❑ No
U>SGJe �
El Yes No
❑ Yes j2No
❑ Yes j'No
❑ Yes ONO
Yes ❑ No
❑ Yes ONO
❑ Yes ErNo
[]Yes P'NTo
,2fYes ❑ No
❑ Yes 1A!j No
❑ Yes ;3No
❑ Yes _,EfNo
❑ Yes _13No
❑ Yes ,ETNo
❑ Yes dNo
Comments (refer to question #) Explain- any YES answers and/or any recommendations orany ot>iee co>t!rments'
Use drawings of.faciirty`to better explain situations. (rise additions! 1
pages as_necessaii`1y):,
)1•_There. W4S SalnP O✓e/Gt�P�,or�i��+ti N;.},-oper.��i7(4)4"� 60 2-606 ZOOS. �
Srtteto SSA+h rv-rl'e'-A ; 4Ll(r t✓as Pair­4 i r
ajve�f-i� i1V4 keGr'-,c ecnyds by
Ceoff ;+-�3 sea,sa� a�td nv4- �,Av �,5 � �al/�,�'d wi-c4e A+�tA S"S yY,I a��0 s�►^�lly;i+�,
K 1 L,P okIA �,e rG✓Ili 0ve IT.�o 1i ell Z �M d�q-)el`J so As r1a4
4,0 r. je t'-x SI'WL.[ De etfr 0 veq 6 /��r�lf P,GGL� year
4 o�c rsaee� rdf ih bef-"J✓dot . Y 1
Reviewer/Inspector Name ��e}-7P ��► 17G�:i �. R
Reviewer/Inspector Signature: Date: 5/0

Facility Number: 3Date of .inspection ZS U Printed on: 10/26/2000
Odor Issues
26' Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0"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 _ffNo
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,,ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes,,dNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
JAdditional Comments an or' rawings:. .
lot. Kee�o ale 1e ` Z ► s 67 ea c �r��7 7 �`� sea so ; a� ►^ o� -`� ! b Ga [ e►ldri AL
� y r
r'eO i --f PAN of ll owe, C e eQG� 6'�-dff,'n5 SG'GtSarl !
B� 50re 4" use ei Wes-1e c��V-rglz-2
sif driled w%�'� n bD day
! s �F
-f U1e Gt 1 r Ga I %o,-� a✓ e.nn f O
S r t0►�
C.1�l�+r1 rear -��,e date an j
Q ti/crar li aG
4o be, welt esl4b1; s ea(-
J
5100

0 Permitted 9Certiified [3 Conditionally Certified E3 Registered Date Last Operatedd or Above Threshold: W
Farm Name: .........-_ZQel A/ .... " 1AL..15FA � 5. County:......_/)/�pL!/i%.......................... k2z)
Q G�
Owner Name:.......... d!!�l%1.....�%rx'f.L.............................................. Phone No:.. 1..�4 .......................
�L I�
Facility Contact: -�? r9111/ .'11J.' Title: iQ&M9............................... Phone No: ...................................................
Mailing Address:.........._..��..htlG.<<...144 .. .........py�.....................2XII,
Onsite Representative :........ 1./li�r,1r, %�..— ... Integrator:r./QP,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
p • l LJ6;W'' I.."1...... �IJT�� , 1 I
Certified O erator• „-.. ...... � ...•.,..., Operator Certification Number: ,,,,,1,,,,,,,,,, 27 „
Location -of Farm:
t
o10r__ mwy
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude EM• 6 66 Longitude • �4 Un«
Dew Current "
- Caoaciity " POnulation
Wean to Feeder
Feeder to Finish
2
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
,_. Boa s
Number of Lagoons Subsurface Drains Present ❑ Area ❑ Spray Field Area
HPonds /., So6d Traps I; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Po
Discharge originated at: El Lagoon [I Spray Field [I Other
/'
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ..........:.d.Z...................................... ........ ........ . .......................... .............................
Freeboard (inches): 66V91- ����� ESQ ®%C /LYA leE-9
5100
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Wr No
❑ Yes No
❑ Yes 0 No
Structure 5 Structure 6
Continued on back

Facili4y Number. 3! — 33B Date of Inspection / lS Printed on: 7/21/2000
S.i Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yes No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 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 21 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Al No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes � No
12. Crop type / 0ASr14L k YE . A/fIkR7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes ElNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes JZ No
b) Does the facility need a wettable acre determination?
❑ Yes $No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage &General Permit readily available?
El Yes
No
18-
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�{ No
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
(-No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
eNo
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
Z No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
X No
it
yiglatiotis;o. clelicieocies were n6ted idiWing 4his. :visit:-Y:ou'Will-teeeive;tid further . .
icorres� oridence: abouti this visit:: : ::::::::::::::: ::::. .....:.: • : • : • : • : • : - : • : • : • : • :
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):
AL
P"M J_n4s
71YXfAhW C-99 C)A) =WltLL 9F
IReviewer/Inspector Name / LZ-lh 07 S I
Reviewer/Inspector Signature: Date: 1� /9 " 5/00

Fatality Number: / — Date of Inspection /1 4 � Printed on: 7/21/2000
!3fdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor Ivlow 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
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
do -omments and/orDrawings:
6-5
Ai
5100

D Division of Sorl and: Water Conserva�on ��perat�on Regrew ,
�0 vision of Soil and Water Conservation Compliance Inspection W
vision:of Water..Qualtty Compliance Inspection:
_ _ -
w �y .00tHer.Agency Operatton_Revrev� -x Y
_ .._ �.. ,..
10,Routine 0 Complaint 0 Follow-up of DM inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection QQ 24 hr. (hh:rn
*Permitted 0 Certified © Conditionally Certified [3Registered 0 Not Operational Date Last Operated
Farm Name: ��......County: .. .fo I�
.......................-........• .....---. .... .........................................
Owner Name: ....................... I...... ..
Phone No:
FacilityContact: .............................................................................. Title:.............................---................................ Phone No: ...................................................
MailingAddress: .................................................................................................... ...................................................................................................... ..........................
Onsite Representative:........... �^!.� Q(/........ Integrator: M.
Certified Operator: .............................. . ................. .................................................... Operator Certification Number:................... ..............
Location of Farm:
r-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------� r
Latitude longitude • �' �° "
r
Design Current Design Current Design .. , Current
Swine
Capacity Po ulation Poultry
p ty Ca achy Po - b ation Cattl"e : Ca aci Po Matron
ty
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer '_' ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder >.- Other
❑ Farrow to Finish
Total-Desip Capacity
-, ❑ Gilts,
_ Total SSLW
❑ Boars
Numberof-lagoons: ❑ Subsurface Drains Present lirl Lagoon Area ❑ Spray Meld Area
Holdtng:Ponds / Solid Traps n.T ❑ No Liquid Waste Management System
.i_" ..
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes t<No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes F<rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):....................................................................................................................................................
9.1.............. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
3/23/99 Continued on back

Facility Number:'Jj — `j Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situations poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type L7, � , Sq • 5-�/ vts'
V P _ - 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14- a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
N6 •vWhti6h :o:r de>Fde. ncies -mere noted• Oi Wing this'visit: - Yoit wi�E-Teceiye ii6 iukft • ; -
6 resp6fideitce. abaut_ this visit .. .. .. . .
❑ Yes XNO
❑ Yes XNo
❑ Yes �K No
❑ Yes 14
❑ Yes N No
❑ Yes U(No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
R—yes ❑ No
❑ Yes XNo
❑ Yes �(No
❑ Yes XNo
❑ Yes tTNo
❑ Yes gNo
❑ Yes Wo
❑ Yes NfNo
❑ Yes [(No
❑ Yes jq No
❑ Yes dNo
❑ Yes P�No
Comments. (i•efert6 question#) Explain any YES answers and/or any recommendattons or any otherinments:°
Use drawin of facili to better ex lain situations. use additionaU a es as necessa
A.
l�Ty-y fit 1- 't +.` t�l►-� �c t �,� d25�`Y i G� �2t5 0-" lam(
3/23/99

]Facility Number — 3 g Date of Inspection
Odor Issues
25.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
ryes
❑ 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
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
5�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
-"' 0
<
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
1
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Longitude �• �' �"
D&ign Current.
Poultry ` Capacity Population `CattEe
❑ Layer ❑ Dai
140 Routine O Complaint O Follow-up of DNVQ inaction O Follow-up of DSWC review Q Other
�Y��Y YID Y i�iYiY
Date of inspection
Facility Number �y—�
Time of Inspection I�L�?� 24 hr. (hh:mm)
©Registered t9 Certified D Applied for Permit © Permitted 113Not O erational Date Last Operated:
Farm Name: ...............
......��``lc��t,-......��ll.�'kA,�........ �rr-t'h,......................................... .... County: ....�!r..................... ..................
.................
Owner Name: � 11.& . .. ................. 1"1L 1lffk! .. .. Phone No: (R-o `i..................................................
..
Facility Contact:.... ............................................... ...... Title:.................... ........ Phone No:
Mailing Address: r 1� if; ll
Onsite Representative:...._Q6i1.,....... 5uiya.............................................................. Integrator:..................................................................
Certified Operator................................................................................................................ Operator Certification Number, ... 1.1.1..7.................
Location of Farm:
Sri....: �.... arv... ............................................. .
...................... ............ ...... .. .................. _...... .... ..
Latitude •.E71'
Swine Capacity '
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
)esign - Current
apactty ° PopulatYon :'.
1�
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes LV No
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-at/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 0 No
❑ Yes `KI No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 50 No
❑ Yes ® No
❑ Yes CS No
❑ Yes t5 No
Continued on back

Facility Nurnher: — 33
8_ Are there lagoons or storage ponds on site which need to be properly closed'?
Structures fI,a coons lioldin Ponds Flush Pits ete.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard tft):............ J.1.`.�t.....................................................
10. Is seepage observed from any of the structures"
❑ Yes N No
❑ Yes t9 No
Structure 5 Structure 6
11. Is erosion, or any either threats to the integrinr of any of the structures observed?
12, Do any of the structures need maintenance/imlrovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type lxif.t! u► ................. .. %i+-'a I.....oSr ......................... . ...LVLX—t."........ 6&..........
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment'?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit`
3 No.violations or deitciencie's.rvere noted during this. visit.- You.will receive no further
correspondence about this.visit'.::.- ::
0 Yes M No
❑ Yes ® No
QM Yes ❑ No
❑ Yes [M No
❑ Yes IN No i
...................................
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes 0 No
❑ Yes 52 No
❑ Yes ® No
® Yes ❑ No
❑ Yes ;U No
❑ Yes No
❑ Yes No
Comments' (reNr'to,question fl: Explain any YES answers and/or any recommendations:orony other.comments.
Use drawings of facility to better explain situations. (use additional pages as.neeksary): t b
V_. E5w, t-c�a,�- s skLO be<- , Ser aJ. sm l( }�l-c,ca d- &.Vsk Slva� bG �l�d A.-
.)CA 1
it, $trtnu� si �� �¢ 1xai tF) �Yd�JLe iC10 t�1C t �i0lL4 ir. ctiV�.
22. CoMct pCrtne, Ar- f&Lj, Ht At
t1Yj '4w eaeh puf1-
7/25/97
�
Reviewer/Inspector'Same - �
R
.� k
Reviewer/Inspector Signature: Date: Vim m

- ❑DSWC Animal Feedlot Operation Review .,
Y
,�❑ DWQ Animal Feedlot Operation Site Inspection r - r
3
m
F
F, r
0 Routine 0 Complaint 0 Follow-up of D"' ) ins etion 0 Follo-w-uR of DSA C: review 0 Other
Date of Inspection -?
FFacility Number
Time of Inspection 24 hr. (hh:mm)
Farm Status: ❑ Registered ❑ Applied for Permit
0 Certified ❑ Permitted
Total Time fin fraction (if hours
(ex:1.25 for I hr 15 min)) Spent on Re%,iew
or Inspection (includes travel and processing)
0 Not O eratiornal DateLastOperated: .................................................................................................. ..........................
Farm Name,..........�dnt!hm ir►EjrO,`(.... ...'�I, M ............................:.. ............. County:......Dt,�4Sx�....................................... ......................
Owner Name:.......t llMtU�.....r.�liia �........... ... Phone No: 11/1A).. _11_ 13...........................................
Facility Contact: ......jon .............................. Title: ...... dk)jk&r.......................................... Phone No:. %Q�.�� 3Z.ci
i•tailing:�dttress:.....'io........ # ;nl,, 11tl...r.24%, .... .............. ....................................... ZIS?Z........
r
Onsite Representative: .....jolt .. ........ GLI l........................................................ Integrator:..,M.wJ..................................................................
Certified Operator:....... .c .......... M_..... 9&.1................................................ Operator Certification Number: ..... OP
Location of Farm:
1. !!„t.... ..........nur......... e vsl......Turn....i�.......o.r.... ....... sk .....11 -•....... 5.....L... mi.4......an..............
It!?...61,..Si c.....c11e :.f�...............................................................................................................................................................................................................,
Latitude =I• i . 1' ®91 . Longitude a ®6 SS CC
Type of Operation Design ; °Current Desi n Current Design Current.
g g
Swine " Capacity Population-- . Poultry Capacity.. Population Cattle . .- Capacity, Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Subsurface Drains Present !!© Lagoon Area !❑ Spray Field Area
Genera
1. Are there any buffers that need maintenance/improvement? ❑ Yes A No
2. Is any discharge observed from any part of the operation? ❑ Yes !S No
Discharge originated at: [ILagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.' ❑ Yes 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 Val/nun?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) El Yes, No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [;8 No
4, Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes jff No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes (A No
4/30/97 maintenance/improvement?
Continued on back

Facility Number: I — 337:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes El No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes P No
Structures (Lagoons and/or N_old n -Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 5� No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure j Structure 6
3.3
10.
Is seepage observed from any of the structures?
❑ Yes
95 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KLNo
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
Wo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
MNo
(If in excess of WMP, o� runoff entering waters of the State, notify DWQ)
15.
Crop type ........... e—'K."4a......................... ..................................... CJ(;a_M............ ....................................................... ...........................................................
16.
Do the receiving crops differ with those designated in the Animal Waste,ManagementPlan (AWMP)?
CkYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
1S.
Does the receiving crop need improvement?
❑ Yes
N No
19.
Is there a lack of available waste application equipment?
❑ Yes
®..No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
E&No
21,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JO No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
R1 No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
19 Yes
❑ No
24.
Does record keeping need improvement?
Yes
❑ No
- r '':„'e' L. S7 w ".� -.. II`a�" /�> P"tf
IL. P-rosion GLtreaS Br. `'U_ tr,re� Oanj 4� Witt 6� (lac' s�tatltc� be. ij Wi'�-- C141
C—a T-eQeedea. &M ors sko�d be, W-se4ed. od44.,r- WC11 O (ay lA SkL
�6. Corr. it J"j :tn SQroI �cS �,A Ad+ deS)" r, CA;wt0.
73. COCM� o�rtU, S G vLJ C S 't-6 a fie Set q, ivy CAW Ma.
70- 5" si�o j �Q mv, -t aJ field -6. [, JJded w"k s ttlJ
6. WLu,, rtCoA *`s s o Adbe- cans i sk W i k CA W AA� nuo- bt
Reviewer/Inspector Name
Reviewer/Inspector Signature: %d�., I _ /-,/ A JA,___., Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: No
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7, 1995
Time: T
Farm Name/Owner: o� ' e
Mailing Address: b- l+-i l I f_c P,' i4 k R.
County: 121 ty_ . _
�a
Integrator. Phone:
On Site Representative: 5 _ Phone: M lob 2-18 " 3
b -Ive."
Physical Address/Location: _ "NIC S � 1-11_� (�►-.•u,� �►1�e.%��t.,,
. IA--,1
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM' Certification Number: ACNEW
Latitude: 00 Longitude: -2L' (;3-' 13 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)or No tual Freeboard: dZ Ft. Inches
•
Was any seepage observed from the lagoon(s)? Yes N Was any erosion observed? Yes d NOT
3
Is adequate Iand available for spray? es r No Is the cover crop adequate? C�or No
Crop(s) being utilized: C-O A-5 F:z_2 ow ►7 A- _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells_? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or& '
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of -the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate waste management records (vo mes of manure, land applied,
spray irrigated on specific acreag with cover p)? Yes or
P `i �'�
Additional Comment : G t_t..� -�-� b
J -1-L-*
112.
•
U"�1 S
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed